As COVID-19, the disease caused by the new coronavirus, spreads in the United States, the Centers for Disease Control and Prevention and the World Health Organization are advising hospitals to increase their use of telemedicine — virtual doctor’s visits over video chat. The goal is to keep what’s known as “the worried well” out of hospitals, where they might get exposed to illnesses, and potentially reduce the burden on doctors and nurses.
Is telemedicine widespread enough and effective enough to make a difference? I spoke with Dr. Robert Wachter, chair of the Department of Medicine at the University of California, San Francisco, and I asked him how patients should think about using telemedicine. The following is an edited transcript of our conversation.
Robert Wachter: The patient with symptoms that feel like the flu and would otherwise be thinking about trying to see their doctor, if now I have the ability to see a doctor, get the information I need, maybe, as testing becomes more widespread, be guided to how I get a test done. If I can do that while sitting in my living room, that feels like a better way of accessing the medical system than requiring an in-person visit for every patient that might need to get care or be triaged.
Wood: In the toolbox, where would you place telemedicine in terms of its importance in either preventing or containing an epidemic like coronavirus?
Wachter: Not super high on the list, because I think at this point an in-person or telemedicine visit between a patient and a doctor is not going to be the central hub of our response. The response is going to be much more in the public health realm about identifying people who have symptoms, being able to test them rapidly. Of course, that creates a challenge for telemedicine, if, at the end of our telemedicine encounter, you’ve got to go get tested. You can’t do that through telemedicine. You have to go somewhere to get a test.
Wood: Tell me about any other advances in tech that you think might be helpful right now, specifically.
Wachter: In terms of other technological capacities, I think a lot of it will come in the realm — rather than of the internet and communications — it is going to come in the way we’re able to, I hope, quickly ramp up the diagnostic testing for this; quickly ramp up vaccine production and other things like that. The way we produce the flu vaccine every year is still not all that efficient. You wonder whether at the end of this, we will take all of those processes that are still a little bit sluggish and invest what needs to be invested to modernize them so that when the the next thing like this happens, we can plug it into an infrastructure in a way that we couldn’t today. Sometimes, unfortunately, you need a crisis to demonstrate that you need to increase your capacity to be able to deal with the next one.
Wood: How often will insurance cover these kinds of visits?
Wachter: Insurance has been a little sporadic and uncertain about how to deal with telemedicine. It’s improved a lot in the last couple of years. I think insurers have recognized that telemedicine is a perfectly reasonable substitute for an in-person visit. Several years ago, we were spending a lot of time and energy battling the insurance companies about whether they’ll cover telemedicine, and if they don’t, the business case to go through what you need to go through to build the capacity — build the system, buy the technology, train everybody — was a little bit weak. That’s changed in the last year or two. I suspect that this outbreak might be the tipping point to change it even more. Most payers are paying for telemedicine visits, paying for them at levels that are not that dissimilar from in-person visits. I think it had to reach that point before health care organizations invested what they needed to invest in — either building their own telemedicine capacity or working with one of the companies. Five or 10 years from now, the idea that I took off half a day of work, drove 20 minutes, parked and paid $15 for parking to go see a doctor for 14 minutes is going to seem crazy. It’s going to be like, “Really, Dad, you did that?” It’s going to be the complete norm that the way you interface with at least the outpatient health care system is through telemedicine visits, and increasingly also through sensors and surveys that you answer and other ways of interacting with the health care system. On our end, it’s going to be doctors, and some of it is going to be technology. That’s all growing, and I think this epidemic is probably going to turbocharge that growth.
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