A recent survey conducted by the Robert Graham Center, the American Academy of Family Physicians, and Anthem caught my attention. The survey was conducted to gauge the attitudes of primary care physicians regarding telehealth. And the results make for interesting reading— providing great insight into how certain providers view and use telehealth. What struck me most is that while great progress has been made in the rate of telehealth adoption among providers, we still have a way to go. According to the survey report, state legal and regulatory issues, reimbursement, and provider training and education continue to be serious barriers to wider adoption of telehealth. And until the landscape evolves to address these barriers, telehealth adoption is likely to stagnate despite the great promise of telehealth holds as a tool to improve quality and access.
By way of quick background, approximately 1,500 family physicians responded to the survey with 15% responding that they use telehealth in their practices (although almost nine out of 10 family physicians indicate that they would use telehealth if they were appropriately reimbursed). Here are some other interesting takeaways from the survey.
Users of Telehealth
As you might expect, the survey report confirms what most of us in this space suspect. First, the survey finds that physicians practicing in rural areas are far more likely to use telehealth in their practice than urban physicians (almost 29% to 11%). Second, physicians who use telehealth are younger and in practice fewer than 10 years. Third, almost all telehealth users reported that they use EHRs in providing care to their patients.
Generally, both telehealth users and non-users agreed that telehealth has the potential to improve health care access, improve continuity of care, and decrease travel time for patients. And while there was general agreement that patients preferred to see their physicians in-person, there was also an acknowledgment that telehealth "may represent an alternative to seeing a physician at all." In other words, even those physicians who did not use telehealth saw the value in its use almost to the same level as telehealth adopters.
Form of Telehealth
Among users of telehealth, approximately half have used telehealth one to five times in the past year and about a quarter report using telehealth more than 20 times in the past year. The form of telehealth used most:
- 48.7% used real-time video
- 30.7% used store-and-forward or text
- 10.8% shared a computer screen using images with audio
- 9.6% used other forms
Uses of Telehealth
- 55% for diagnoses or treatment
- 26% for chronic disease management
- 20% for second opinion
- 21% for follow-up
- 13% for other reasons
- 16% for emergency care
- 6% for administrative purposes
So, what does this all mean? For me, it is further confirmation that telehealth is widely accepted by physicians generally but that many barriers will need to be overcome for telehealth to become more routine among physicians and other providers. The survey report notes that “creating guidelines for the use of telehealth services in clinical practice, definitions of quality, and measurable outcomes” are a must for greater adoption. The report also underscores the need to establish “standardized reimbursement procedures” for telehealth including the development of new billing codes and reimbursement mechanisms. I wholeheartedly agree with all of those conclusions. Many stakeholders are working on solutions to one or more of these barriers. Ultimately, however, I think significant change will come from consumers and patients themselves, who will continue to demand better access and more innovative delivery models outside the conventional office visit.