Getting used to seeing your doctor virtually? Telehealth coverage might not last

CHICAGO — Before COVID-19 hit, Jenny Thomas had always visited her doctor in person.

But now that the Chicago resident is home more, she’s been seeing her doctor over video, instead, often in her pajamas.

"It was so easy, and she was right there," Thomas, 46, said of her doctor at Rush University System for Health. "I'll definitely go that route again in the future."

Like Thomas, many people are using telehealth for the first time as they try to stay physically distant to avoid spreading the coronavirus. State, federal and health insurance rule changes — made in response to COVID-19 — have made it easier and more financially viable for physicians to offer virtual health care.

But the future of telehealth remains uncertain because it's unclear how such visits will be covered by insurance beyond the next few months.

The Chicago area’s biggest hospital systems say they’ve had more than a million telehealth appointments combined since the pandemic started, and demand remains strong, even as people have started leaving their homes more in recent months. In Illinois, the percentage of primary-care visits done virtually shot up from zero in February to nearly 47% in April for people on traditional Medicare.

Health-care and advocacy groups say action is needed from state and federal lawmakers if widespread use of telehealth is to survive beyond the COVID-19 crisis.

"A lot of important advances have been made over the last six months, so we want it to continue," said Danny Chun, a spokesman for the Illinois Health and Hospital Association. "The future of health care should and must include telehealth."

Before COVID-19, most Illinois health systems weren't offering much in the way of telehealth. Health insurance companies typically didn't reimburse health systems and doctors the same for virtual visits as in-person ones.

"I think many providers were very interested in telehealth, but because they couldn't be reimbursed for the service, it was a nice-to-have, not a need-to-have," said Laura Messineo, vice president of telehealth at Amita Health, which has 19 hospitals in Illinois.

But when it became clear that social distancing was key to slowing spread of the illness, Illinois Gov. J.B. Pritzker issued an executive order requiring health insurers regulated by the state to cover in-network virtual visits for patients and often waive patients' out-of-pocket costs. The order does not apply to self-funded plans, often offered by large employers.

The state also required it to be covered for people on Medicaid, a state- and federally funded health insurance program that serves those with low incomes and disabilities, among others.

Medicare also made it easier for seniors to take advantage of virtual care. Previously, the program had mostly covered it only in rural areas and in hospitals and nursing homes.

In addition, the federal government relaxed rules that had made offering telehealth more difficult for health systems.

The results were dramatic.

NorthShore University HealthSystem went from fewer than 2,000 virtual visits a year before COVID-19 to about 38,000 virtual visits in April and 35,000 in May. Amita conducted more than 50,000 visits in April. Rush had about 140,000 between March and August.

Many patients have been thrilled about the shift. Mary Patton, 84, of Peoria, Ill., appreciates the convenience of virtual appointments, given how busy she is with her church, local politics and as a volunteer lobbyist for the AARP.

“There are times you have to actually meet in person, but many times you don’t,” Patton said. “I used to just see all my doctors in person but I don’t need to now, which saves me a lot of time.”

It also has allowed health systems, which lost money early in the pandemic because elective surgeries were canceled, to continue seeing patients.

But the rule changes that led to the explosive growth of virtual visits in recent months aren't permanent.

Pritzker’s order requiring insurance companies to cover telehealth was originally set to expire this summer. Pritzker has been renewing it, with the latest extension set to last through Oct. 17. He plans to continue renewing it “as the pandemic continues, and until the Illinois General Assembly passes a bill requiring telehealth coverage for private insurers,” said spokeswoman Jordan Abudayyeh. A law would be needed to make the changes permanent. Waivers issued by the federal government that made it easier for doctors to offer the services are set to expire in January.

And health insurers have been mum about how they’ll continue to cover telehealth over the long term, including the state’s two largest health insurance companies: Blue Cross and Blue Shield of Illinois and UnitedHealthcare.

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Many patients, such as 16-year-old Yalina Lopez, worry that as COVID-19 concerns fade, so will virtual medical appointments.

Lopez, of Berwyn, Ill., has Emery-Dreifuss muscular dystrophy, a condition that can affect joints, muscles and the heart, and she mostly uses a wheelchair to get around.

Before the pandemic, it was an ordeal to go to her doctors' appointments at Lurie Children’s Hospital, which sometimes lasted less than a half-hour.

"It's an all-day affair that makes my days really exhausting," Lopez said.

Since COVID-19 started, about three-fourths of Lopez’s doctors appointments have been conducted by video.

Lopez is among those asking Congress to help ensure that virtual health services are here to stay. She recently spoke with several members of Congress about the topic as part of the Children’s Hospital Association advocacy.

Vamshi Rao, a neurologist at Lurie and one of Yalina Lopez’s doctors, said he was skeptical of telehealth before COVID-19.

But he said it's proven invaluable as a way to continue seeing his patients, some of whom are at high risk of becoming seriously ill if they catch COVID-19.

He’s also noticed some unexpected benefits, such as being able to speak with more of his patients' family members and seeing his patients' homes while prescribing equipment.

"It's not 100% of the exam that I really want through telehealth, but it comes pretty close," Rao said.

Telehealth isn’t for everyone, or every situation.

Also, many patients — and some doctors — worry about the quality of care provided virtually.

That was the top reason some Chicago-area residents said they would not be open to telehealth in a survey conducted this summer byconsulting firm West Monroe.

Research has shown that virtual health visits can improve patient outcomes when used for managing chronic diseases, including heart failure, diabetes, and mental-health conditions, according to the federal Agency for Healthcare Research and Quality. When used in primary care, for non-urgent matters, the accuracy of diagnoses made over telehealth seems to be about the same as those made in person, according to the agency.

Technology also can be a barrier. Leaders of Chicago-area health systems said they so far hadn't seen many problems with people accessing virtual appointments. Virtual care can include a simple phone call for patients who lack computers or smartphones.