Use of telehealth is increasing steadily throughout the medical profession, and family physicians who aren't currently using the technology may want to consider doing so for a number of reasons, including as a possible way to reduce burnout and attract new patients.
Those are just some of the conclusions reached in the report "Telehealth Index: 2019 Physician Survey"(www.americanwell.com) by American Well, a Boston-based firm that provides telehealth services for physicians, health systems and employers.
"We believe this 2019 physician survey begins to paint a clearer picture of the trajectory of telehealth adoption among physicians and the role key organizations will play in its advancement," the firm stated in its report.
The survey polled 800 U.S. physicians from a wide range of specialties and asked a series of questions about telehealth use. Of those surveyed, 62.5% were categorized as primary care physicians. Overall, the results suggested that a considerable shift is underway in the way physicians perceive telehealth and use it in their practices.
- A survey of 800 U.S. physicians from a wide range of specialties found that the proportion of those using telehealth has increased dramatically in the past few years.
- In 2015, 5% of physicians reported using telehealth to see patients; by the end of 2018, 22% of physicians were using the technology.
- Willingness to try telehealth also increased from 57% to 69% during that period.
Physicians See Value in Telehealth
The survey found that between 2015 and the end of 2018, the proportion of physicians who used telehealth to see patients increased considerably -- from 5% to 22%. The physicians who used telehealth reported several benefits from the technology:
- 93% said telehealth improves patient access to care,
- 77% said it contributes to more efficient use of time,
- 71% said it reduces health care costs,
- 71% said it allows for high-quality communication with patients and
- 60% said it adds to the doctor-patient relationship.
Fifteen percent of physicians who used telehealth said they had used it to see patients "frequently" (defined as twice a week or more) in the past year. Another 48% said they had used telehealth "occasionally," or one to two times per month, and 20% said they had not used the technology in the previous year.
Projecting into the future, 72% of physicians currently using telehealth in some capacity said they expect to be using it frequently or at least "sometimes" (once a week or more) three years from now. Only 3% of physicians did not expect to be using it at all.
Kicking the Tires
Just as actual use of telehealth increased, so did willingness to try the technology, which rose from 57% in 2015 to 69% by the end of 2018. Physician age appeared to be a factor; about three-quarters of all physicians 44 and younger said they were willing to use telehealth, whereas only 60% of physicians 55 and older reported the same.
In terms of specialty, 91% of urologists surveyed indicated they were willing to use telehealth, followed by 89% of emergency medicine physicians. On the low end were radiologists and cardiologists; 38% and 40% of those specialists, respectively, expressed a willingness to use the technology.
Although family physicians were not listed specifically, 70% of internists and 63% of physicians in the survey's pediatrics-primary care category said they were willing to use telehealth.
Physicians reported several reasons for their willingness to use telehealth, including:
- Increased access. For patients, telehealth could help reduce barriers to care such as time and distance.
- Improved work-life balance. For physicians, telehealth could offer the chance to work remotely and have a more flexible schedule, which in turn could reduce physician burnout.
- Better outcomes. Physicians surveyed thought that telehealth could improve patient outcomes by allowing them to provide more consistent, timely and appropriate care.
- Patient recruitment and retention. Physicians also thought that offering telehealth services could help them increase their patient base while maintaining existing patients.
- Being on the leading edge. Physicians viewed telehealth as an advance and expressed a desire to be at the leading edge of the technology.
Change Is Coming
Increased use of and willingness to try telehealth was linked to another important finding.
Physicians who reported that they currently do not use telehealth were asked how likely they were to start using it within the next three years. Fifty percent of physicians who don't currently use telehealth said they were likely or very likely to start using it within that period; only 11% said they were very unlikely to use it.
Based on that response, American Well estimated that by 2022, between 341,000 and 591,000 physicians would be using telehealth to see patients.
Family Physician Expert Perspective
AAFP News reached out to Steve North, M.D., M.P.H., of Spruce Pine, N.C., chair of the Academy's Telehealth Member Interest Group, to discuss the survey. On behalf of that group, North cautioned his FP colleagues to consider the source before reading too much into the survey's findings.
"It is important to remember that this is an industry-sponsored survey and, therefore, needs to be viewed through this lens," North advised. Among his group's biggest concerns, he added, were poor descriptions of sampling methods and of the types of physicians who responded to the survey, along with some evidence of industry bias.
North said he and his MIG colleagues did agree with the finding that physicians have a growing interest in telehealth. They also noted some benefits to the technology that "include moving the doctor-patient relationship from one that is driven by the physician's schedule to one that is driven by patient needs." One potential result of this, North said, might be more interactions between patients and physicians, resulting in more patient engagement.
At the same time, North said his group noted some significant obstacles.
"Reimbursement continues to be a major barrier. There is a high level of variability from state to state regarding what can be reimbursed and at what level. This limits adoption," he said.
"Additionally," North added, "the CMS restriction(mhealthintelligence.com) on physicians at federally qualified health centers and rural health clinics serving as the distant site in a telehealth encounter further limits the ability of many family physicians to adopt this technology."
Regarding the telehealth MIG's latest activities, North said, "Currently, we are working to provide mutual support to family physicians who are working to implement telehealth in both small practices and health systems.
"We have begun discussing how we can promote resolutions to the Congress of Delegates that will expand the ability of family physicians to use and be reimbursed for telehealth and decrease the fragmentation of care created by insurance companies offering their own telehealth platforms that are not integrated with a patient's primary care physician."
He recommended a number of Academy resources for family physicians interested in learning more about telehealth. In addition to joining the telehealth MIG, North noted that the AAFP offers information on the Academy's telehealth/telemedicine policy, advocacy efforts related to the technology and associated practice management issues.
North also recommended that family physicians look to federally funded agencies, such as the South Central Telehealth Resource Center,(learntelehealth.org) where they can get additional information on building telehealth programs.
Finally, North reminded family physicians who want to use telehealth that they need to create a system where the technology works for them, not the other way around.
"I think that the most important part of implementing telehealth in your practice is to build the program and then find the technology," he said. "Too often, we are seduced by innovative technology and try and build a clinical program that will allow us to use it."
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