Since being diagnosed with cancer last year, Kent Manuel has regularly visited an oncologist near his home in Indianapolis. It’s been a difficult time: After spinal surgery for paralysis caused by cancer, he is regaining the use of his legs with physical therapy, but still uses a wheelchair.
Now, Mr. Manuel said, “I’m dealing with the pain.” His oncologist recommended palliative care, a medical specialty that helps people with serious illnesses cope with discomfort and distress and maintain their quality of life.
So in November, Mr. Manuel, 72, a semi-retired accountant, began seeing Dr. Julia Frydman, a palliative care doctor. “We talk about what works and what doesn’t,” he said. “Listen to what I have to say. It’s very flexible.”
The first two drugs prescribed to reduce pain had troublesome side effects. On the third try, though, “I think we got to something that works,” he said. His pain hasn’t completely subsided, but it has lessened.
Dr. Frydman, senior medical director of a cancer-care technology company called Thyme Care, works hundreds of miles away in a Manhattan office. She and Mr. Manuel used a telehealth video link, an option that barely existed in traditional Medicare before the Covid pandemic, thanks to restrictive federal policies.
Medicare substantially expanded its telehealth coverage in 2020, and the expansion has been regularly renewed. It all could have ended on December 31st.
Supporters of telemedicine, also called telemedicine, experienced difficult days as Congress considered a continuing resolution to fund the government late last year. Included in the 1,500-page bill was a two-year extension to expand Medicare coverage for telemedicine.
Republicans had agreed to the overall resolution, but changed their minds after Elon Musk and Donald Trump condemned it. “This killed the bill,” said Kyle Zebley, senior vice president for public policy at the American Telemedicine Association.
Initially it seemed that the death of the resolution meant the end of expanded telemedicine coverage. Ultimately, however, Congress approved a narrower version, a three-month extension.
So telemedicine lives, at least until March 31st.
Zebley, who estimates that 20-30% of medical encounters could happen virtually, expects further revamping. Telemedicine is “so popular and so bipartisan in nature that I can’t imagine the Trump administration and Congress letting it lapse,” he said.
Tricia Neuman, who directs the Medicare policy program at KFF, the nonprofit health policy research organization, agrees. “Telehealth coverage appears to be here to stay as an option for Medicare patients,” he said in an email.
Its use has declined since the start of the pandemic. When patients were afraid to show up for medical appointments and many doctors’ offices closed their offices, Medicare began covering video and audio home visits for more types of providers and many more conditions.
Almost instantly, the use of telemedicine skyrocketed. In 2020, nearly half of Medicare beneficiaries had at least one such visit. By the end of last year, that percentage had fallen to about 13%.
This still represents much higher usage than at the start of 2020, when approximately 7% of beneficiaries had virtual visits.
While telemedicine works better for some services than others, “some patients have begun to rely on it,” Dr. Neuman said.
Take palliative care, which is not widely available everywhere. Indiana, for example, received an unexceptional rating of 2.5 stars for palliative care capacity on the Center to Advance Palliative Care’s state scorecard.
Telemedicine can help bridge the gap. “By working closely with oncologists who see them in person,” Dr. Frydman said, “we are able to care for patients with advanced cancer and get them access.”
Even if Mr. Manuel could quickly make an appointment with a local palliative care doctor, “I’m disabled, so traveling is a hassle,” he said.
A brief in-person consultation can require a strenuous two hours of getting into a car (an assistant drives it), securing a wheelchair and then unloading it, entering a medical facility, waiting, and then reversing the process.
Instead, “it’s very nice to sit in my house, hold the phone in front of my face and just talk,” he said.
Other patients have described a similar hybrid approach. Jim Seegert, 74, a retired graphic designer in Hopewell Junction, New York, sees his primary care doctor in person four times a year to manage his diabetes, hypertension and high cholesterol.
“I’m a face-to-face type of person,” he explained. Additionally, he needs blood tests and “there are things that can’t be done over the Internet.”
But to discuss the results, schedule a virtual visit, usually by phone. “I’m happy to have this option,” he said.
Bruce Lerner estimated he would have had 10 telemedicine visits in 2024. “I had a rough year,” said Lerner, 67, an attorney in Washington, D.C. “I had Covid. I had shingles. I had pneumonia.”
Sometimes his doctors at One Medical, the Amazon-owned primary care practice, told him to come to an office or get a chest X-ray at a radiology clinic.
About half the time, however, they listened, advised and prescribed virtually. “It not only reduces unnecessary office visits, but it also probably reduces emergency room visits,” Lerner said.
Helen Epstein, 77, of Lexington, Massachusetts, grew tired of driving an hour in traffic to and from Massachusetts General Hospital. Her doctor visits have piled up in recent years as Ms. Epstein, a writer, has been successfully treated for uterine cancer, recovered from a stroke and battled atrial fibrillation.
So when it comes to seeing his primary care doctor, he’s happy to schedule video visits. “Because she had been my doctor for a long time, it was a very easy transition,” Ms. Epstein said.
Her husband credits telemedicine with saving him a trip to the emergency room after a friend’s dog bit his leg. In the video, the doctor could see the injuries and determined that home treatment would be sufficient.
In part because much of the research into telemedicine was undertaken during the initial phase of the pandemic, an abnormal time, questions persist about its costs and effectiveness.
An initial study of around 200 elderly patients using telemedicine, for example, found overall satisfaction. However, nearly 40% said it was worse than in-person visits, and some found the technology frustrating.
That may be less true three years later, but “the main barrier is still technology,” Dr. Frydman said. Some providers now send links to patients so they don’t have to remember logins and passwords, and they hire staff to help them connect.
Another early study, using Medicare claims data, reported that telemedicine was associated with slightly more hospitalizations and doctor encounters, as well as slightly higher costs per patient. But that may reflect greater hospital capacity in areas with high telemedicine use during the pandemic, the authors cautioned, not necessarily lower-quality care.
On the other hand, another survey also found an increase in patient visits and costs in health systems with increased use of telemedicine, but no change in hospital admissions and lower emergency room use.
More recently, a clinical trial involving patients with advanced lung cancer (average age: 65 years) found equivalent satisfaction and quality of life scores between those who received palliative care via video visits and those who received it in person.
“The data is really clouded because we were still looking at the evidence of the public health emergency,” Dr. Frydman said. Now, he added, “we would benefit from further outcome studies.”
Mr. Manuel, for example, became a believer. He believes telemedicine is “immensely more efficient,” he said, and “expands the pool of professionals I can consult with.”
“I will select telemedicine over an in-person visit whenever it is available.”