However, little is known about physician experiences initiating telehealth and system-level and contextual factors that fostered or discouraged adoption during the COVID-19 pandemic and implications of use beyond the pandemic. Įxpanded telehealth use has the potential to permanently transform healthcare delivery systems and access to care for older adult populations facing challenges to in-person care, as well as improving chronic condition management, and reducing healthcare costs. Yet, technology use among older adults is growing in the US, and 27% of Medicare beneficiaries accessed telehealth during the COVID-19 pandemic. Notable barriers include internet and device access, design challenges, privacy and trust concerns, and cost.
While the older adult population spans an age group of many decades with varied abilities and health concerns, older adults tend to face greater barriers to technology and internet use compared to younger adults. Older adults (aged 65 years and older) are the most vulnerable to severe complications and death due to COVID-19, however they are also less likely to benefit from expanded telehealth access and use. Relaxation of state licensing requirements allowed for out-of-state physicians to practice in more jurisdictions. Health Insurance Portability and Accountability Act (HIPAA) violation penalties were suspended if telehealth was provided in good faith, permitting use of Facetime and other non-HIPAA-compliant platforms. Medicare expanded coverage for telehealth by (1) waiving the audio-video requirement for certain telehealth services, (2) introducing payment for remote physiologic monitoring, and (3) allowing hospitals to bill for services furnished remotely by hospital-based clinicians. The Centers for Medicare and Medicaid Services (CMS) and many private health insurance payers allowed payment parity between in-person and virtual visits. This rapid uptake of telehealth was accelerated by deregulation of payment and regulatory policy. In the United States (US), the coronavirus disease (COVID-19) pandemic promulgated a 154% increase in telehealth visits in March 2020 compared to March 2019. Our data provide policy insights that if placed into action could facilitate the long-term success of telehealth and encourage a more flexible healthcare delivery system in the US. Conclusionsįrontline physicians who treated older adults during the COVID-19 pandemic were largely in favor of continuing telehealth use beyond the pandemic however, they noted that sustainability would depend on enacting policies that address access inequities and reimbursement concerns. Physicians noted that payment parity with in-person visits, between video and telephone visits, and relaxation of restrictive regulations would enhance their ability to continue to offer telehealth. Challenges included unequal access for rural, older, or cognitively impaired patients.
Benefits of using telehealth to treat older adults included reducing deferred care and increasing timely care, improving efficiency for physicians, enhancing communication with caregivers and patients, reducing patient travel burdens, and facilitating health outreach and education. Resultsįrontline physicians described telehealth as a more flexible, value-based, and patient-centered mode of health care delivery. We completed framework analysis of the transcribed interviews to identify emerging themes and used the Quadruple Aim to organize themes. We recruited a diverse sample of geriatricians ( n = 18), primary care ( n = 15), and emergency (n = 15) physicians from all United Stated (US) regions, rural-urban settings, and academic-community practices who cared for older adult patients during the pandemic using purposive sampling methods. We conducted semi-structured interviews from September 2020 to November 2020 with 48 physicians. Therefore, our objective was to understand experiences of frontline physicians caring for older adults via telehealth during the COVID-19 pandemic. Little is known about physician experiences initiating telehealth and factors that fostered or discouraged adoption during the COVID-19 pandemic with older adult patients.
Telehealth delivery expanded quickly during the COVID-19 pandemic after the reduction of payment and regulatory barriers, but older adults are the least likely to benefit from this expansion.
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