Since his cancer diagnosis last year, Kent Manuel has regularly seen an oncologist near his home in Indianapolis. It’s been a tough time: After spinal surgery for a stroke caused by his cancer, he’s regaining the use of his legs with physical therapy but still uses a wheelchair.
Now, Mr. Manuel said, “I’m dealing with pain.” His oncologist recommended it. Palliative care, a clinical specialty which helps people with serious illnesses cope with pain and suffering and maintain quality of life.
So in November, Mr. Manuel, 72, a semi-retired accountant, began seeing Dr. Julia Friedman, a palliative care physician. “We talk about what works and what doesn’t,” he said. “She listens to what I have to say. She’s very flexible.”
The first two drugs he prescribed to ease the pain had troubling side effects. On the third try, though, “I think we landed on something that’s working,” he said. His pain has not completely subsided, but it has lessened.
Dr. Friedman, senior medical director of a cancer care technology company called ThimCare, works hundreds of miles away in a Manhattan office. He and Mr. Manuel used a video telemedicine link — an option that barely existed in traditional Medicare before the Covid pandemic, thanks to restrictive federal policies.
Medicare Substantially expanded its telemedicine coverage in 2020, and the extension has been renewed regularly. All this could have ended on December 31.
Supporters of telemedicine, also known as telehealth, endured some nail-biting 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 Medicare’s expanded coverage for telemedicine.
Republicans had agreed to the resolution but changed their minds after Elon Musk and Donald Trump condemned it. “It killed the bill,” said Kyle Zibley, senior vice president of public policy at the American Telemedicine Association.
Ultimately, Congress approved a narrower version, a three-month extension. So telemedicine survives at least until March 31.
Mr. Zibley, who estimates that 20 to 30 percent of clinical encounters may take place in practice, expects more renewals. Telemedicine is “so popular and so bipartisan in nature, I can’t imagine the Trump administration and Congress allowing it to die,” he said.
Tricia Neuman, who directs the Medicare Policy Program at KFF, a nonprofit health policy research organization, agreed. “It appears that telehealth coverage is here to stay as an option for Medicare patients,” he said in an email.
Its use has declined since the early epidemics. When patients were afraid to keep medical appointments and many practices closed their offices, Medicare began covering video and audio home visits. For more types of providers and many more terms.
Almost immediately, the use of telemedicine increased. In 2020, nearly half of Medicare beneficiaries had at least one such visit. By the end of last year, This ratio was reduced About 13 percent.
This still represents much higher usage than in early 2020, when about 7 percent of beneficiaries made virtual visits.
While telehealth works better for some services than others, “some patients have come to rely on it,” Dr. Newman said.
palliative care, which is not widely available everywhere; Indiana, for example, did not receive a 2.5-star rating for palliative care capacity at the Center to Advance Palliative Care. State Scorecard.
Telemedicine can help fill this gap. “Working closely with oncologists who see them in person,” Dr. Friedman said, “we are able to provide better care and access to patients with advanced cancer. “
Even if Mr. Manuel was able to quickly arrange an appointment with a local palliative care doctor, “I’m disabled, so travel is a hassle,” he said.
A brief in-person consultation can require two grueling hours to get into a car (driven by a caregiver), secure and unload a wheelchair, enter a medical facility, wait. , and then in reversing the process.
Instead, “it’s so nice to sit in your house and put the phone in front of your face and just talk,” he said.
Other patients described a similar hybrid approach. Jim Segert, 74, a retired graphic designer in Hopewell Junction, NY, sees his primary care doctor in person four times a year to manage diabetes, high blood pressure and high cholesterol.
“I’m a face-to-face kind of guy,” he explained. Plus, it requires a blood test, and “there are things that can’t be done on the Internet.”
But to discuss the results, he usually schedules a virtual visit by phone. “I’m glad to have the option,” he said.
Bruce Lerner estimated that he had 10 telehealth visits in 2024. “I had a rough year,” said Mr. Lerner, 67, a lawyer in Washington, D.C. “I had Covid. I had shingles. I got pneumonia.”
Sometimes his physicians at One Medical, an Amazon-owned primary care practice, tell him to come into the office or get a chest X-ray at the radiology clinic.
About half the time, though, he listens, advises, and practically prescribes. “Not only does it reduce unnecessary office visits, it probably also reduces ER visits,” Mr. Lerner said.
Helen Epstein, 77, of Lexington, Mass., is tired of driving an hour through traffic to and from Massachusetts General Hospital. Her medical visits piled up in the past few years as Ms. Epstein, a writer successfully treated for uterine cancer, recovered from a stroke and suffered atrial fibrillation.
So when it comes to consulting her primary care doctor, she’s happy to schedule a video visit. “Since she had been my therapist for a long time, it was a very easy transition,” Ms. Epstein said.
Her husband credits telemedicine with saving a friend from going to the emergency room after his dog bit his leg. On video, their doctors could see the injuries and determine that home treatment would be sufficient.
In part because most of the research on telemedicine was conducted during the early pandemic, an unusual period, questions about its costs and effectiveness persist.
one A preliminary study of approximately 200 elderly patients Using telemedicine, for example, found general satisfaction. Yet nearly 40 percent said it was worse than in-person visits, and some found the technology frustrating.
That may be less true three years from now, but “the primary barrier is still technology,” Dr. Friedman said. Some providers now send patients links so they don’t have to remember logins and passwords, and hire staff to help them connect.
Another one Preliminary study, using Medicare claims datareported that telehealth was associated with fewer hospitalizations and encounters with clinicians, as well as slightly higher costs per patient. But this may reflect greater hospital capacity in areas with high telehealth use during the pandemic, the authors cautioned, not necessarily lower quality care.
on the other hand, Another investigation It also found increased patient visits and costs to the health system with greater telemedicine use, but no change in hospitalizations and less emergency department use.
More recently, a clinical trial involving patients with lung cancer (average age: 65). Equal satisfaction and quality of life scores Among those who received palliative care via video visit and those who received it in person.
“The data is really cloudy because we were still seeing evidence from public health emergencies,” Dr. Friedman said. Now, he added, “we would benefit from further studies of the results.”
Mr. Manuel, for one, has become a believer. He found telemedicine to be “much more efficient,” and “it broadens the group of professionals I can consult with,” he said.
“I would choose telemedicine over in-person visits whenever it’s available.”