It's become a truism that telehealth use saw an enormous jump in 2020, spurred by the COVID-19 pandemic and enabled by the relaxation of federal regulations.   

We also know that utilization has gradually tapered off as patients have become somewhat more comfortable seeking in-person care – but that many individuals, having experienced the convenience of virtual services, are unwilling to give them up again.  

What's less certain, however, is what that utilization will look like in the future, particularly as the end of the public health emergency looms. 

CareCloud CEO and president A. Hadi Chaudhry sat down with Healthcare IT News to share his perspective and weigh in on what needs to happen to safeguard access to virtual care beyond the end of COVID-19.  

Q. What were some of the changes you saw at CareCloud during the pandemic when it came to telehealth?  

A. We launched our first fully integrated telehealth solution in the 2018-2019 time frame. Today it is available either as a part of our overall suite of products in the electronic health record and practice management systems, or it can be independently used by providers. It is available either through a web browser on a desktop computer, or through tablets or smartphone apps. This also helps because many people are using a smartphone.

So that's also one of the drivers today from the adoption perspective: It's becoming easier and easier for the users to start adapting to the telehealth technology.   

In terms of when the pandemic started, if you think about the numbers in December 2019 or January 2020, one-tenth of about 1% of the total appointments were telehealth related. So basically most of the appointments were in-person, face-to-face appointments.

During the pandemic, somewhere around in the second quarter of 2020, this number actually even went up to about 25% of the appointments. It's important to understand that the denominator is reduced at that time because the overall visit numbers were reduced.   

But currently this number is hovering around somewhere between 5% to 6% of the total appointments. And we did see an increase again around early 2021, at the time of the Delta variant. Our overall telehealth appointments have increased by about 114 times from the beginning of 2020.   

What is driving all this, of course, is the regulatory changes during this public health emergency.   

Q. Did some specialties see a greater increase in numbers? Were there regional differences in utilization?

A. From the specialty perspective, behavioral health is getting serious attraction toward telehealth. There's not such a clinical need to be sitting face-to-face. When we go back and look at our numbers, even today, behavioral health stands about 400 times more appointments versus the beginning of 2020, which was almost negligible.

Regionally speaking, as of October of this year, the highest increases were in the Midwest, and the Northeast region saw the highest telehealth adoption as a percentage of overall appointments.  

We do see more opportunity in the rural areas, but at the same time, we encounter limitations with technology and internet capabilities.  

Q. Let's take a minute to look ahead. We've been obviously hearing a lot about the potential end of the public health emergency and what effect that might have on telehealth utilization.

What are some of your predictions for 2022 and beyond about the way telehealth will be used, especially as the COVID 19 pandemic continues?  

A. We are looking at it as virtual care – not only just telehealth. When I talk about virtual care, one aspect is, yes, the basic telehealth virtual appointment versus the face-to-face visits.   

But in addition to that, we do see a lot of trends toward increased use of remote patient monitoring. As more and more wearable devices are becoming common in the technology, they have even started to get some FDA approvals as well.

Blood pressure, oxygen level, pulse rate, respiratory rate – all those things can be captured and sent back to the software system and doctors. Whether it's government payers or the commercial payers, they have started to cover more and more of these initiatives.   

I think the industry is going through a transformation. Thirty years ago, if you had a car, you had to monitor the oil level, the water level – you probably had to check it once a week. But today, you only have to worry about when there is a problem, or it gives you an alert.   

In the same way, you don't need to be checking the patient all the time. So the devices will keep on monitoring the technology and will keep track of everything. And whenever there is an alert, that alert will be fired back to the doctor, and someone can get engaged and direct the patient [to] what needs to be done next.  

I think we will see more and more utilization of telehealth, remote patient monitoring, chronic care management and all of these related things in the years to come.  

For some patients, it might be a little difficult to see a doctor on a computer versus sitting in front of you. It will take a little more time. But we strongly believe it will automatically evolve. And this situation will take care of itself on its own as the time passes by.  

Q. Do you have any hopes in terms of actions that Congress might take to safeguard the telehealth flexibilities?

You've mentioned reimbursement and paying for remote patient monitoring. But are there any sort of looming priorities that you think the government should have in terms of making sure that these innovations can continue?  

A. First of all, we should think about the public health emergency. There is a high probability that, even if the public health emergency is lifted in 2022, some of these telehealth-related initiatives will continue, maybe in a slightly different shape or form.   

But one priority to address is the licensing-based requirement. When it comes to telehealth, it's much better not to have those state-level restrictions in place.  

From the reimbursement standpoint, today, telehealth procedures are largely being paid almost at the same or at a similar level as they otherwise would have been paid at a face-to-face session. It may not continue at the 100% level, but it probably would still be better than what it used to be before COVID levels.   

Because this adoption has already taken place, there is no reason for anyone to go back to the old times. So I think the rules should be around making it further improved.   

I think those two would be the key drivers towards this transformation. Because those are the two major limiting factors. 

This interview has been condensed and lightly edited for clarity.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.