Mobile phone screens showing telehealth virtual care appointment

Telehealth guide: the state of telemedicine in 2023

Written on April 14, 2023 by Theresa Vuskovich, DMD. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

Telehealth and telemedicine will continue enhancing patient care and facilitating patient access in 2023. As the COVID-19 pandemic progressed, telehealth emerged as a viable solution to ensure safe and easy access to healthcare. The United States (US) Department of Health and Human Services (HHS) revised several telehealth policies during the pandemic to make telehealth more accessible.[1]

However, the US HHS and Biden Administration will end the COVID-19 public health emergency (PHE) on May 11, 2023.[1] As the public health emergency ends, some telehealth policies will also come to an end. Nevertheless, several telehealth policies amended due to COVID-19 will remain in effect until December 31, 2024.[1] With telehealth policies evolving, it is important to understand the future implications.

This telehealth guide: the state of telemedicine in 2023 will explore the definition, policy evolution, and benefits of telehealth and telemedicine.

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Defining telehealth and telemedicine

The broad definition of telehealth and telemedicine is the use of technology to provide healthcare remotely.[2] Technology for telehealth can include video conferencing, phone calls, and text messaging.[2] Telehealth and telemedicine are often used interchangeably, but they differ.[2]

While telehealth and telemedicine enable patients to receive healthcare remotely, telemedicine primarily describes virtual visits with a physician. On the other hand, telehealth can include other healthcare professionals such as pharmacists, nurse practitioners, social workers, and nutritionists. This article will use the term telehealth to refer to telemedicine and telehealth.

The following are some examples of telehealth visits:[3]

  • Synchronous: Synchronous telehealth refers to the delivery of health information in real time. Synchronous telehealth may foster a better relationship between the patient and provider. Additionally, healthcare providers use this form of telehealth to collaborate on patient care.
  • Facilitated Virtual Visit (FVV): Facilitated virtual visits happen when the patient is in a location with diagnostic equipment and the physician is in another location. A nurse or medical assistant may gather and present diagnostic data for the physician, who can create a treatment plan. Healthcare providers also use FVV to collaborate on patient care.
  • Asynchronous: Asynchronous telehealth is also referred to as "store-and-forward" telehealth. Healthcare providers and patients exchange information at different times through text messaging, email, or a patient portal. Remote patient monitoring is another type of asynchronous telehealth that uses technology to monitor a patient's health status.

The Consolidated Appropriations Act of 2023 preserves many of the COVID-19-related telehealth flexibilities

The Consolidated Appropriations Act of 2023 is a bill passed by the Biden Administration in December 2022.[4] The Consolidated Appropriations Act of 2023 maintains some telehealth flexibilities established during the COVID-19 PHE.[4] The following are some telehealth policies preserved by the Consolidated Appropriations Act of 2023 until December 31, 2024 [1,4]:

  • Removes geographical restrictions for telehealth services not related to behavioral/mental health
  • Allows audio-only telehealth for some services
  • Removes in-person visit requirement for behavioral/mental telehealth services
  • Extends the type of practitioners who can deliver telehealth to physical therapists and speech-language pathologists

The Act also ensures some Medicare policies remain permanent. Permanent policy changes to telehealth for patients with Medicare include the following [1]:

  • Allows Medicare patients to receive behavioral/mental health care via telehealth
  • Removes geographical restrictions for behavioral and mental telehealth services
  • Permits audio-only communication platforms for the delivery of behavioral and mental health services
  • Allows hospital emergency departments in rural areas to act as originating sites

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The Consolidated Appropriations Act of 2023 does not extend the Ryan Haight Act waiver

The Act represents progress toward a broader acceptance of telehealth. However, it does not maintain every policy established during COVID-19.[4-7] The Act doesn't extend the waiver on in-person meetings for telehealth prescriptions under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 (Ryan Haight Act).[4-7] The Ryan Haight Act prohibits healthcare providers from prescribing controlled medications online without conducting an in-person medical evaluation.[7]

During the COVID-19 pandemic, HHS and the Drug Enforcement Administration (DEA) allowed scheduled drug prescriptions without requiring a prior in-person visit.[8] After the PHE ends on May 11, 2023, prescribing scheduled drugs will require an in-person visit.[8] A telehealth provider can prescribe an initial 30-day supply of scheduled medication, but additional prescriptions require an in-person visit.[6]

The following are examples of commonly prescribed scheduled drugs [9]:

  • Adderall
  • Ritalin
  • Buprenorphine
  • Ambien
  • Tramadol
  • Valium
  • Xanax

Federal and state governments are altering current policies to adapt to the post-PHE healthcare landscape.[10] The current policies are intended to ensure patients have access to safe, reliable care. Telehealth can answer many of the current problems with healthcare, such as affordability, accessibility, and health equity.[11-14]

Telehealth continues to grow in demand and importance

The American Telemedicine Association (ATA) and the American Medical Association (AMA) believe telehealth will continue to expand and become an increasingly important feature of modern healthcare.[11,12] Both patients and healthcare providers are increasingly turning to telehealth due to its convenience and cost-effectiveness.[13] Telehealth visits are often less expensive than in-office visits.

A 2021 AMA survey of 2,232 physicians found 85% of physicians are using telehealth and plan to continue offering a mix of telehealth and in-person visits.[14] The same survey revealed that telehealth improves patient satisfaction, leading to a greater demand for telehealth services.[14] Additionally, physicians believe telehealth allows them to provide more comprehensive quality care.[14]

The demand for telehealth services will continue to grow as both healthcare providers and patients recognize the benefits of telehealth.[14] Due to an aging population and a clinician shortage in rural areas, telehealth is becoming an increasingly important part of modern healthcare.[3] Aside from improved patient and provider satisfaction, the following are other benefits of telehealth[3,11-16]:

  • Improves access
  • Enhances continuity of care
  • Provides access to specialists in rural areas
  • Reduces healthcare expenses
  • Improves overall quality of healthcare
  • Reduces exposure to infections
  • Protects people with chronic health conditions

Although telehealth expands access and improves patient care, the AMA and ATA recognize the need for further improvements.[13,14,17] One of the most significant barriers is the "digital divide."[14] According to physicians, technology, digital literacy, and broadband internet access are the top 3 barriers to telehealth. Another barrier identified by physicians is reimbursement uncertainties.[14]

Future efforts by policymakers and medical associations are intended to improve telehealth delivery.[17] The ATA created the Patient Voices for Telehealth Coalition (PVTC) to represent the patient's perspective throughout the evolution of telehealth.[17] As telehealth policies evolve, patients and providers need to stay informed about the changes occurring.

Gain access to telehealth services via Everlywell

Virtual care telehealth visits are available via Everlywell. Virtual care visits provide fast, easy real-time access to synchronous telehealth via video chat. You can address your symptoms with the right tests, prescriptions, or lifestyle recommendations. During your first visit, you will meet with a licensed nurse practitioner, who will help you determine how to reach your health goals.

Virtual care visits enable you to access care no matter where you are. Virtual care visits use technology to make scheduling easy and protect your privacy. Additionally, you can take one of Everlywell's at-home tests and share your results with a virtual care provider. Your healthcare provider can create a personalized treatment plan to address your symptoms using your results.

Virtual care visits can address symptoms such as headaches, fatigue, weight changes, stomach pain, urination burning, sleeping problems, and skin or hair changes. You can also get a one-time prescription for some medical conditions. Virtual care visits are available nationwide and can provide care for what's bothering you.

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References

  1. Telehealth policy changes after the COVID-19 public health emergency. Hhs.gov. URL. Accessed April 19, 2023.
  2. Telehealth, telemedicine, and telecare: What's what? Fcc.gov. URL. Accessed April 19, 2023.
  3. Mechanic OJ, Persaud Y, Kimball AB. Telehealth Systems. StatPearls Publishing; 2022. URL
  4. Consolidated appropriations act of 2023 extends telehealth waivers. Klgates.com. URL. Accessed April 19, 2023.
  5. DEA announces proposed rules for permanent telemedicine flexibilities. D.E.A. URL. Accessed April 19, 2023.
  6. Drug Enforcement Administration. Telemedicine prescribing of controlled substances when the practitioner and the patient have not had a prior in-person medical evaluation. Federal Register. 2023;88:12875-12890. URL
  7. Lacktman NM. DEA.'s proposed rules on telemedicine controlled substances prescribing after the P.H.E. ends. Foley.com. Published February 27, 2023. URL. Accessed April 20, 2023.
  8. Prescribing controlled substances via telehealth. Hhs.gov. URL. Accessed April 20, 2023.
  9. Is my prescription a controlled medication? Dea.gov. URL. Accessed April 20, 2023.
  10. Executive summary: Tracking telehealth changes state-by-state in response to COVID-19. Manatt. URL. Accessed April 20, 2023.
  11. American Telemedicine Association Policy Principles. American Telemedicine Association. URL. Published July 22, 2020. Accessed April 20, 2023.
  12. American Medical Association. What to expect in telehealth in 2023? Here are 5 predictions. American Medical Association. URL. Published January 9, 2023. Accessed April 14, 2023.
  13. Future of Health Closing the Digital Health Disconnect: A Blueprint for Optimizing Digitally Enabled Care. American Medical Association. URL. Accessed April 19, 2023.
  14. American Medical Association. 2021 Telehealth Survey Report. Ama-assn.org. URL. Accessed April 20, 2023.
  15. Law L, Kelly JT, Savill H, Wallen MP, Hickman IJ, Erku D, Mayr HL. Cost-effectiveness of telehealth-delivered diet and exercise interventions: A systematic review. J Telemed Telecare. 2022 Feb 2:1357633X211070721. doi: 10.1177/1357633X211070721. Epub ahead of print. PMID: 35108135. URL
  16. Kelly JT, Law L, De Guzman KR, Hickman IJ, Mayr HL, Campbell KL, Snoswell CL, Erku D. Cost-effectiveness of telehealth-delivered nutrition interventions: a systematic review of randomized controlled trials. Nutr Rev. 2023 Apr 4:nuad032. doi: 10.1093/nutrit/nuad032. Epub ahead of print. PMID: 37016937. URL
  17. American Telemedicine Association. American Telemedicine Asociation Action. URL. Published January 13, 2022. Accessed April 20, 2023.
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