Telemedicine for seniors gets a last-minute reprieve

Since his cancer diagnosis last year, Kent Manuel has regularly visited an oncologist near his home in Indianapolis. It was a tough time: After spinal surgery for paralysis caused by cancer, he can move his legs again with physical therapy, but is still in a wheelchair.

Now, Mr. Manuel said, “I'm struggling with pain.” His oncologist recommended palliative care, a medical specialty that helps people with serious illnesses manage discomfort and stress and maintain their quality of life.

In November, Mr. Manuel, 72, a semi-retired accountant, began Dr. To see Julia Frydman, a palliative care doctor. “We discuss what works and what doesn’t,” he said. “She listens to what I have to say. She’s very flexible.”

The first two medications she prescribed for pain relief had bothersome side effects. On the third try, however, “I think we landed on something that works,” he said. His pain hasn't completely subsided, but it has subsided.

Dr. Frydman, the chief medical director of a cancer treatment technology company called Thyme Care, works hundreds of miles away in an office in Manhattan. She and Mr. Manuel used a video telemedicine connection — an option that barely existed in traditional Medicare before the Covid pandemic thanks to restrictive federal guidelines.

Medicare significantly expanded its telehealth coverage in 2020, and the expansion was renewed regularly. This could all have ended on December 31st.

Advocates for telemedicine, also known as telehealth, had an exciting few days as Congress considered a continuing resolution to fund the government at year's end. Included in the 1,500-page bill was a two-year extension of expanded Medicare coverage for telemedicine.

Republicans had approved the general resolution but changed their mind after Elon Musk and Donald Trump condemned it. “That killed the bill,” said Kyle Zebley, senior vice president of public policy at the American Telemedicine Association.

At first, it seemed as if the resolution's failure would mean the end of expanded telemedicine coverage. Eventually, however, Congress agreed to a narrower version, a three-month extension.

So telemedicine is alive, at least until March 31st.

Mr. Zebley, who estimates that 20 to 30 percent of medical encounters could take place virtually, expects further renewal. Telemedicine is “so popular and so bipartisan that I can't imagine the Trump administration and Congress allowing it to be repealed,” he said.

Tricia Neuman, who directs the Medicare policy program at KFF, the nonprofit health policy research organization, agreed. “Telehealth care appears to remain an option for Medicare patients,” she said in an email.

Its use has declined since the start of the pandemic. As patients became fearful of attending doctor's appointments and many practices closed their offices, Medicare began covering video and audio home visits for more providers and many more conditions.

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, that share had fallen to about 13 percent.

That still represents significantly higher usage than early 2020, when about 7 percent of beneficiaries had virtual visits.

Although telemedicine works better for some services than others, “some patients rely on it,” Dr. Neuman.

Receive palliative care, which is not widely available everywhere. Indiana, for example, received a less-than-stellar 2.5-star rating for palliative care capacity on the Center to Advance Palliative Care's state rating map.

Telemedicine can help close this gap. “By working closely with oncologists who see them in person,” said Dr. Frydman, “we are able to provide good care and access to patients with advanced cancer.”

Even if Mr. Manuel had managed to 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 two grueling hours of getting into a car (a caregiver 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 at my house, hold a phone in front of my face and just talk,” he said.

Other patients described a similar hybrid approach. Jim Seegert, 74, a retired graphic designer in Hopewell Junction, N.Y., visits his family doctor in person four times a year to treat diabetes, high blood pressure and high cholesterol.

“I’m a personal person,” he explained. He also needs blood tests and “there are things you can’t do on the internet.”

But to discuss the results, he arranges a virtual visit, usually by telephone. “I’m glad to have the option,” he said.

Bruce Lerner estimated that he had ten telemedicine visits in 2024. “I had a tough year,” said Mr. Lerner, 67, a lawyer 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, would ask him to come into an office or get a chest X-ray at a radiology clinic.

However, about half the time they were listening, advising and prescribing virtually. “Not only does it reduce unnecessary office visits, but it probably also reduces the number of emergency room visits,” Lerner said.

Helen Epstein, 77, of Lexington, Massachusetts, is tired of driving an hour through traffic to and from Massachusetts General Hospital. Her doctor visits increased in recent years as Ms. Epstein, a writer, was successfully treated for uterine cancer, recovered from a stroke and struggled with atrial fibrillation.

When it comes to seeing her primary care doctor, she likes to schedule video visits. “Because she had been my doctor for a long time, the transition was very easy,” Ms. Epstein said.

Her husband credits telemedicine with saving him a trip to the emergency room after a friend's dog bit his leg. Her doctor could see the wounds on the video and concluded that home treatment would be sufficient.

Also because much of the research on telemedicine was conducted during the early pandemic, an unusual time, questions remain about its cost and effectiveness.

For example, an early study of about 200 older patients using telemedicine found overall satisfaction. Still, nearly 40 percent said it was worse than in-person visits, and some found the technology frustrating.

That may be less true three years later, but “the biggest obstacle is still technology,” said Dr. Frydman. Some providers now send their patients links so they don't have to remember their login information and passwords, and hire staff to help them connect.

Another early study using Medicare claims data reported that telemedicine was associated with slightly more hospitalizations and physician encounters, as well as slightly higher costs per patient. However, the authors cautioned that this could be due to greater hospital capacity in areas with high telemedicine use during the pandemic and not necessarily poorer quality of care.

On the other hand, another study also found increased patient visits and costs in health systems with greater use of telemedicine, but no change in hospital admissions and lower emergency room utilization.

Recently, a clinical trial of patients with advanced lung cancer (median age: 65 years) found that satisfaction and quality of life were equivalent between those who received palliative care via video visit and those who received it in person.

“The data is really clouded because we were still studying evidence of the public health emergency,” Dr. Frydman. Now she added: “We would benefit from more studies on the results.”

Mr. Manuel, for example, has become a believer. He finds telemedicine “immensely more efficient,” he said, and “it expands the pool of professionals I can consult.”

“I will choose telemedicine over an in-person visit whenever it is available.”