Telemedicine for seniors is getting last-minute relief

Since his cancer diagnosis last year, Kent Manuel regularly visits an oncologist near his home in Indianapolis. It was a complex period: after spinal surgery due to paralysis caused by cancer, thanks to physiotherapy he regained the employ of his legs, but he still uses a wheelchair.

Now Mr. Manuel said, “I can deal with the pain.” His oncologist recommended palliative care, a medical specialty that helps people with grave illnesses cope with discomfort and suffering and maintain their quality of life.

That’s why in November, Mr. Manuel (72), a semi-retired accountant, started dating Dr. Julia Frydman, a palliative care doctor. “We talk about what works and what doesn’t,” he said. “She listens to what I have to say. She is very versatile.”

The first two medications she prescribed to reduce pain had annoying side effects. But on the third try, “I think we found something that works,” he said. The pain didn’t go away completely, but it did decrease.

Dr. Frydman, senior medical director at cancer technology company Thyme Care, works hundreds of miles away in an office in Manhattan. She and Mr. Manuel used a link to video telemedicine, an option that was almost non-existent in established Medicare before the Covid pandemic thanks to restrictive federal policies.

Medical care has significantly expanded its telemedicine reach in 2020, and the extension was regularly renewed. This could all end on December 31st.

Supporters of telemedicine, also known as telehealth, experienced a tense few days as Congress considered whether to continue funding the government behind schedule last year. The 1,500-page bill included a two-year extension of expanded Medicare coverage for telemedicine.

Republicans agreed to the resolution, but changed their mind after Elon Musk and Donald Trump condemned it. “It killed the bill,” said Kyle Zebley, senior vice president for public policy at the American Telemedicine Association.

Ultimately, Congress approved a narrower version, i.e. a three-month extension. So telemedicine is alive, at least until March 31.

Zebley, who estimates that 20 to 30 percent of medical encounters may be conducted virtually, expects a continued resurgence. Telemedicine is “so popular and so bipartisan that I can’t imagine the Trump administration and Congress would let it expire,” he said.

Tricia Neuman, who directs the Medicare policy program at KFF, a nonprofit health policy research organization, agreed. “It appears that telehealth will remain an option for Medicare patients,” she said in an email.

Its employ has declined since the pandemic began. When patients were afraid to come to doctor’s appointments and many clinics closed their offices, Medicare began providing in-home video and audio visits for more providers and many more conditions.

Almost immediately, the employ of telemedicine increased. In 2020, nearly half of Medicare beneficiaries had at least one such visit. Tardy last year this percentage has decreased to about 13 percent

This still represents significantly higher utilization than in early 2020, when approximately 7 percent of beneficiaries completed virtual visits.

While telehealth works better for some services than others, “some patients have come to rely on it,” Dr. Neuman said.

Take advantage of palliative care, which is not widely available everywhere. For example, Indiana received a subpar 2.5-star rating for palliative care capacity from the Center for the Advancement of Palliative Care state scorecard.

Telemedicine can aid fill this gap. “By working closely with oncologists who see them face-to-face,” Dr. Frydman said, “we are able to provide good care and access for patients with advanced cancer.”

Even if Mr. Manuel could quickly get an appointment with a local palliative care doctor, “I’m disabled, so traveling is a pain,” he said.

A brief in-person consultation may require two arduous hours of getting into a car (driven by a caregiver), securing a wheelchair, then unloading it, entering a medical facility, waiting, and then reversing the process.

Instead, “it’s very nice to sit at home and hold the phone in front of your face and just talk,” he said.

Other patients have described a similar hybrid approach. Jim Seegert, 74, a retired graphic designer from Hopewell Junction, Recent York, sees his primary care doctor in person four times a year to treat his diabetes, high blood pressure and high cholesterol.

“I am a person who likes direct contact,” he explained. Plus, he needs blood tests, and “there are things that can’t be done over the Internet.”

However, to discuss the results, a virtual visit is scheduled, usually by phone. “I’m glad I have this option,” he said.

Bruce Lerner estimated he completed 10 telehealth visits in 2024. “I had a abrasive year,” said Mr. Lerner, 67, a Washington lawyer. “I had Covid. I had shingles. I had pneumonia.

At times, doctors at One Medical, an Amazon-owned primary care practice, would tell him to come into their office or get a chest X-ray at the radiology clinic.

However, in about half of the cases, they listened, advised and prescribed virtually. “Not only does this reduce unnecessary office visits, but it also probably reduces ER visits,” Mr. Lerner said.

Helen Epstein, 77, of Lexington, Massachusetts, is tired of driving hours in traffic to and from Massachusetts General Hospital. Her visits to the doctor had multiplied over the past few years as the writer Ms. Epstein was successfully treated for uterine cancer, recovered from a stroke and struggled with atrial fibrillation.

Therefore, when it comes to a consultation with a primary care physician, he willingly schedules video visits. “Because she had been my doctor for a long time, the transition was very simple,” Ms. Epstein said.

Her husband credits telemedicine with saving him a trip to the emergency room after a friend’s dog bit his leg. In the video, the doctor could see the wounds and said that home treatment would be enough.

In part because most of the research on telemedicine was conducted early in the pandemic, an unusual time, questions remain about its costs and effectiveness.

Some an early study in about 200 elderly patients for example, the employ of telemedicine has proven to be generally satisfactory. However, nearly 40 percent said it was worse than in-person visits, and some found the technology frustrating.

Perhaps that statement will be less true three years later, but “the primary barrier is still technology,” Dr. Frydman said. Some providers now send patients links so they don’t have to remember logins and passwords, and employ staff to aid them connect.

Other early study using Medicare claims datareported that telehealth was associated with slightly more hospitalizations and physician encounters, as well as slightly higher costs per patient. The authors caution that this may reflect greater hospital capacity in areas with habitual employ of telehealth during the pandemic, but not necessarily lower quality of care.

On the other hand, another investigation also showed increased patient visits and costs in healthcare systems characterized by greater employ of telemedicine, but no change in hospitalizations and lower emergency department employ.

A clinical trial involving patients with advanced lung cancer (average age: 65 years) was recently discovered. equivalent results in terms of satisfaction and quality of life among people who received palliative care via video visits and those who received it in person.

“The data is really unclear because we were still analyzing the evidence related to the public health risk,” Dr. Frydman said. Now, she added, “we would benefit from more outcome research.”

First, Mr. Manuel became a believer. He finds telemedicine “extremely more effective,” he said, and “expands the pool of specialists I can consult with.”

“I will choose telemedicine over an in-person visit when available.”