Posted: 31 Jul. 2018 5 min. read

Medicare’s 2019 payment proposal is another reason to embrace virtual care

By Steve Burrill, vice chairman, US health care providers leader, Deloitte LLP

The virtual door to the doctor’s office swung open a little wider on July 12 when the Centers for Medicare and Medicaid Services (CMS) proposed that Medicare pay physicians for virtual check-ins and other tech-enabled services.

Over the years, we have seen regulatory and payment barriers, along with sometimes clunky technology, limit the adoption of virtual care among health care providers. As these barriers fall away, and as the technology improves, health system leaders and physicians should try to get ahead of the trend. Along with the potential to extend the reach of physicians, improve outcomes, and enhance patient experience, I think the ability to offer virtual care could also give health systems and physicians an advantage over traditional and non-traditional competitors. Physical contact between doctors and their patients will always be important, and virtual care isn’t going to replace that. But such technology could be an important tool for hospitals and physicians.

While virtual care isn’t new (I have been talking and writing about it for years), it has been slow to gain traction. But the pace of adoption appears to be accelerating as CMS, state regulators, and health plans encourage adoption. Consider this:

  • Medicaid offers telehealth coverage in 49 of 50 states and the District of Columbia.1
  • As of 2016, 74 percent of large employer-sponsored health plans had incorporated telehealth into their benefits (up from 48 percent in 2015).2
  • Some states are exploring, or have already passed, legislation allowing physicians to conduct virtual visits with patients outside of their own state. Parity laws that require virtual visits to be paid at the same rate as face-to-face encounters are becoming more common in states.3
  • In its 1,400-page proposed rule for the 2019 Medicare Physician Fee Schedule, CMS proposes—and seeks public comment on—ways for Medicare to pay for phone or video chats between patients and physicians. These virtual visits could be conducted without a face-to-face appointment. The agency is also considering paying physicians for the time it takes to review videos or images that a patient transmits to the office.

Physicians, consumers see promise in virtual chronic-care management

Evidence of improved health outcomes, cost savings, and the potential for better access and more convenience for patients are among the reasons we expect virtual health to become more commonplace in hospitals and physician practices. Some studies estimate that virtual health strategies can help reduce hospital stays.After discharge, the technology can cut readmission rates by making it possible for patients to be monitored remotely.5

The ability to remotely monitor and manage chronic conditions are among the most promising uses of virtual care technology, according to the results of the Deloitte 2018 Survey of US Physicians. Along with connecting physicians to patients, virtual care can connect primary care doctors to specialists who can work together in managing a patient’s condition.

About 70 percent of the 624 primary care and specialty physicians we surveyed said remote patient monitoring could be particularly useful in the treatment of chronically ill patients. A majority of respondents (67 percent) also saw potential in email/patient portal consultations, and 65 percent said remote care management and coaching would be useful in managing the treatment of chronically ill patients. We also found that primary care physicians are more than twice as likely as specialists to see virtual care technology as a useful tool in the management of chronically ill patients.

Case in point: Massachusetts General Hospital’s primary care practices have been offering virtual visits for some chronic conditions since 2012. A recent study among hypertension patients from MGH and another Boston hospital found no significant difference in outcomes between chronically ill patients who met virtually with a primary care doctor and those who met their doctor in person.6

Results from our upcoming consumer survey found that patients who have one or more common chronic diseases have been highly satisfied with their virtual visits. Survey respondents whose conditions have a major impact on their lives are even more likely to report high satisfaction with virtual visits. However, follow-up questioning indicates that consumers see a need for improvement. We also found that the vast majority of consumers (77 percent) have never had a virtual health care visit, though many of them (57 percent) said they are interested in trying it. Stay tuned for our upcoming paper detailing more findings on consumers’ experiences and attitudes toward virtual health from our consumer survey.

The ability to offer virtual care could create a competitive edge

Patients wait an average of 24 days to schedule an appointment with a specialist—up from 18.5 days in 2014, according to the results of a 2017 survey from Merritt Hawkins, a physician search firm and subsidiary of AMN Health Care. The longer appointment times likely indicate a shortage of physicians, according to the report, which evaluated wait times for commonly used specialty physicians in 15 large cities.

Virtual care could help address physician shortages by extending the reach of doctors and by offering around-the-clock access to consumers. Patients can get a quick answer to a medical question or be triaged and sent to a hospital, clinic, or physician office.

We live in a world where some of the most successful transportation companies don’t have cars, and the largest operators of vacation rentals don’t own properties. Hospitals without beds might not be far behind. Three years ago, a large midwestern hospital system opened a virtual care center with four floors, more than 300 employees, and no hospital beds…or patients.

As regulatory and payment barriers go away, we could see a shift in market share from traditional providers (e.g., physician offices, clinics, and hospitals) to technology-driven clinicians that offer more convenient and cost-efficient options to patients. To keep pace and preserve market share, traditional provider groups might need to revamp their business models.

Despite the name, virtual care is real care. It connects patients to care providers and can also connect primary care doctors to specialists. The technology can transcend time and space, allowing patients and physicians to interact without needing to be together in one place. Let’s see where this new world takes us.

1. Center for Connected Health Policy:
3. Center for Connected Health Policy, 2017 report 
4. American Telemedicine Association, State Policy Resource Center
5. National Center for Biotechnology Information, US National Library of Medicine, Using telehealth to reduced all-cause 30-day hospital readmissions among heart failure patients 
6. Massachusetts General Hospital, May 2018 press release,


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