Some Dark Clouds for Telehealth

 

Warning Signs:

As a 30+ year veteran of telemedicine (mostly teleradiology and teledentistry) I have always been one of its biggest fans.  I remain enthusiastic, but there are several warning signs that should be considered.

Telehealth usage peaked in the early days of the Covid-19 pandemic and has since stabilized.  The industry is guessing where usage goes from here as pundits debate the pros and cons of utilization going forward.  While claims compared to pre-covid levels have risen significantly, a plateau seems to have been reached.

This summer, Telehealth giant Amwell reported that they expect fewer telehealth visits through the fall and winter.

https://www.fiercehealthcare.com/tech/amwell-expects-fewer-telehealth-visits-fall-winter-as-delta-variant-creates-uncertainty

 

Investing in Telehealth

An investor would have been well advised to avoid the two largest telehealth companies, Amwell and Teledoc since the beginning of 2021.  Amwell shares are down 65% and Teladoc are down 30% through mid-October. One smaller company looking to take advantage of the SPAC phenomenon, Up Health Inc., has seen a decline of 85 % YTD.  Investors continue to pour money into the sector with digital health funding reaching $15B by the end of the second quarter.

https://www.fiercehealthcare.com/digital-health/telehealth-funding-soars-to-4-2b-record-shattering-2021

An investor would have been better advised to invest in one of the companies acquired by Amwell (Silver Cloud, Conversa) or Teladoc (Livongo, In Touch in 2000).

Industry News

Also of note, Google shut down its telehealth efforts (for the second time).

https://www.businessinsider.com/google-health-shutting-down-david-feinberg-leaves-2021-8.

Haven, the Amazon-Berkshire-JPMorgan venture to disrupt health care, is disbanding after 3 years

https://www.cnbc.com/2021/01/04/haven-the-amazon-berkshire-jpmorgan-venture-to-disrupt-healthcare-is-disbanding-after-3-years.html

Closer to home, at the end of June, now ex-Gov. Andrew Cuomo allowed New York’s executive orders regarding telehealth practice across state lines to expire.

https://www.timesunion.com/opinion/article/Expiration-of-telehealth-order-devastating-for-16420352.php

The potential for fraud continues to be a threat to telehealth growth:

https://news.bloomberglaw.com/health-law-and-business/doj-targets-telemedicine-fraud-in-1-4-billion-enforcement-spree

And the biggest threat may be challenges with cyber-security.

https://www.healthcareitnews.com/news/telehealth-biggest-threat-healthcare-cybersecurity-says-report

Reimbursement

Primary care doctors are also concerned about the sustainability of virtual care. If regulations and payment restrictions on digitally delivered care relaxed temporarily during COVID-19 are restored, 41% of clinicians say their practice may not be able to continue offering telehealth. Meanwhile, roughly a fifth of clinicians have already had to pull back their use of telemedicine since payments were reduced.

https://www.healthcaredive.com/news/quiet-suffering-primary-care-struggles-covid-19-telehealth/607996/

Telehealth/ telemedicine is here to stay and may succumb to the predictions of just being part of health or medicine while the industry looks for the “Next Big Thing”.  Any Ideas?  I’d love to hear from you.

 

Howard Reis

HEALTHePRACTICES

hreis@healthepractices.com.

 

 

 

How Do You Do Teledentistry? (Revisited)

Howard Reis, President, HEALTHePRACTICES

When I first started working as the CEO of The TeleDentists up until today when I continue working with them as an advisor and Board member, I continue to get asked one common question.  “How do you do teledentistry?”  The question is a natural one as most of us think of a visit to the dentist to include a cleaning, an X-Ray and (hopefully not) a cavity repair.  I can answer the question a bit better today having the benefit of being able to review close to 10,000 teledental visits.

The reasons patients contacted The TeleDentists remained quite consistent from the first time we measured the results.  They had toothaches, bleeding gums or broken teeth.  Parents had teething children.  Seniors had problem with their dentures.

The disposition of cases also stayed quite consistent.  We were able to prescribe (non-narcotic) medications and could also get the patient an appointment to see a local dentist if that was deemed necessary.

There has been some shift in the type of questions asked as the pandemic progressed.  Patients want to know if it is safe to return to the dentist’s office.  They also want help in finding a dentist as it has become more difficult to schedule an appointment due to closed offices and some limited hours.

I’ve also been asked, “What are things that can be treated with teledentistry” (and without entering the patient’s mouth).  Here’s just a partial list of what has been experienced:

  • Do I need ortho?
  • Whitening questions—what to use, how safe?
  • Cold Sores/herpetic infection
  • Canker Sores/Aphthous Lesions
  • Sensitive teeth
  • Dry Mouth—symptoms/solutions
  • “I have an appointment Monday, but swelling started and I can’t get ahold of my dentist” palliative care/intermediate help when someone has a dentist
  • Preventive Services that can be done by NP or Med Tech:
  • Fluoride Varnish application— “immunize against decay”
  • I need a dentist referral. Don’t know any.
  • Consultation with Diabetics about improving oral health/reducing A1Cs

And there’s more.

The TeleDentists recently connected with an Accountable Care Organization in Michigan to provide connectivity to three hospital emergency rooms (and soon three urgent care centers).  Also launched is The Virtual Tooth Fairy which connects a child to a hygienist for reassurance and instructions about taking care of their teeth.

TeleDentistry also combines the E-Commerce.  At The Marketplace on The TeleDentists web site you can find solution for Dry Mouth, TMJ, missing teeth, teeth aligners among other.  See https://www.theteledentists.com/marketplace.

Looking forward we expect to see Remote Patient Monitoring, and the incorporation of Artificial Intelligence to assist in the practice of teledentistry.  I do not believe teledentistry replaces dentists.  It helps them take better care of patients, especially patients who continue to find an office visit to be difficult.  And when an office visit is necessary, both the patient and dentist can be better prepared.

Contact:  Howard Reis hreis@healthepractices.com