Since his cancer diagnosis last year, Kent Manuel has regularly seen an oncologist near his home in Indianapolis. It’s been a tough time: After spinal surgery for paralysis caused by his cancer, he is regaining the use of his legs with physical therapy but still uses a wheelchair.
Now, Mr. Manuel said, “I’m dealing with pain.” His oncologist recommended palliative care, a medical specialty that helps people with serious illnesses cope with discomfort and distress and maintain quality of life.
So in November, Mr. Manuel, 72, a semiretired accountant, started seeing Dr. Julia Frydman, a palliative care doctor. “We talk through 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 to reduce pain had troublesome side effects. On the third try, though, “I think we’ve landed on something that’s working,” he said. His pain hasn’t fully abated, but it has diminished.
Dr. Frydman, the senior medical director at a cancer care technology company called Thyme Care, works hundreds of miles away in a Manhattan office. She and Mr. Manuel used a video telemedicine link — an option that barely existed in traditional Medicare before the Covid pandemic, thanks to restrictive federal policies.
Medicare expanded its telemedicine coverage substantially in 2020, and the expansion has regularly been renewed. That could all have ended on Dec. 31.
Supporters of telemedicine, also called telehealth, endured some nail-biting days as Congress considered a continuing resolution to fund the government past year’s end. Included in the 1,500-page bill was a two-year extension for expanded Medicare coverage for telemedicine.
Republicans had agreed to the resolution, but changed their minds after Elon Musk and Donald Trump condemned it. “That killed the bill,” said Kyle Zebley, senior vice president for public policy at the American Telemedicine Association.
Finally, Congress approved a narrower version, a three-month extension. So telemedicine lives, at least until March 31.
Mr. Zebley, who estimates that 20 to 30 percent of medical encounters could occur virtually, expects further renewal. Telemedicine is “so popular and so bipartisan in nature I can’t imagine the Trump administration and Congress allowing it to lapse,” he said.
Tricia Neuman, who directs the Medicare policy program at KFF, the nonprofit health policy research organization, agreed. “Telehealth coverage appears to be here to stay as an option for Medicare patients,” she said in an email.
Its use has declined since the early pandemic. When patients were afraid to keep medical appointments and many practices closed their offices, Medicare began covering at-home video and audio visits for more kinds of providers and many more conditions.
Almost instantly, telemedicine use soared. In 2020, almost half of Medicare beneficiaries had at least one such visit. By late last year, that proportion had receded to about 13 percent.
That still represents far greater use than in early 2020, when about 7 percent of beneficiaries had virtual visits.
Though telehealth works better for some services than others, “some patients have come to rely on it,” Dr. Neuman said.
Take palliative care, which isn’t widely available everywhere. Indiana, for example, received a not-great 2.5-star rating for palliative care capacity on the Center to Advance Palliative Care’s state scorecard.
Telemedicine can help fill the gap. “Working closely with oncologists who see them in person,” Dr. Frydman said, “we are able to take good care of patients with advanced cancer and get them access.”
Even if Mr. Manuel had been able to quickly arrange an appointment with a local palliative care doctor, “I’m disabled, so travel is a hassle,” he said.
A brief in-person consultation can require two arduous hours of getting into a car (a caregiver drives him), securing a wheelchair and then unloading it, entering a medical facility, waiting, and then reversing the process.
Instead, “it’s very nice to sit in my home and 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., sees his primary care doctor in person four times a year to manage diabetes, high blood pressure and high cholesterol.
“I’m a face-to-face kind of person,” he explained. Besides, he needs blood tests, and “there are things that can’t be done on the internet.”
But to discuss the results, he schedules a virtual visit, usually by phone. “I’m happy to have the option,” he said.
Bruce Lerner estimated that he had 10 telehealth visits in 2024. “I had a rough year,” said Mr. Lerner, 67, a lawyer in Washington, D.C. “I had Covid. I had shingles. I had pneumonia.”
Sometimes his clinicians at One Medical, the Amazon-owned primary care practice, told him to come to an office or get a chest X-ray at a radiology clinic.
About half the time, though, they listened, advised and prescribed virtually. “It not only reduces unnecessary office visits, but it probably also reduces E.R. visits,” Mr. Lerner said.
Helen Epstein, 77, of Lexington, Mass., has wearied of driving an hour through traffic to and from Massachusetts General Hospital. Her medical visits piled up over the past few years as Ms. Epstein, a writer, was successfully treated for uterine cancer, recovered from a stroke and contended with atrial fibrillation.
So when it comes to consulting her primary care doctor, she’s happy to schedule video visits. “Because she’d been my physician for a long time, it was a very easy transition,” Ms. Epstein said.
Her husband credits telemedicine with sparing him an emergency room trip after a friend’s dog bit his leg. On video, their doctor could see the wounds and determined that home treatment would suffice.
In part because much of the research on telemedicine was undertaken during the early pandemic, an abnormal period, questions persist about its costs and effectiveness.
An early study of about 200 older patients using telemedicine, for instance, found general satisfaction. Yet almost 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 primary barrier is still technology,” Dr. Frydman said. Some providers now send patients links so that they don’t need to remember logins and passwords, and hire staff to help them connect.
Another early study, using Medicare claims data, reported that telehealth was associated with slightly more hospitalizations and encounters with clinicians, as well as with modestly higher per-patient costs. But that could reflect greater hospital capacity in areas with high telehealth use during the pandemic, the authors cautioned, not necessarily lower-quality care.
On the other hand, another investigation also found increased patient visits and costs in health systems with greater telemedicine use, but no change in hospitalization and lower emergency department use.
More recently, a clinical trial involving patients with advanced lung cancer (average age: 65) found equivalent satisfaction and quality-of-life scores among those who received palliative care through video visits and those who received it in person.
“The data are really clouded because we were still looking at evidence from the public health emergency,” Dr. Frydman said. Now, she added, “we’d benefit from more studies of outcomes.”
Mr. Manuel, for one, has become a believer. He finds telemedicine “immensely more efficient,” he said, and “it widens the group of professionals I can consult with.”
“I will elect telemedicine over an in-person visit whenever it’s available.”
