Telehealth will save lives—for as long as it has funding
The federal government and private insurers greatly increased Americans' telehealth access during the pandemic. Will these changes be permanent?
Stephen Johnson is a St. Louis-based writer whose work has been published by outlets including PBS Digital Studios, HuffPost, MSN, U.S. News & World Report, Eleven Magazine and The Missourian.
- When telehealth visits began skyrocketing after the pandemic began, hospitals had to increase their number of virtual appointments by magnitudes. Most did it seamlessly.
- Big Think spoke to Dr. Martin Doerfler, senior vice president of clinical strategy and development at Northwell Health, about this transition and how it benefited patients.
- Telehealth has proven its value during the pandemic, but it might stop evolving unless the federal government redesigns the regulatory framework so that insurers cover it and patients can afford it.
When COVID-19 began spreading across the U.S. in early 2020, the nation's telehealth infrastructure entered a trial by fire.
It was paramount for hospitals to minimize in-person care—not only to limit the spread of the virus, but also to ensure hospitals wouldn't become overwhelmed, like they had in Italy. That's a key reason why, in March, Medicare and most private insurers sought to increase access to telehealth by relaxing restrictions, waiving fees, and reimbursing practitioners for virtual visits at the same rate as in-person visits.
Soon after the establishment of these temporary measures, telehealth visits skyrocketed. A report from the U.S. Department of Health and Human Services found, for example, that about 43 percent of primary care visits were conducted through telehealth in April, compared to just 0.1 percent in February.
How did that transition go? Despite having just weeks to prepare, most U.S. health care organizations managed to massively increase their virtual caseload with astounding seamlessness. Dr. Martin Doerfler, senior vice president of clinical strategy and development at Northwell Health, was one of the thousands of health care professionals who witnessed the transition.
"We went from the proverbial 'zero to 60' over a matter of weeks, and provided good care with very high degrees of patient satisfaction," Doerfler said.
Prior to the pandemic, Northwell Health—the largest hospital system in New York—was conducting about 150 telehealth visits per month between 20 to 40 physicians. But in May alone, Northwell had conducted approximately 65,000 visits with roughly 8,000 health care professionals across the health system.
Doerfler cited an example of a single mother whose young child had chronic illnesses, including respiratory problems, which made in-person visits especially dangerous during the pandemic. The pediatrician was able to evaluate the child, speak to the mother through a telehealth translation service, and provide the family with the necessary steps to keep the child healthy. The mother was happy to avoid having to take her child on public transportation to visit a hospital in person and still receive the care she needed.
Three hours to drive 200 miles is no different than three hours to take two trains, two buses and a cab.
Clinicians at Northwell have used telehealth to adapt to the pandemic in many ways, from sending phlebotomists to elderly patients' homes after virtual visits, to connecting new mothers with lactation specialists via secure, encrypted telehealth channels.
"There are all sorts of examples throughout health care where this technology, and the willingness of patients and clinicians to embrace it, allowed for care of the type of issues that are normally done face-to-face," Doerfler said.
Telehealth programs that existed before the pandemic also helped to keep both patients and hospital staff safe by minimizing in-person visits. For example, Northwell's TelePsychiatry Department connects people in crisis, who might typically go to the emergency department, with a behavioral health specialist in about 45 minutes, any time of day or week. That is a considerable improvement since emergency department staffing typically does not include psychiatrists or other specialists who can help someone experiencing a behavioral health emergency.
The success of telehealth during the pandemic begs the question: Why hasn't US health care already embraced virtual care?
What are the obstacles facing telehealth?
One of the biggest obstacles to widespread adoption of telehealth has been a lack of national legislation providing financial incentive for health centers to adopt it.
States laws vary on how practitioners are paid for telehealth visits. In some states, laws require insurance providers to cover telehealth visits at parity—at the same rate as in-person visits. But in states without parity laws, there's little incentive for health care organizations to invest in telehealth infrastructure and training.
Access is also a major obstacle. The Centers for Medicare and Medicaid Services (CMS) generally reimburse practitioners for telehealth visits only when patients live in "designated rural underserved areas."
But not all underserved areas are in small, remote places. After all, a single parent living in Brooklyn, New York, might also have trouble accessing quality health care.
"Three hours to drive 200 miles is no different than three hours to take two trains, two buses and a cab," Doerfler said. "So access is almost certainly going to be improved by the greater availability of telehealth in that direct-to-patient, in-their-home-or-office, setting."
Lack of internet access is also a problem. A paper published by the JAMA Network in August found that 41 percent of Medicare beneficiaries don't have a computer at home with access to high-speed internet, and roughly the same number don't have a smartphone with an unlimited data plan.
What is the future of telehealth?
Credit: Daniilvolkov via AdobeStock
Lawmakers in both parties and health care professionals have indicated a desire to make permanent some of the regulatory changes to telehealth enacted during the pandemic. That's key, because without the financial incentives to continue expanding telehealth, health care providers may revert to the pre-pandemic approach.
"One issue, which is important for health care and non-health-care folks to know, is that telehealth will continue to expand dramatically as long as there's funding and reimbursement for it," said Michael Dowling, Northwell's president and CEO. "If the insurance companies and government decide, 'We don't want to pay for telehealth going forward or virtual visits,' then it's going to slow down. If there is no delivery system, no health care system, hospital, or doctor is going to continue to expand telehealth if they don't get reimbursed for it."
Yet some of the nation's biggest insurers have already stopped waiving telehealth deductibles and copays for some customers, even though there's no clear end in sight for the pandemic.
The long-term solution, Doerfler said, is for CMS to start paying for telehealth services, at parity, up and down the chain, and passing federal legislation that requires self-insured health care plans to pay for telehealth services as they would in-person visits.
Telehealth is proven to work for urgent care, primary care and some specialty care, and it clearly expands access to behavioral health care, according to Doerfler. "Some have said that costs of providing telehealth are lower than face-to-face care, but most of the costs are unchanged, and new ones are added with technology requirements. When the patient receives a very specific service there are billing codes used to define that service. If the service is less, the code represents that. If the service is the same, the code will represent that and needs to be paid at parity."
Doerfler added that, while telehealth can't replace all traditional health care services, it should be "in the toolbox" for patients and physicians.
"In the modern world, where this type of technology is being used for all sorts of personal and business uses, excluding something as personal as your care between you and your doctor from fitting into that modern paradigm makes no sense," Doerfler said.
People often make a killing in stocks, but what else do people buy in hopes of selling for a fortune?
- Outside of stocks and bonds, some people make money investing in collectibles and make a fair amount on them.
- One stamp even sold for a billion times its face value.
- The extreme dependence on future collectability limits the potential of most of these opportunities.
Pokémon Cards<iframe width="730" height="430" src="https://www.youtube.com/embed/hVUmTaSoB5Y" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p> For those who weren't content to catch them all in a video game came a trading card game where you could collect them all. Some classic cards have gained tremendous stature among collectors and Pokéfanatics and sell for extremely high prices. </p><p> An older card featuring Charizard, a fire breathing dragon, regularly sells for thousands <a href="https://www.lifesuccessfully.com/gaming-articles/the-most-wanted-pokemon-cards-charizard#/" target="_blank" rel="noopener noreferrer">online</a>. Given that the card could be purchased for a couple of dollars in 1999, this is quite the return. A particular pack of the cards, which cost $5 in 2003, now sells for $650, one hundred and thirty times the original asking <a href="https://adamrybko.medium.com/stocks-or-pokemon-cards-an-introduction-to-alternative-investing-32fe499083c4" target="_blank" rel="noopener noreferrer">price</a>. </p><p> Of course, not every card will fetch these high prices. Buying cards as an investment is tricky. You have to essentially guess at which cards will be considered highly valuable at a later date and will be unable to collect any dividend before selling them.</p><p> Furthermore, you have to presume that people will be collecting the cards years after buying them. While Pokémon has remained popular, it is a bit of an outlier in terms of enduring success.</p>
Shoes<p> People from all walks of life, from skateboarders to the First Lady of the <a href="https://www.rappler.com/newsbreak/in-depth/imelda-marcos-shoes-mixed-legacy" target="_blank" rel="noopener noreferrer">Philippines</a>, enjoy collecting shoes. An entire subculture exists for people interested in collecting sneakers, and some people make quite a profit in it.</p><p> The Nike SB Dunk Low Reese Forbes Denims, priced initially at $65 in 2002, are commonly valued in the thousands of dollars now. The Nike Air Jordan 1 Retro High x Off White "Chicago" shoe sold for $190 a mere four years ago, but now sells for $4000 a <a href="https://sixfiguresneakerhead.com/sneaker-model-return-alternative-investment-stock-x-reseller/" target="_blank" rel="noopener noreferrer">pair</a>. </p><p> A <a href="https://www.huffpost.com/entry/sneakers-good-investment_n_5bd1f5ebe4b0d38b588143ee?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAALOu0F9zs5DBHHOIjMgHOZR6K88W3rZkyD3ftBMz2nzlHfoxD4MS2Iz1vF3H-a4_xzOWIIrsJyv76Gj6xwUXaRIRdjq7M2m7I6-lxihWIcEfs7F9PgOwnx82JXPfXmWL7-RQlNUufOyvd8V6TCzMEYrEjzMXVU77IWk9MjOEtsln" target="_blank" rel="noopener noreferrer">Huffington Post</a> article points out that most of these shoes offered better returns than gold over the same period. The same article quotes YouTube personality <a href="https://www.youtube.com/user/mrFOAMERSIMPSON" target="_blank" rel="noopener noreferrer">Mr. Foamer Simpson</a> and his explanation of the difficulties of making money on shoes:</p><p style="margin-left: 20px;"> "There's a guessing game or element of unpredictability that makes it exciting for some collectors. With sneakers, you kind of never know. Sure, you know what sneakers are more limited or which ones were harder to get, but even with that, it fluctuates a lot. A sneaker that was very valuable two years ago might all of a sudden crash and no longer be valuable."</p>
Toys of all kinds<iframe width="730" height="430" src="https://www.youtube.com/embed/0uYnj1i1EQw" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p> If there's one thing everybody loves, it's what they loved when they were children. That often translates into old and rare toys fetching insane prices at auction.</p><p> Beanie Babies, those little stuffed animals from the 90s, once sold at a price of thousands of dollars <a href="https://www.thefiscaltimes.com/2015/03/02/How-Great-Beanie-Baby-Bubble-Went-Bust" target="_blank" rel="noopener noreferrer">online</a>, not bad considering they sold for $5. Lego sets, particularly those featuring well-known franchises like Star Wars, can sell for hundreds of dollars <a href="https://finance.yahoo.com/news/20-geeky-collectibles-could-millions-201624881.html" target="_blank" rel="noopener noreferrer">online</a>. </p><p> As with Pokémon cards, the success stories are dependent on what people are interested in collecting long after most people forgot the toy existed.<strong> </strong>While some collectors have ideas on how to gauge what might or might not end up being valuable later, there seems to be a considerable amount of luck involved.</p>
Stamps<p> The hobby of kings has occasionally made some people as rich as one, with rare stamps and extensive collections fetching high prices at auction.</p><p> One of the famous "Inverted Jenny," stamps, a rare misprint showing an upside-down airplane, sold for $1,593,000 at <a href="https://www.linns.com/news/us-stamps-postal-history/2018/november/nov-15-jenny-invert-sale-record.html" target="_blank" rel="noopener noreferrer">auction</a>. The most valuable stamp in the world, the British Guiana 1c magenta, last sold for $9,480,000, a billion times its face <a href="http://www.sothebys.com/en/auctions/2014/magenta-n09154.html" target="_blank" rel="noopener noreferrer">value</a>. For those interested in a shorter-term investment, the USA Forever stamp has gained a face value of 75% since its introduction and can still be used to send a letter.</p>
Coins<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTUxNjY2Ny9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzMjUwNzk3OX0.HMBXb1mbiL0D-JbFcD7pBWNZ8TcOB4mzcJ6ri2aCNOg/img.jpg?width=1245&coordinates=0%2C1%2C0%2C1&height=700" id="41fe2" class="rm-shortcode" data-rm-shortcode-id="57f1ae74688caf29e150c4ce2f7c5b41" data-rm-shortcode-name="rebelmouse-image" data-width="1245" data-height="700" />
- Charles Darwin speculated that wingless insects thrived on windy islands so they wouldn't be blown off the land.
- While the reasoning was slightly faulty, researchers have now proved Darwin's 165-year-old "wind hypothesis."
- This finding is yet another example of how environments shape the animals that inhabit them.
Photo: Christian / Adobe Stock<p>Monash researchers looked at three decades of data on various insect species living in Antarctica and 28 Southern Ocean islands—including Svalbard, Jan Mayen, Ellef Ringnes, Bathurst, and St. Matthew—and discovered a trend: wind (as well as low air pressure and freezing temperatures) made flight nearly impossible to resident insects. They simply didn't have the energetic resources needed to take to the sky. Better to crawl around and scavenge.</p><p>Darwin wasn't completely right. He thought the evolutionary adaptations were due purely to wind throwing insects off the island. But nutrition matters too. Flight consumes a ton of energy. The windier it is, the harder insects have to work. Battling a gale requires an inordinate amount of calories. As the team writes, </p><p style="margin-left: 20px;">"Strong winds can also inhibit normal insect flight activity, thereby increasing the energetic costs of flying or maintaining flight structures. This energy trade-off is more complex than Darwin's single-step displacement mechanism because it requires genetic linkage between traits associated with flight ability, flight propensity, and fecundity or survival." </p><p>Still, you have to hand it to the man. During a time when most humans assumed animals were all the result of metaphysical tinkering, Darwin gazed out into nature and connected the dots. His mind has inspired over a century-and-a-half of scientific progress as we continue to build on—and, as this study shows, prove—his theories. </p><p>Darwin knew that every animal is the product of its environment, and therefore must respect both its boons and its boundaries. Talk about a lesson we need today. Environments are known to become very hostile to foreign invaders when pushed too hard. Right now, we're courting disaster. Hopefully, we won't wait for evolution to ground our ambitions. </p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a> and <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank" rel="noopener noreferrer">Facebook</a>. His most recent book is</em> "<em><a href="https://www.amazon.com/gp/product/B08KRVMP2M?pf_rd_r=MDJW43337675SZ0X00FH&pf_rd_p=edaba0ee-c2fe-4124-9f5d-b31d6b1bfbee" target="_blank" rel="noopener noreferrer">Hero's Dose: The Case For Psychedelics in Ritual and Therapy</a>."</em></p>
Scientists discover burrows of giant predator worms that lived on the seafloor 20 million years ago.
- Scientists in Taiwan find the lair of giant predator worms that inhabited the seafloor 20 million years ago.
- The worm is possibly related to the modern bobbit worm (Eunice aphroditois).
- The creatures can reach several meters in length and famously ambush their pray.
A three-dimensional model of the feeding behavior of Bobbit worms and the proposed formation of Pennichnus formosae.
Credit: Scientific Reports
Beware the Bobbit Worm!<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="1f9918e77851242c91382369581d3aac"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/_As1pHhyDHY?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span>
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