COVID-19 surfaces an old truth: good health care consists mostly of talking

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You don’t need a physical exam to get diagnosed most of the time. And you don’t always need to be in the same room as your doctor to be treated.

We in medicine have known this for decades. Most of the information leading to a diagnosis comes from the history. The physical exam provides perhaps 10% of the useful information. And most medical treatment involves education and a prescription pad – or, these days, an electronic prescription that can be delivered from anywhere.

COVID-19 brought this issue to light. In a time when the risks of going to a medical office seemed to outweigh the benefits, it was astounding how rapidly medical care transitioned to online. The use of telemedicine skyrocketed within days. And it remains much higher than pre-pandemic.

The key factor was payment. Early in the pandemic, the federal government and many states enacted regulations to require that telemedicine be paid for. Prior to that, providers were generally paid only for services delivered face-to-face.

Why was that? Why would payers previously not pay for telemedicine? Part of it was inertia, but part is because of the healthcare marketplace.

Let’s say I’m a private insurance company in the 2010s, and I’m paying for face-to-face visits. This year I decide it’s important for my plan members to have access to remote video care. No one else in my marketplace is doing this, and there’s no way to know what the effects will be. My overall costs might go down by avoiding emergency department visits, but my overall costs could go up. If my costs go up, the premiums I charge next year will go up. So there is a risk I’ll lose business. I’m an insurance company, and my job is to reduce risk, so I decide against paying for remote video visits.

But with the government coverage mandates in 2020, there was a level playing field. Everyone had to compete on the same terms.

In this way, a few intelligent regulations changed the whole system overnight. It was an emergency, and someone had to do something. It worked.

Now we have a new opportunity. We can change medical care so that its main component – talking – is reimbursed and can occur anywhere. What will happen?

We do have an issue figuring out when a physical interaction is necessary and providing one. This has not been worked out yet.

But if we do all this right, it might expand access to medical care. After all, there are countless people who can’t leave their homes, who don’t have transportation, and who live hours away from the nearest provider. If the payment structures remain, there’s a massive amount of good work that can be done by extending medical expertise through the internet to these folks in their homes.

This expertise doesn’t have to be just physicians or advanced practice providers. It can be dietitians, mental health counselors, physical and occupational therapists. The list is long.

We can improve the total health of the nation this way. We can reduce suffering.

For more information, contact Brook at

Written by Michael Merrill, MD, MS, MBA

on March 3, 2022.

Mike is the Chief Medical Officer at Brook. Formerly CMO of United Memorial Medical Center at Rochester Regional Health, Medical Director for Innovation and Science at Independent Health, and a partner in Endion Hospitalists. He has degrees from Dartmouth College, Columbia University, the University of Liverpool, and SUNY Buffalo, where he is currently Associate Clinical Professor of Medicine.