Virtual Care Is Here To Stay — Are You Ready?
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It's no secret that the usage of telemedicine was abruptly changed by the COVID-19 pandemic. According to a study published by The Journal of the American Medical Association in early 2021, telehealth visits jumped from 0.3 percent of provider visits in 2019 to 23.6 percent in 2020. It made sense during this public health emergency. In February 2020, the U.S. Centers for Disease Control (CDC) advised medical practitioners to adopt social distancing practices, so digital remote accessibility not only protected medical staff and patients from COVID transmission, these actions also helped replace some lost revenues for many health care providers, as in-patient visits decreased by 37 percent from 2019 to 2020.
As the pandemic spread in early 2020, The Center for Medicare and Medicaid Services (CMS) adopted flexibility in HIPAA regulations as well as increasing the types of telehealth visits that qualified for reimbursement which opened the door for the rapid expansion of adoption. Other contributing factors included allowing physicians to practice across state lines and waiving the need for a pre-existing doctor/patient relationship. According to a McKinsey analysis, telehealth usage peaked in April 2020 and now has stabilized at 38 times the pre-pandemic usage.
However, questions remain about the future of telehealth. Patients and providers have become more comfortable with virtual care, ensuring its continued usage. Yet, Public Health Emergency (PHE) regulations and reimbursement models are considered temporary measures for now. Where does it all go from here? The future depends on several factors, dependent on the most immediate challenges.
Pre-pandemic telehealth regulations resulted in a lack of parity payment. Low reimbursement provided little incentive for providers to adopt telehealth. In fact, reimbursement rates and covered visits pre-pandemic made it challenging for providers to afford a telehealth offering. While reimbursements were still not as high as in-person visits, payment parity did help replace revenues and make telehealth more fiscally viable during the pandemic. However, a longer-term solution would require congressional action for the permanent extension of the CMS pandemic telehealth coverages.
In addition, while pandemic standards allowed physicians to provide telehealth services for patients across state lines, provider payment remains a problem since billing is often not approved across states. Until cross-state billing issues are addressed and reimbursements become more equitable, providers may need help implementing reliable and secure digital self-pay channels. Healthcare systems are likely to find solutions by adopting the models created for fast-paced industries like restaurants or retail.
In the rush to implement video conference calls to help replace lost revenues and provide safer access to care, there was a trade-off between privacy and ease of use. Many of these were simply video-based point solutions and therefore not integrated into the provider's health care system (EHR). Since its likely PHE enforcement waivers for privacy will terminate with the end of this national emergency, this interoperability will likely become integral to maintaining patient privacy and security. If so, solutions may all be consolidated into the large, cumbersome health record companies with sometimes poor patient and provider experiences, or alternatively, result in the balkanization of critical patient health information across the patient's providers. Among other challenges, this could lead to potential higher costs or lower revenues through inefficiencies of duplicate entry by medical staff, mismatching of medical codes or even errors in patient services or medications. A longer-term telehealth strategy, supplemented with appropriate governance, will become necessary for telehealth to maintain a viable option post-pandemic.
Part of relaxed CMS rules was the elimination of penalties for providers using non-HIPPA compliant video conferencing services during the pandemic. As a result, the software and the devices implemented could introduce new security vulnerabilities during the collection, transmission, or storage of patient data. Hackers and malware pose an increasing threat to the security of telehealth systems, so hospitals have already begun returning to HIPPA-compliant standards and exploring alternatives. Post-PHE, a comprehensive evaluation of security protocols, as well as reviewing the types of devices used, can not only maintain the data integrity that helps reduce risks to patient safety and health, but also the associated damage to the provider's reputation should a breach occur.
The pandemic dramatically illustrated the need for alternative accessibility, including telehealth. If changes to reimbursement occurs, the continued expansion of synchronous and asynchronous virtual health options could potentially provide many long-term benefits. Here are three reasons healthcare systems should consider expanding from telehealth to virtual care initiatives.
Reimbursement models are incentivizing the shift from fee-for-service to value-based care with a focus on care management as well as the infrastructure required to deliver preventative care. At the same time, chronic conditions are on the rise for Americans, secondary to an aging population. There are opportunities for virtual care to be a catalyst for improving health outcomes by bringing care closer to the patient and reducing obstacles to treatment. For example, chronic conditions often require frequent appointments, regular diagnostics, and complex medication regimens sometimes resulting in poor patient engagement. While in-person visits are critical for chronic care, virtual options could result in better patient engagement by eliminating inconveniences–like time away from work or family or by providing better access to physicians on the patient's schedule. When chronic care patients take a more active role in his or her care management, health outcomes improve.
Patients can take advantage of a broader approach to treatment through virtual care, like lifestyle or nutrition coaching not typically available during an in-person visit. Remote monitoring can provide important data to drive evidence-based clinical decision-making for patients. Follow-up visits can often be conducted virtually, reducing exposure to infections at the provider's location. Even medications can be effectively managed through technology enablement. All of these may have long-term impact on health outcomes as well as potential reduction of delivery costs.
In addition to contributing to improved health outcomes, virtual care can open healthcare access to areas not currently being served, such as surrounding rural markets, thus increasing patient volume. AI-based tools such as virtual triaging can better optimize provider and staff productivity by prioritizing care delivery and directing patients to the most appropriate level of care (i.e. urgent care instead of emergency room).
Combined with at-home and remote diagnostics and monitoring, virtual models can also increase net patient revenue. The new Physician Fee Schedule 2022 includes the remote therapeutic monitoring codes. These codes can specifically be used to monitor medication adherence and even allow the patient to self-report clinically relevant health information, such as symptoms or side effects. If managed appropriately, providers can reduce no-shows and create convenient appointment times for patients before and after work or school schedules.
Most importantly, virtual health may help ease the burden of declining provider workforce. The Association of Medical Colleges reports that physician and nurse shortages will climb to between 54,100 and 139,000 physicians by 2033. Technology can empower patients to more effectively manage their own care and providers to remotely monitor patient health.
Consumerization will continue to expand into healthcare. Technology-enabled service models in other industries have transformed consumer expectations in the types of interactions they have with all organizations, including healthcare. As virtual care expands from simple video visits to remote monitoring and integration with electronic health records, patient satisfaction will improve. Virtual care provides convenient access, but more importantly, increases patient and provider interactions and communications, provides immediate access to needed specialists and even empowers patients with self-help options, all enhancing brand loyalty for healthcare systems.
There is a long way to go, but once the alignment and equity of reimbursement models occur and there is a full break from the fee-for-service mentality, the healthcare systems who ride the telehealth momentum started by the pandemic will be far ahead.