Telehealth - Do I Have Your Attention Now?

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Michael Crow, President of Arizona State University recently recounted his experience with   shifting all teaching online for ASU’s 119,000 students because of the coronavirus pandemic. Crow said the situation reminded him of what his dad would say when something went wrong: “Do I have your attention now?”

This question is also spot on today as we see the swift adoption and greater use of telehealth—“Do I have your attention NOW?”

As telehealth technology has grown over the past decade, health care organizations have at times reluctantly dipped their toes in the water. They studied, worked up analysis and considered the required investments. And they asked: Does a digital “front door” make sense? Would patients be able to manage the technology? Would they like it? Could you provide quality health care on a screen? What about reimbursement? Will we be able to cover our costs? Will doctors and nurses reject the idea of their patients on a screen instead of an exam table?

After answering these questions, a few health systems implemented modest telehealth programs. According to Becker’s Hospital Review analysis, 109 health systems representing approximately 10% of the industry established some level of telehealth in 2019.

And over the last few months, some health care providers and their technology partners have taken some big steps.

The medical group at a large Midwestern academic health center set up a telehealth program in two weeks. Leaders of SLUCare® Physician Group, the academic medical practice of Saint Louis University, went to the local Best Buy, bought computers and connected with patients via Zoom. Concerned about patient access, medical group leaders worked with faith groups to set up “tele-hubs” in community churches. With people to support the visits, and keep the church environment clean, patients who could not make a trip to the university—and risk exposure—received required care. Some patients were so happy with the option, they immediately made their telehealth follow-up appointment.

According to EHRN, a journal of Epic, the country’s largest EHR provider, telehealth visits increased 300-fold from a year ago, and adoption of telehealth was consistent across adult age groups. Long resistant to telehealth because of concerns over quality or fraud and abuse, the Medicare program traditionally paid for telehealth visits only sparingly and with plenty of restrictions. The coronavirus crisis and the sequestering of millions of seniors in their homes forced the federal government to ease federal regulations that allow providers to practice across state lines and change Medicare reimbursement to pay an equal amount for a telehealth visit. 

While Covid-19 quickly made the case for telehealth, doctors, hospitals, insurers and federal and state policy makers must take steps to cement telehealth as a more routine part of the care continuum and enhance its broader uptake.

This means that reimbursement must reflect the value of the service provided.  Despite advances in payment, many physicians report serious financial losses despite telehealth implementation.  Payers must recognize that consumers are more likely to engage in health care and prevention if it is accessible and convenient and not underestimate the value of more frequent and less intensive care that may result in better outcomes. Telehealth reimbursement must be set to ensure that it is a source of financial strength for the doctor’s office or clinic rather than just a cost center.

For federal programs like Medicare and Medicaid, the case for telehealth expansion is clear. Telehealth promotes population health and patient risk management. Patients with chronic conditions may be seen more frequently and quickly in the event of deterioration in condition. Properly used with other technology aids – heart rate, blood pressure, glucose and oxygen monitors, for example – physicians can get a better, ongoing view of their patient’s daily life.

And for patients in remote and rural areas, telehealth services will give them access to specialists only accessible in large cities and academic medical centers. And we must make sure these communities have access to broadband services so they can participate in telehealth medicine.

Of course, we must protect and guard against potential abuses. We must make sure that the quality of care is appropriate, that telehealth care is not overutilized and that personal health information is protected with the same scrutiny as it would be in a physician’s office.

Let’s not lose the lessons learned through this crisis. We have struggled in this county to develop affordable, accessible health care and to engage populations. This crisis sent us an important message. Let’s listen and follow it where it leads.

Kavita Patel, M.D. is a practicing physician and a former staffer in the Obama White House.

Peter Urbanowicz is the former Chief of Staff to HHS Secretary Alex Azar.

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