Category Archives: Virtual Visit

Thinking through the new continuum of urgent care

Posted on by • Posted in Chat-Based Care, Consumer Loyalty, Consumer Preferences, Consumerism, Physician, Primary Care, Telemedicine, Urgent Care, Virtual Care Strategy, Virtual Healthcare, Virtual Visit • Leave a comment

https://mailchi.mp/d594e7a0c816/the-weekly-gist-june-19-2020?e=d1e747d2d8

About ZOOM+Care | On-Demand Healthcare Unlike Any Other

We’ve both received care from of Portland, OR-based Zoom+Care when traveling, and are big fans of its highly efficient, consumer-centric clinic design and urgent care model. We’ve heard reports from across the country that urgent care visits have been slow to rebound as in-person healthcare services have reopened (no surprise that people are reticent to return to a care setting where sitting in a waiting room next to a coughing patient is often part of the experience).

We wondered if Zoom+Care, with scheduled appointments and operations that largely eliminate the wait, had fared any better, and recently we caught up with Torben Nielsen, the company’s CEO, to hear about his experiences across the past three months. As COVID-19 hit in March, Zoom+Care quickly eliminated self-scheduled visits and took many of its 50 clinics offline, requiring all patients to be triaged virtually before any in-person care. The company had a robust chat visit function already in place, and like most health systems, quickly brought video and phone visits online in the first weeks of the pandemic.

They’ve now delivered more than 30,000 virtual visits. With 34 percent of virtual visits coming from patients in markets where Zoom+Care does not have clinics, telehealth has driven rapid expansion into new markets, presenting both opportunities (virtual demand highlights where to site new clinics) and challenges (the need to quickly develop referral relationships for the 10-20 percent of telemedicine patients who would benefit from in-person follow-up).

Telemedicine visits have continued to grow even as self-scheduling was turned back on and in-person volume returned. Nielsen thinks centralization will be a big part of their ongoing virtual care strategy. Over the years Zoom+Care learned that chat visits required a different provider skill set, necessitating a dedicated team—and the same is true of phone and video visits. They’re also exploring what specialty care can be managed virtually, and the best modes to deliver it.

Case in point: it’s no surprise that a visually-oriented specialty like dermatology is well-suited for virtual. But with the grainy images of videoconferencing software, telemedicine falls far short of chat-based care, where a patient can send a high-resolution image and text back and forth with the provider. Given that payment for chat visits falls fall short of video visits, Zoom+Care is now exploring new relationships and economic models to support a multimodal, multispecialty care model.

A fascinating conversation, and confirmation that creating the ideal access platform will require not just layering telemedicine on top of the existing “physical” clinic footprint, but redesigning the entire care journey to create a seamless and connected access experience.

 

 

 

 

Navigating a Post-Covid Path to the New Normal with Gist Healthcare CEO, Chas Roades

Posted on by • Posted in Affordability, Board, Board Assessment, Board Competency, Board Engagement, Brand Loyalty, Branding, Business to Consumer Model, Capitation, Cash, Cash Reserves, Competition, Consumer Loyalty, Consumer Trust, Consumerism, Coronavirus, Corporate Overhead, Corporate Strategy, Cost Management, Cost Reduction, Crisis, Crisis Management, Cross Subsidy Model, Debt Service, Decision Making, Demographics, Disruption, Disruptive Technology, Economic Crisis, Economic Stimulus, Efficiency, Elective Procedures, Elective Surgery, Fee for Service Reimbursement, Financial Incentives, Financial Viability, Financially Distressed, Focus, Governance, Health Insurance Coverage Adequacy, Health Insurance Industry, Health Policy, Health System, High Deductible Health Plans, High Drug Prices, High Prices, Hospital, Hospital Industry, Job, Job Market, Job Search, Job Security, KPI Dashboards, Labor Spend Management, Leadership, Leadership Alignment, Leadership Trust, Market Consolidation, Market Power, Market Share, Market Trends, Market Uncertainty, Medical Group, Member Health, Mergers & Acquisitions, Net Income, Nonoperating Income, Objectivity, Operating Expense Reduction, Operating Expenses, Operating Income, Operating Margin, Operating Performance, Operating Revenue, Out of Pocket Expenses, Pandemic, Physician, Physician Employment, Physician Independent Network (IPA), Physician Multispecialty Network, Physician Practice Management, Price Transparency, Pricing, Primary Care Delivery Model, Primary Care Loyalty, Private Equity, Profit Model, Quality, Quality of Care, Safety, Strategic Alignment, Strategic Leadership, Strategy, Streamlining Operations, Supply Chain, Surprise Bills, Telemedicine, Trust, Trusted Brand, Truth, Value, Value Creation, Value Proposition, Value-Based Healthcare, Virtual Healthcare, Virtual Reality, Virtual Visit, Workplace Safety • Leave a comment

https://www.lrvhealth.com/podcast/?single_podcast=2203

Covid-19, Regulatory Changes and Election Implications: An Inside ...Chas Roades (@ChasRoades) | Twitter

Healthcare is Hard: A Podcast for Insiders; June 11, 2020

Over the course of nearly 20 years as Chief Research Officer at The Advisory Board Company, Chas Roades became a trusted advisor for CEOs, leadership teams and boards of directors at health systems across the country. When The Advisory Board was acquired by Optum in 2017, Chas left the company with Chief Medical Officer, Lisa Bielamowicz. Together they founded Gist Healthcare, where they play a similar role, but take an even deeper and more focused look at the issues health systems are facing.

As Chas explains, Gist Healthcare has members from Allentown, Pennsylvania to Beverly Hills, California and everywhere in between. Most of the organizations Gist works with are regional health systems in the $2 to $5 billion range, where Chas and his colleagues become adjunct members of the executive team and board. In this role, Chas is typically hopscotching the country for in-person meetings and strategy sessions, but Covid-19 has brought many changes.

“Almost overnight, Chas went from in-depth sessions about long-term five-year strategy, to discussions about how health systems will make it through the next six weeks and after that, adapt to the new normal. He spoke to Keith Figlioli about many of the issues impacting these discussions including:

  • Corporate Governance. The decisions health systems will be forced to make over the next two to five years are staggeringly big, according to Chas. As a result, Gist is spending a lot of time thinking about governance right now and how to help health systems supercharge governance processes to lay a foundation for the making these difficult choices.
  • Health Systems Acting Like Systems. As health systems struggle to maintain revenue and margins, they’ll be forced to streamline operations in a way that finally takes advantage of system value. As providers consolidated in recent years, they successfully met the goal of gaining size and negotiating leverage, but paid much less attention to the harder part – controlling cost and creating value. That’s about to change. It will be a lasting impact of Covid-19, and an opportunity for innovators.
  • The Telehealth Land Grab. Providers have quickly ramped-up telehealth services as a necessity to survive during lockdowns. But as telehealth plays a larger role in the new standard of care, payers will not sit idly by and are preparing to double-down on their own virtual care capabilities. They’re looking to take over the virtual space and own the digital front door in an effort to gain coveted customer loyalty. Chas talks about how it would be foolish for providers to expect that payers will continue reimburse at high rates or at parity for physical visits.
  • The Battleground Over Physicians. This is the other area to watch as payers and providers clash over the hearts and minds of consumers. The years-long trend of physician practices being acquired and rolled-up into larger organizations will significantly accelerate due to Covid-19. The financial pain the pandemic has caused will force some practices out of business and many others looking for an exit. And as health systems deal with their own financial hardships, payers with deep pockets are the more likely suitor.”

 

 

 

 

My telemedicine visit was a little too “normal”

Posted on by • Posted in Consumerism, Coronavirus, Physician, Primary Care, Telemedicine, Virtual Healthcare, Virtual Visit • Leave a comment

https://mailchi.mp/d594e7a0c816/the-weekly-gist-june-19-2020?e=d1e747d2d8

In Depth: COVID-19 and Telemedicine in N.H. | New Hampshire Public ...

Needing a quick prescription refill, I logged on to my first post-COVID telemedicine visit with my primary care physician this week—and while I appreciated being able to meet with my doctor from my living room, the experience revealed the kinks in the way many practices are delivering virtual care. To schedule, I filled out a form on the website, which triggered a follow-up call from practice staff the next morning.

Straightforward, but far from an “Open Table” level of simplicity. The technology worked just fine: a single click on an emailed link launched Microsoft Teams (which happened to already be installed on my laptop), and I was met by a medical assistant dialing in from an exam room in the practice. She took my information, said the doctor would be joining shortly, and left.

So I waited. And waited. The camera was on, and I was left looking at the blood pressure cuff, otoscope and ophthalmoscope hanging on the wall—literally the same view I would’ve had sitting on the exam table (I just needed to don a paper gown and turn the thermostat down ten degrees to completely replicate the experience of being there in person). I waited some more—22 minutes to be precise, as the webinar screen had a count-up clock recording just how long I was looking at the wall.

My doctor is a great clinician, and surely was running behind because she was spending time with a patient who needed her attention. Once she came into the room, the visit was efficient—and we talked about the challenges of transitioning to virtual care. I was happy to cut the practice some slack since I know them, but it would have been really underwhelming if I were a new patient—honestly, I probably wouldn’t be a repeat user. And it fell far short of what is needed to create a differentiated virtual care offering.

Like everything else “digital” in our lives, we want telemedicine to be easy, integrated, efficient and on time—and our expectations for experience are set outside of healthcare. One thing was made painfully obvious: providers need to make sure not to replicate the frustrating parts of traditional office visits, as they look to create a lasting, sustainable virtual care platform.

 

 

 

 

Telehealth could grow to a $250B revenue opportunity post-COVID-19: analysis

Posted on by • Posted in Access, Access & Quality of Healthcare, Chronic Care Management, Clinical Outcomes, College of Healthcare Information Management Executives (CHIME), Consumer Preferences, Consumerism, Coronavirus, Emergency Care, Health System, Home Health, Hospital, Hospital Industry, Medicaid, Medicare, Necessary Care, Office Visit, Outcomes, Pandemic, Patient Satisfaction, Physician, Physician Practice Management, Primary Care, Provider Satisfaction, Telemedicine, Virtual Healthcare, Virtual Visit • Leave a comment

https://www.fiercehealthcare.com/tech/telehealth-could-grow-to-a-250b-revenue-opportunity-post-covid-mckinsey-reports

virtual visit

With the acceleration of consumer and provider adoption of telehealth, a quarter of a trillion dollars in current U.S. healthcare spend could be done virtually, according to a new report.

During the COVID-19 pandemic, consumer adoption of telehealth has skyrocketed, from 11% of U.S. consumers using telehealth in 2019 to 46% of consumers now using telehealth to replace canceled healthcare visit, according to consulting firm McKinsey & Company’s COVID-19 consumer survey conducted in April.

McKinsey’s survey also found that about 76% of consumers say they are highly or moderately likely to use telehealth in the future. Seventy-four percent of people who had used telehealth reported high satisfaction.

Health systems, independent practices, behavioral health providers, and other healthcare organizations rapidly scaled telehealth offerings to fill the gap between need and canceled in-person care. Providers are ready for the shift to virtual care: 57% view telehealth more favorably than they did before COVID-19 and 64% are more comfortable using it, according to McKinsey’s recent provider surveys.

Pre-COVID-19, the total annual revenues of U.S. telehealth players were an estimated $3 billion, with the largest vendors focused on virtual urgent care.

Telehealth is now poised to take a bigger share of the healthcare market as McKinsey estimates that up to $250 billion, or 20% of all Medicare, Medicaid, and commercial outpatient, office, and home health spend could be done virtually.

The consulting firm looked at anonymized claims data representative of commercial, Medicare, and Medicaid utilization.

The company’s claims-based analysis suggests that approximately 20% of all emergency room visits could potentially be avoided via virtual urgent care offerings, 24% of healthcare office visits and outpatient volume could be delivered virtually, and an additional 9% “near-virtually.”

Up to 35% of regular home health attendant services could be virtualized, and 2% of all outpatient volume could be shifted to the home setting, with tech-enabled medication administration.

Many of the dynamics that have helped to expand telehealth adoption are likely to be in place for at least the next 12 to 18 months, as concerns about COVID-19 remain until a vaccine is widely available.

Going forward, telehealth can increase access to necessary care in areas with shortages, such as behavioral health, improve the patient experience, and improve health outcomes, McKinsey reported.

Providers and patients are concerned that recent federal and state policies expanding access to telehealth will be rolled back once the emergency period ends.

Industry groups, including the College of Healthcare Information Management Executives (CHIME), are calling on lawmakers to ensure the changes enacted by Congress and the administration become permanent.

McKinsey’s research indicates providers’ concerns about telehealth include security, workflow integration, effectiveness compared with in-person visits, and the future for reimbursement.

“We call on Medicare and all other insurers to continue to fund telehealth programs and work collaboratively on coverage and coding to lessen provider burden. We cannot go back to pre-COVID telehealth; instead, we must go forward. Patients will demand it and providers will expect it,” CHIME CEO and President Russell Branzell said in a recent statement.

Telehealth also is drawing bipartisan support. Senator Marsha Blackburn, R-Tenn., urged Congress to “continue to support this expansion and codify the administration’s changes to support the health needs of the American people,” in a recent news release.

Rep. Robin Kelly, D-Illinois, is introducing a bill directing HHS Secretary Alex Azar to oversee a telehealth study looking at the technology’s impact on health and costs, Politico reported in its newsletter today.

 

Taking advantage of the telehealth opportunity

Healthcare providers and payers will need to take action to ensure the full potential of telehealth is realized after the crisis has passed, according to McKinsey.

There continue to be challenges as providers cite concerns about telehealth include security, workflow integration, effectiveness compared with in-person visits, and the future for reimbursement. There also is a gap between consumers’ interest in telehealth (76%) and actual usage (46%). Factors such as lack of awareness of telehealth offerings and understanding of insurance coverage are some of the drivers of this gap.

“The current crisis has demonstrated the relevance of telehealth and created an opening to modernize the care delivery system,” McKinsey consultants wrote. “Healthcare systems that come out ahead will be those who act decisively, invest to build capabilities at scale, work hard to rewire the care delivery model, and deliver distinctive high-quality care to consumers.”

McKinsey outlined steps industry stakeholders should take to drive the growth of telehealth.

 

Payers: Health plans should look to optimize provider networks and accelerate value-based contracting to incentivize telehealth. Align incentives for using telehealth, particularly for chronic patients, with the shift to risk-based payment models.

Payers also should build virtual health into new product designs to meet changing consumer preferences, This new design may include virtual-first networks, digital front-door features (for example, e-triage), seamless “plug-and-play” capabilities to offer innovative digital solutions, and benefit coverage for at-home diagnostic kits.

 

Health systems: Hospitals and health systems should accelerate the development of an overall consumer-integrated “front door.” Consider what the integrated product will initially cover beyond what currently exists and integrate with what may have been put in place in response to COVID-19, for example, e-triage, scheduling, clinic visits, record access.

Providers also should build the capabilities and incentives of the provider workforce to support virtual care, including, workflow design, centralized scheduling, and continuing education. And, health systems need to take steps to measure the value of virtual care by quantifying clinical outcomes, access improvement, and patient/provider satisfaction. Include the potential value from telehealth when contracting with payers for risk models to manage chronic patients, McKinsey said.

 

Investors and health technology firms: These players also can support the new reality of expanded telehealth services. Technology firms should consider developing scenarios on how virtual health will evolve and when, including how usage evolved post-COVID-19, based on expected consumer preferences, reimbursement, CMS and other regulations.

Investors also should develop potential options and define investment strategies based on the expected virtual health future. For example, combinations of existing players/platforms, linkages between in-person and virtual care offerings and create sustainable value. Investors and technology companies also can identify the assets and capabilities to implement these options, including specific assets or capabilities to best enable the play, and business models that will deliver attractive returns.

 

 

 

 

How Many More Will Die From Fear of the Coronavirus?

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Chronic Care Management, Chronic Conditions, Clinical Testing, Contact Tracing, Coronavirus, Deferred Healthcare, Emergency Care, Employer-Based Health Insurance, Fear, Health Insurance Coverage Adequacy, Health Policy, Health System, High Deductible Health Plans, Hospital, Hospital Industry, Infection Control, Infection Control Plan, Infectious Virus, Mortality, Office Visit, Out of Pocket Expenses, Pandemic, Physician, Preexisting Conditions, Preventable Disease, Preventative Care, Public Health, Public Safety, Quarantine, Social Distancing, Telemedicine, Underinsured, Unemployment, Unemployment Insurance, Uninsured, Unintended Consequences, Virtual Healthcare, Virtual Visit • Leave a comment

Fear of contracting the coronavirus has resulted in many people missing necessary screenings for serious illnesses, like cancer and heart disease.

Seriously ill people avoided hospitals and doctors’ offices. Patients need to return. It’s safe now.

More than 100,000 Americans have died from Covid-19. Beyond those deaths are other casualties of the pandemic — Americans seriously ill with other ailments who avoided care because they feared contracting the coronavirus at hospitals and clinics.

The toll from their deaths may be close to the toll from Covid-19. The trends are clear and concerning. Government orders to shelter in place and health care leaders’ decisions to defer nonessential care successfully prevented the spread of the virus. But these policies — complicated by the loss of employer-provided health insurance as people lost their jobs — have had the unintended effect of delaying care for some of our sickest patients.

To prevent further harm, people with serious, complex and acute illnesses must now return to the doctor for care.

Across the country, we have seen sizable decreases in new cancer diagnoses (45 percent) and reports of heart attacks (38 percent) and strokes (30 percent). Visits to hospital emergency departments are down by as much as 40 percent, but measures of how sick emergency department patients are have risen by 20 percent, according to a Mayo Clinic study, suggesting how harmful the delay can be. Meanwhile, non-Covid-19 out-of-hospital deaths have increased, while in-hospital mortality has declined.

These statistics demonstrate that people with cancer are missing necessary screenings, and those with heart attack or stroke symptoms are staying home during the precious window of time when the damage is reversible. In fact, a recent poll by the American College of Emergency Physicians and Morning Consult found that 80 percent of Americans say they are concerned about contracting the coronavirus from visiting the emergency room.

Unfortunately, we’ve witnessed grievous outcomes as a result of these delays. Recently, a middle-aged patient with abdominal pain waited five days to come to a Mayo Clinic emergency department for help, before dying of a bowel obstruction. Similarly, a young woman delayed care for weeks out of a fear of Covid-19 before she was transferred to a Cleveland Clinic intensive care unit with undiagnosed leukemia. She died within weeks of her symptoms appearing. Both deaths were preventable.

The true cost of this epidemic will not be measured in dollars; it will be measured in human lives and human suffering. In the case of cancer alone, our calculations show we can expect a quarter of a million additional preventable deaths annually if normal care does not resume. Outcomes will be similar for those who forgo treatment for heart attacks and strokes.

Over the past 12 weeks, hospitals deferred nonessential care to prevent viral spread, conserve much-needed personal protective equipment and create capacity for an expected surge of Covid-19 patients. During that time, we also have adopted methods to care for all patients safely, including standard daily screenings for the staff and masking protocols for patients and the staff in the hospital and clinic. At this point, we are gradually returning to normal activities while also mitigating risk for both patients and staff members.

The Covid-19 crisis has changed the practice of medicine in fundamental ways in just a matter of months. Telemedicine, for instance, allowed us to pivot quickly from in-person care to virtual care. We have continued to provide necessary care to our patients while promoting social distancing, reducing the risk of viral spread and recognizing patients’ fears.

Both Cleveland Clinic and Mayo Clinic have gone from providing thousands of virtual visits per month before the pandemic to hundreds of thousands now across a broad range of demographics and conditions. At Cleveland Clinic, 94 percent of diabetes patients were cared for virtually in April.

While virtual visits are here to stay, there are obvious limitations. There is no substitute for in-person care for those who are severely ill or require early interventions for life-threatening conditions. Those are the ones who — even in the midst of this pandemic — must seek the care they need.

Patients who need care at a clinic or hospital or doctor’s office should know they have reduced the risk of Covid-19 through proven infection-control precautions under guidelines from the Centers for Disease Control and Prevention. We’re taking unprecedented actions, such as restricting visiting hours, screening patient and caregiver temperatures at entrances, encouraging employees to work from home whenever possible, providing spaces that allow for social distancing, and requiring proper hand hygiene, cough etiquette and masking.

All of these strategies are intended to significantly reduce risk while allowing for vital, high-quality care for our patients.

The novel coronavirus will not go away soon, but its systemic side effects of fear and deferred care must.

We will continue to give vigilant attention to Covid-19 while urgently addressing the other deadly diseases that haven’t taken a pause during the pandemic. For patients with medical conditions that require in-person care, please allow us to safely care for you — do not delay. Lives depend on it.

 

 

 

Charting the rebound of physician office visits

Posted on by • Posted in Consumerism, Coronavirus, Health Policy, Health System, Hospital, Hospital Industry, Office Visit, Physician, Physician Practice Management, Quality of Care, Telemedicine, Virtual Healthcare, Virtual Visit • Leave a comment

https://mailchi.mp/f2774a4ad1ea/the-weekly-gist-may-22-2020?e=d1e747d2d8

MultiBrief: Telehealth is keeping doctors, patients connected in ...

As patients begin to return to doctors’ offices, we were intrigued to read an analysis out this week from the Commonwealth Fund that provides a first glimpse into the pace of the recovery. Researchers from Harvard University and healthcare technology company Phreesia analyzed data from 12M visits at over 50,000 physician practices, finding that in-person visits had declined nearly 70 percent by mid-April, compared to pre-pandemic levels.

Behavioral health providers, medical specialists and primary care practices maintained the most volume, and procedural specialists were the hardest hit. Many practices deployed telemedicine quickly, but even with those added encounters, total visits were still down by nearly 60 percent. While visits are starting to return, it’s likely that physician practices are in for a long, slow rebound. Telemedicine as a percentage of all visits peaked in late April, and by mid-May, in-person visits had reached 55 percent of pre-pandemic levels.

Even if virtual volumes pull back from their COVID high, we’re likely to see telemedicine play a much more expansive role moving forward. Dr. Rushika Fernandopulle, CEO of Iora Health, shared his company’s learnings from their COVID-19 response, predicting that ultimately 70-80 percent of physician encounters could be virtual, necessitating a need to reorganize care delivery around populations, instead of practices.

Expect the next year to be a reckoning as changes in payment and regulations, combined with a heated marketplace for virtual care, continue to shift the balance between in-person and virtual care.

 

 

What we’ve learned from the telemedicine explosion

Posted on by • Posted in Consumerism, Coronavirus, Expectations, Health Policy, Health System, Hospital, Hospital Industry, Medical Group, Medicare, Office Visit, Pandemic, Physician, Physician Practice Management, Telemedicine, Virtual Healthcare, Virtual Visit, Virtual Visit Punctuality • Leave a comment

https://mailchi.mp/aa7806a422dd/the-weekly-gist-may-8-2020?e=d1e747d2d8

Why telemedicine could be the next big thing in employee healthcare

In our decades in healthcare, we’ve never seen a faster care transformation than the rapid growth in telemedicine sparked by COVID-19. Every system we’ve spoken with over the past two months reports its doctors are now performing thousands of “virtual visits” each week, often up from just a handful in February. As one chief digital officer told us, “We took our three-year digital strategic plan and implemented it in two weeks!”

This week, we convened leaders from across our Gist Healthcare membership to share learnings and questions about their telemedicine experiences. COVID-19 brought down regulatory and payment hurdles, as well as internal cultural barriers to adoption—but leaders expressed a concern that current payment levels and physician enthusiasm could dissipate. Some insurers have hinted at pulling back on payment, although they will have a hard time doing so as long as Medicare maintains “parity” with in-person visits.

Switching to 100 percent telemedicine was easier than most doctors anticipated. But as practices now begin to ramp up office visits, new questions are emerging about how to integrate digital and physical visit workflow, requiring providers to rethink office layout and technology within the practice: is there a good physical space in the office to conduct televisits? Zoom and FaceTime have worked in a pinch, but what platform is best for long-term operational sustainability and consumer experience?

Telemedicine has also raised consumer expectations: patients expect providers to be on time for a virtual appointment—setting a bar for punctuality that will likely carry over to their next in-person office visit. Across the rest of this year, health systems and physician groups will continue to push the boundaries of virtual care, establishing how far it can be extended to provide quality care in a host of specialties.

But at the same time, systems must also prepare for growing complexity in 2021: what is the right balance of in-person versus virtual care? How should telemedicine integrate with urgent and emergency care offerings? How should physician compensation change? And as payers and disruptors expand their virtual care offerings, how can providers differentiate their own platforms in the eyes of consumers? We’ll continue to share learnings as our members work through the myriad challenges and opportunities of this new virtual care expansion.

 

 

 

CMS rolls back more Medicare, telehealth regs for providers working through pandemic

Posted on by • Posted in American Medical Association (AMA), Coronavirus, Diagnostic Testing, Health Policy, Health System, Hospital, Hospital Industry, Hospital Outpatient Departments, Medicaid, Medicare, Medicare ACO, Nursing Home, Occupational Therapy, Office Visit, Pharmacist, Physical Therapy, Physician, Primary Care, Speech Language Pathologists, Telemedicine, Virtual Visit • Leave a comment

https://www.healthcaredive.com/news/CMS-second-round-COVID-rollbacks/577199/

 

How Telemedicine Is Changing Healthcare

Dive Brief:

  • CMS issued a another round of sweeping regulatory rollbacks Thursday that will temporarily change how some providers care for patients and get compensated during the ongoing pandemic.
  • Practitioners such as therapists previously restricted from providing telehealth services for reimbursement can now do so, and CMS is also upping payments for telephone-only telehealth visits. Accountable care organizations also scored a major win in the Thursday rule drop, with CMS pledging they wouldn’t be dinged financially for lower-than-expected health outcomes in their patient populations from COVID-19.​
  • Other major changes are related to COVID-19 testing for Medicare and Medicaid beneficiaries. A written practitioner’s order is no longer needed for diagnostic testing for Medicare payment purposes. The agency also said it will cover serology, or antibody testing, including certain FDA-authorized tests that patients self-collect at home.

Dive Insight:

The new rules come out of the recent public health emergency declaration, building on others announced in late March and early April. This round of changes, which take effect immediately, focuses on expanding testing capacity to help reopen the U.S. economy, according to CMS, along with delivering expanded care to seniors.

Major provider lobbies the American Hospital Association and American Medical Association praised the changes, noting that Medicare patients have been canceling needed medical appointments because of physical distancing and transportation challenges.

The Trump administration, which allowed traditional Medicare to temporarily cover telehealth in March, continues to expand virtual care access. CMS is expanding the types of specialists allowed to provide telehealth services for reimbursement to include physical therapists, occupational therapists, speech language pathologists and others. In the past, only doctors, nurse practitioners, physician assistants and certain others could do so.

Earlier changes included waiving the video requirement for telehealth patients without access to interactive audio-video technology – particularly those in rural areas. CMS is increasing payments for telephone visits from a range of about $14-$41 to about $46-$110, according to the release.

The rollbacks are a “major victory for medicine that will enable physicians to care for their patients, especially their elderly patients with chronic conditions who may not have access to audio-visual technology or high-speed Internet,” the AMA said.

Michael Abrams, managing partner of Numerof & Associates, a healthcare consulting firm, said the current, rapid adoption of telehealth is an experiment, and depending on the results, waivers could eventually become permanent.

“Once you increase pricing, you almost never roll it back,” Abrams said. “If this new pricing on telehealth visits makes it more attractive, attractive enough to substitute telehealth for in-office visits, that not only lowers the cost of care, but makes it very much more accessible, particularly for those whose ability to see a physician is limited.”

In a victory for ACOs, CMS said the value-based organizations wouldn’t incur any financial penalties because of COVID-19 testing and treatment for their patient populations. Roughly 60% of ACOs said previously they were likely to drop out of their risk-based model to avoid potential losses, according to the National Association of ACOs.

CMS is also allowing ACOs to remain at the same level of risk for another year, instead of bumping them up to the next risk level. NAACOs said it was “appreciative” of the changes in a statement, though they asked for additional relief for providers in two-sided risk arrangements.

Other loosened restrictions include those on who can administer COVID-19 diagnostic tests for payment to include any healthcare professional authorized to do so under state law, including pharmacists. Medicare and Medicaid recipients can now get tested at parking lot sites operated by pharmacies and other entities for reimbursement.

Outpatient hospital services such as wound care, drug administration, and behavioral health services can now be delivered in temporary expansion locations, including parking lot tents, converted hotels or patients’ homes for reimbursement, so long as they’re temporarily designated as part of a hospital.

Hospital outpatient departments that relocate off-campus are paid at lower rates under current law, but CMS is making a temporary exception to continue paying those physicians at their standard rates.

The agency will also pay for certain partial hospitalization services – that is, individual psychotherapy, patient education, and group psychotherapy – that are delivered in temporary expansion locations, including patient homes.

CMS is also now requiring nursing homes to inform residents, their families, and representatives of COVID-19 outbreaks in their facilities.

 

 

 

Op-Ed: As a doctor, I use telemedicine. With the coronavirus threat, it could revolutionize healthcare

Posted on by • Posted in Coronavirus, Health Insurance Coverage Adequacy, Health Policy, Health System, Hospital, Hospital Industry, Medical Group, Medicare, Physician, Physician Practice Management, Physician Workforce, Telemedicine, Virtual Visit • Leave a comment

https://www.latimes.com/opinion/story/2020-03-17/op-ed-as-a-doctor-i-use-telemedicine-with-the-coronavirus-threat-it-could-revolutionize-healthcare?fbclid=IwAR1D6sHWYhvei0Hda4dRuqRaydyxO7AVRjWQj-2UTFqwf3gdKaWuVfxa2Hs

Image result for Op-Ed: As a doctor, I use telemedicine. With the coronavirus threat, it could revolutionize healthcare

As a physician, waiting for the worst of coronavirus to hit, I see a lot to fear. It seems increasingly likely that this will be one of the most significant pandemics in modern human history, and that it will change our approach to healthcare going forward. But not all of its legacy will be negative. Here’s one thing I hope will come out of the crisis: an increased reliance on telemedicine, something that should have happened long ago.

A few months ago, when I was between jobs, I took a part-time job in a rural hospital serving a county of more than 150,000 people. On the verge of bankruptcy, the hospital was unable to attract many specialists to join its ranks, and in desperation, had turned to telemedicine to cover many services. So, for example, if a patient was rushed to the emergency room after a stroke, there was unlikely to be a neurologist in the room. Instead, a neurologist would assess the patient on a mobile screen from far away, with local nursing staff and doctors aiding him or her.

I had been skeptical of telemedicine going in. Physical exams are the bedrock of how doctors and nurses assess patients. We look patients and their loved ones in the eye, palpate sore spots with our fingers and offer comfort with a hand on a shoulder. Physical contact, I’d always thought, was at the heart of how doctors and patients communicate.

It was with this skepticism that I found myself next to a young man who been brought to the emergency room after attempting to take his own life. Again. This time, instead of seeing a psychiatrist in person, he saw one on a screen with wheels. The psychiatrist was in some distant location, but she had been in touch with the local doctors and had access to his medical records. Despite her physical remoteness, she connected with him, and he opened up. She knew of all the local resources to refer him to, and at the end of her conversation, she had developed a real rapport with him. After the visit ended and the nurse wheeled the monitor out of the room, I asked the young man what he thought, and to my surprise, he told me he was more comfortable with this than an in-person visit. He wasn’t the only one — many patients say they prefer a virtual doc to one sitting across from them.

Over the past few decades, medical care has been transformed by technology. Whenever a new drug becomes available, or a medical procedure is approved by the FDA, the medical community is quick to deploy it. Yet, when it comes to how we see patients, our current practices haven’t changed much since the time of Hippocrates. If a patient is sick they either have to come see us in clinic, urgent care, the emergency room or the hospital. Despite the internet transforming every aspect of our lives, from how we find love to how we order groceries, the way we deliver medical care has stagnated.

In the United States, not only are doctors often inaccessible for those living in rural areas, hospitals everywhere have huge economic challenges. One healthcare executive jokingly told me his hospital made more money from its parking lots than its clinics.

The response to COVID-19 might help change that.

One of the main reasons China has been able to slow coronavirus transmission has been because of a dramatic increase in virtual visits. In fact, China has moved half of all medical care online, allowing patients to consult with their doctors and get prescriptions from the comfort of their homes. Hospitals have been notorious petri dishes for deadly bugs since long before COVID-19, and this pandemic has brought that risk into crystal-clear focus. On Tuesday, Medicare announced that it will greatly expand coverage for telemedicine visits, previously sharply restricted. And at a White House briefing, the government announced it was urging states to similarly expand Medicaid coverage to include telemedicine visits by Skype, Facetime or other platforms. Some insurers have also said they will cover telehealth visits at parity with in-person visits.

These measures are commendable, but policies need to be put in place to ensure that the expansion of telemedicine is not temporary. Of course, in-person visits will still be necessary in many cases. But supporting telemedicine on a par with such visits has the potential to protect patients and healthcare personnel and allow for much more efficiency in the system. That said, physicians and nurses will need high-quality training to provide compassionate and thorough care to a patient from across a computer screen. Technology that allows patients to be “examined” remotely needs to be better studied and made more accessible. And since the backbone of telemedicine is reliable high-speed internet, Congress should consider Elizabeth Warren’s plan to bring broadband internet to the remotest parts of this country, to ensure broad access to these services.

This week my team converted most of our clinic visits from face to face to virtual visits. Some were over the phone, others were over video, often with a family member present as well. While there were some patients that still needed to be seen in person, we were able to minimize the risk of viral transmission not only for patients, but also for valuable members of our clinical team. Even before this crisis, as part of my job at the Veterans Affairs Health System in Boston, I often consulted with patients I had never seen as part of an “E Consult” system. While I was initially nervous when I first started doing this, it allowed me to expand my footprint far beyond what I could manage if I were seeing every patient in person.

At some point, I fervently hope the coronavirus will be a thing of the past. But I hope it leaves behind a legacy. I hope it changes how well we wash our hands, how well we fund public health and how well we protect the healthcare workers caring for our sickest patients. And, most of all, I hope it pushes us to embrace telemedicine.

 

 

 

 

5 Ways Technology is Transforming the Healthcare Industry

Posted on by • Posted in 3D Printing, Artificial Intelligence, Health Policy, Health System, Hospital, Nanomedicine, Nanopharmaceuticals, Pharmaceutical Industry, Polypill, Robot-Assisted Surgery, Technology, Trends, Virtual Healthcare, Virtual Reality, Virtual Visit • Leave a comment

5 Ways Technology is Transforming the Healthcare Industry

5 Ways Technology is Transforming the Healthcare Industry