By Dr. John Showalter, MD, MSIS, Chief Product Officer, Jvion.
COVID-19 catalyzed a rapid shift to telehealth that was years in the making. Reimbursement, once a barrier to adoption, was overcome when CMS announced that Medicare would cover telehealth to allow socially-distant care to continue. As a result, 69% of all patient encounters were done via telehealth in April, with that proportion even higher in areas with severe outbreaks of COVID-19.
Today, April feels like a lifetime ago, and telehealth accounts for only 21% of visits. But the consensus is clear: telehealth is here to stay.
A recent survey found almost 70% of providers were more motivated to continue using telehealth after the pandemic, citing better access to care (68%), more timely care (83%), improved patient health (60%), and improved financial health for their practices (57%). And now that CMS has permanently expanded telehealth coverage, any uncertainty over the long-term financial viability of telehealth can be put to rest.
Of course, not everything can be done via telehealth. Telehealth works great for chronic disease management, behavioral health, hospital/ED follow-ups and preventative care, but there are many procedures that can only be done in person. How then can providers determine which patients should be seen in person and who can be seen via telehealth?
This question is now more urgent than ever, as hospitals nationwide confront a surge in patients admitted with Covid-19. To manage capacity and keep patients safe, providers will want to see patients virtually whenever possible.
Deferred care is another concern for providers. Some 41% of US adults deferred medical care they needed this year to avoid the coronavirus. To prevent these patients from deteriorating and suffering worse health outcomes in the future, it’s critical that providers re-engage with these patients as soon as possible before it’s too late. Telehealth is often the safest way to do so.
By Rahul Varshneya, founder and president, Arkenea.
Rural communities, often located amid isolated yet beautiful landscapes, are a defining feature of much of the United States of America. But those same landscapes can, at times, make it arduous for people to gain access to something as basic as a healthcare facility.
In these regions, patients are often tens of hundreds of miles from the location of their nearest caregiver. Community hospitals, with limited budgets and low volumes, generally don’t have specialists. And even if they do, there are too few to ensure constant coverage.
Telehealth is transforming these situations to everyone’s advantage.
A recent study of Intermountain’s neonatal telehealth program evaluated the effect of video-assisted resuscitation on the transfer of newborns from eight community hospitals to newborn ICUs in Level 3 trauma centers. The service produced a 29.4% reduction in a newborn’s odds of being transferred, which corresponds annually to 67 fewer transfers — and estimated savings of $1.2 million for affected families.
By leveraging telehealth, patients can receive expert treatment locally without the added cost and risk of transfer to a bigger hospital. Local hospitals retain vital revenue and ameliorate their services. Community members get better care that’s based on evidence-based best practices. Health care is far better overall.
1) Bringing Patients and Care Providers Closer for Better Outcomes
Most patients in the rural or suburban settings of the southwest, like the ones living in the remote terrains of Nevada, lack the necessary resources to travel to a healthcare facility.
Even for patients living in the urban areas, public transportation can be grueling and tedious. Less mobile or older patients might also not always have family or acquaintances who can be their caretaker and take them for frequent clinical visits.
Telemedicine can help such patients feel more independent. One study found that the use of a specific home-telemedicine strategy for care coordination improved functional independence in non-institutionalized veterans with chronic conditions.
Not only does telemedicine adoption help patients manage their conditions, it is equally beneficial for healthcare providers too.
Hospitals, clinics, public health offices and private practice healthcare providers in the southwest have been receiving free technical assistance for implementing or expanding their current telemedicine programs from various government authorities for quite some time now.
Since laws governing telehealth and reimbursement greatly differ by state, various Telehealth Research Centers (TRCs) spread across the country help providers discover the latest telemedicine and telehealth laws and regulations that apply in the state where the provider’s practice is based.
TRCs are also helping providers – generally free of charge – in developing a business model for telehealth in their healthcare setting, selecting the appropriate telemedicine platform as well as equipment, and providing education to patients alike on how to leverage telemedicine technologies to improve health outcomes and access to healthcare services.
Since the invention of the stethoscope, technology and innovation have been transforming how the healthcare industry delivers improved standards of care for individuals in every field of medicine. A more recent example of this is the widespread adoption of telehealth capabilities to bring care directly to patients no matter where they are.
This adoption trend has accelerated in response to COVID-19, when the use of telehealth technology skyrocketed with 48% of physicians meeting patients online in April. Since then, telehealth appointments have begun to level off and decline, but over the past year and the foreseeable future, telehealth and the delivery of care through screens and mobile devices will likely play a key role in the future of healthcare.
However, the increased use of telehealth creates additional risks stemming from increased data generation and data sharing such as video recordings, email exchanges between physicians and patients, and broader sharing of protected health information (PHI) between patients, providers and third-party organizations. This level of sharing increases the likelihood that data may become stored in an unsecured location. As for the healthcare providers and all other organizations that handle PHI, the challenge is now to get a better grasp on compliance, protect patient data and mitigate the risk of malicious actors or reputation damaging fines. Here’s how to do it:
Understanding the Rising Risk to Patient Data
The Health Insurance Portability and Accountability Act (HIPAA) was established in 1996 and has since served to give patients power over their health records and hold healthcare organizations and their partners accountable for safeguarding the PHI data of patients.
HIPAA generally applies to PHI in all forms, but the Security Rule applies specifically to electronic PHI (ePHI). And as telehealth becomes a new normal and the administrative workforce continues to work remotely, ePHI’s presence will proliferate making compliance an even more extensive task. Meaning that while telehealth offers many tangible benefits to patients and providers, it is also a double-edged sword that requires heightened attention not just now but at all times. Here are a few things to keep in mind:
By Devin Partida, technology writer and the editor-in-chief, ReHack.com.
The COVID-19 pandemic has presented the medical industry with one of its most significant challenges yet. While the virus has pushed health care systems to their breaking point, some positives have arisen from this hardship. The demand for digital health services has skyrocketed, and many of these tools will continue to improve health care after the pandemic.
Healthcare organizations have had to turn to new technology in response to the extremes of COVID-19. In doing so, the medical industry has become more resilient, safe and efficient than ever. Many of these technologies are so advantageous that they’ll become standard practice in post-COVID medicine.
Many digital health services will remain long after researchers find a way to halt the pandemic, but here are five of the most significant.
1. Remote Consultation Services
Few medical technologies have been as crucial during COVID-19 as telemedicine, specifically remote consultation. Between January and early June, telehealth adoption rose by 50% as concerns over catching the virus in hospital waiting rooms grew. In April, remote consultation accounted for almost half of all Medicare primary care visits.
Now that so many health systems support remote consultation, it won’t likely go away. These services have improved public safety and made health care more accessible. In a nation where access to health care has traditionally fallen short, that’s an indispensable resource.
People who live in rural areas of the United States are more likely than those in urban communities to die prematurely from all five of the leading causes of death, per the Center for Disease Control. Remote-based care and telehealth-based visits can help people reduce or manage these conditions. However, rural medical and dental practices must ensure constant internet connectivity.
Telehealth is an excellent resource for caregivers to monitor their patients’ chronic conditions, is an excellent way to deliver care quickly in an emergency, such as a stroke, and virtual visits offered through the technology can reduce barriers to care.
But the most obvious challenge with offering telehealth services to patients is maintaining consistent internet connectivity without encountering dropped connections caused by a single internet connection network. Traditionally, most networks use single line connectivity to maintain the entire network, but doing so can prove to be costly and harmful to practice and patient health.
However, bonded internet can eliminate these challenges while delivering a continuous internet connection, especially important to small medical and dental practices.
Bonded internet vs. standard single connection
A traditional standard, single connection internet network can likely meet the most basic business demands of medical and dental practices—however, those that require continuous, dependable, fast internet benefit from bonded internet connectivity.
In simple terms, bonded internet combines multiple connections (unlike a single connection network) to ensure stable connectivity. Bonded internet secures an always-on connection by continuously monitoring the network for the best connection. With bonded internet, all network traffic passes through an aggregator, which divides the data stream, and routes it through an individual internet connection.
What do you envision when you think of rural living? Chances are, images of pastoral fields, idyllic red barns, and even herds of dairy cows come to mind.
While such a vision is a reality for at least some of the 60 million Americans who live in rural areas — sparsely populated regions confusingly described by the U.S. Census Bureau as “not urban” — living in a rural area has its downsides when it comes to healthcare.
Lack of access to high-quality, affordable healthcare providers plagues rural America. One main reason is that hospitals located in low-population regions face significant financial struggles. According to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina-Chapel Hill, 132 rural hospitals shuttered their doors since 2010, leaving many Americans with fewer care options.
Unsurprisingly, COVID-19 has only accelerated rural hospital financial hardship, potentially making in-person office visits even more of a herculean challenge.
Technological innovations, including in-app communication and HIPAA compliance, enable telemedicine to become a must-needed lifeline for rural communities requiring medical care and guidance. In short, tech is shifting the healthcare landscape for the better.
Telemedicine, defined as the practice of using technology to deliver care at a distance, is mitigating and sometimes wholly eliminating long travel times required to visit a rural healthcare facility. Via the use of HIPAA-compatible live chats, video meetings, and phone calls, people living in sparsely populated areas receive quality care and guidance from the comfort of their homes.
Telehealth is a $2.6B industry and has grown more than 25% since 2015. The global COVID-19 pandemic has switched telehealth’s use and acceptance into overdrive, and nearly every healthcare discipline is utilizing some form of telehealth platforms as part of their clinical offerings.
As the pandemic brought life to a stand-still, industries and employees were placed into one of two categories: those who provided essential services like grocery store staff, doctors, and emergency medical personnel and those who were deemed non-essential.
Non-essential businesses were ordered to shut down all operations while government officials figured out the next best steps for the safety of its citizens. Initially, physical therapy and other non-clinical medical professions were deemed non-essential. This changed when the Department of Homeland Security, along with state governments and healthcare officials, deemed physical therapy an essential healthcare service that should continue to treat its patients.
This acknowledgment placed the physical therapy sector in an interesting predicament. On one hand, many municipalities had issued stay-at-home orders. Even with the re-categorization of physical therapy as an essential healthcare service, many patients simply feared leaving their homes and chose to postpone much-needed physical therapy appointments until the virus was contained.
This dilemma forced physical therapy practitioners to explore the telehealth platform as a way to continue treating patients and to create a much-needed revenue stream for the health of the practice.
COVID-19 Triggers Regulatory Changes
The telehealth industry was already changing dramatically due to COVID-19. To help telehealth services become more widely available, Centers for Medicare and Medicaid Services Administrator Seema Verma relaxed HIPAA restrictions that had previously limited telemedicine as a patient care option.
The deregulations included the ability of physicians to treat patients across state lines without becoming licensed in that particular state and ushered in the development of IT infrastructures that did not meet compliance or regulatory parameters established by HIPPA laws. Lastly, a rapid introduction and approval of dozens of new billing codes were issued to itemize and enable medical professionals to bill Medicare for telehealth services.
For example, Medstar Health, an integrated health system in the Washington D.C. area, went from 10 telehealth visits per week to 4,000 per day. FAIR Health reported that telehealth claims went from their March 2019 base of 0.17% of all claims to 7.57% by the end of March 2020—a 43-fold increase in the first month of the pandemic alone. In the Northeast, where COVID hit incredibly hard, telehealth visits increased 150-fold.
By Troy Corley, executive vice president of service delivery, Proactive MD.
In an ideal world, individuals would be able to access health care services in a quick and convenient manner — regardless of where they live. However, entirely too many residents in rural areas face a variety of barriers to access, limiting their ability to obtain the health care they need.
For many patients living in rural areas, having to drive for more than an hour just to see the nearest primary care practitioner is entirely too common. Because of this and other barriers, patients are generally not equipped to be proactive and preventive with their health due to the significant investment required to receive basic care.
Making matters worse, rural patients often face traditionally higher rates of poverty and are less likely to have health insurance than their urban counterparts. These economic challenges, in combination with higher rates of underlying chronic disease, make rural patients more likely than city dwellers to face poor health outcomes and suffer complications from heart disease, cancer, unintentional injury, chronic lower respiratory disease and stroke.
Today, about 60 million Americans, or nearly 20% of the U.S. population, live in Census-defined rural areas. And with the U.S. Department of Health and Human Services reporting only 39.8 primary care physicians are available per 100,000 people in rural populations, the gap in care between rural and urban Americans is only growing wider. The provider shortage — coupled with increased transportation challenges, social inequities, and the additional access barriers brought about by COVID-19 — makes physical access to care extremely difficult for many rural communities.
The Rise of Telehealth
While the current pandemic has forced the U.S. health care system to face numerous challenges, it has catalyzed the rapid adoption of telehealth services to safely deliver care at a distance.
As patients embrace this digital transformation, health care providers are beginning to look outside of their traditional base to reach new patients in unexpected locales. Employing telehealth services reduces access barriers for patients in rural areas, allowing them to receive basic care regardless of how far they live from a physician’s office.
Q&A with Matt Fairhurst, CEO and co-founder, Skedulo.
Skedulo is a champion of the deskless workforce, providing a comprehensive productivity platform that improves the lives of the mobile worker. Operating heavily in the healthcare sphere, Skedulo works with home healthcare agencies and organizations including Solace Pediatrics, Eastseals, and New Jersey Respiratory Associates (NJRA). Matt Fairhurst is the co-founder and CEO of Skedulo. Matt’s background is in user experience and user interface design, and, from this, he has a passion for building great products. Here he discusses telehealth, technology innovation and the future of healthcare.
What’s been the experience of the practice or the health system with the technology, and how has its real-world application changed the way they practice or the business of care?
Telehealth is a positive development in the healthcare industry, one that, 20 years ago, people never thought would be possible. It allows patients to “visit” the doctor without having to leave their home via video chats, and it also enables caregivers to visit patients in their homes and still be able to complete the job efficiently.
Pre-pandemic, telehealth was often seen as a backup option for healthcare providers, for example if the patient lived elsewhere and was unable to come in for a physical appointment. Then once the pandemic hit, telehealth became the temporary default and was practiced out of necessity in order to limit potential contamination. Now, providers are beginning to think about how they want to incorporate telehealth into their regular model of care. Practicing telehealth is less expensive and allows more patients to be seen. While it won’t replace in-person care, it certainly will stick around once the pandemic passes and be incorporated into how healthcare systems practice their business of care.
Why were doctors and people reluctant to adopt telehealth prior to the pandemic?
The healthcare industry has always been resistant to adopting technology and interoperability, and that includes telehealth services. Many providers held on to the belief that virtual services were inadequate compared to in-person services. The silver-lining of COVID’s effect on healthcare is that it’s propelling the industry forward and forcing an openness to digital transformation. And technology — thanks to biometric devices and software innovation — is finally catching up to make telehealth a seamless and truly comparable option to certain in-person services.
Q&A with Life Image president and CEO, Matthew Michela
Seventy-five percent of consumers are willing to share their health data with their preferred local healthcare institution, according to a recent survey. That is a significant increase from the approximately 53% surveyed pre-COVID-19 who were willing to share data to help a doctor provide better care.
The drastic shift to virtual care and a population focused on the dangers of COVID-19 spurred the acceleration and adoption of technology tools bringing healthcare to the Digital Age. And, as consumers become increasingly more active and engaged in managing risks to their health there is a notion that tools to access and manage their health data remain available in a post-COVID healthcare setting.
How can organizations adapt to the COVID-fueled consumer revolution and exceed patient expectations for healthcare?
Consumer-oriented healthcare technology remains significantly behind other types of services. Not because healthcare technology is inferior but because mature technology present everywhere in our lives isn’t applied to healthcare. The tools and patient portals available today fail to help consumers manage the logistics, payment, evaluation, and coordination of their care. Consider the way medical information is actually available to patients, and try not to be frustrated when you realize that getting rid of faxes and CDs in healthcare will be considered a major industry breakthrough.
Starting from this context, the digitization of healthcare, more specifically, putting healthcare data at patients’ fingertips through the app economy, is now understood by consumers as essential and recognition of its importance has been accelerated by COVID-19. Unfortunately, it took a pandemic to fully realize that giving patients control of their medical data improves interoperability and moves clinical information more quickly to where it is useful.
The pandemic also presented to healthcare organizations a direct need to manage patient records longitudinally. With many more consumers surprised and frustrated to learn that something so seemingly simple as medical records is so difficult to access and share. Patients are waiting for their service providers in earnest for a practical and bonafide digital experience to materialize. COVID-19 has been a catalyst to drive adoption of more comprehensive portals to store and share complex medical data and successful organizations will address these needs.