{"id":28838,"date":"2020-09-11T18:20:29","date_gmt":"2020-09-11T18:20:29","guid":{"rendered":"https:\/\/dev.mtelehealth.com\/?p=28838"},"modified":"2020-09-11T18:20:29","modified_gmt":"2020-09-11T18:20:29","slug":"the-new-normal-interrupted","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/the-new-normal-interrupted\/","title":{"rendered":"The New Normal, Interrupted"},"content":{"rendered":"\n

U.S. healthcare was gearing up for a rebound that includes telehealth. But then the pandemic surged back.<\/em><\/p>\n\n\n\n

Don\u2019t bother asking Keith Blechman, M.D., when his practice will get \u201cback to normal.\u201d<\/p>\n\n\n\n

Operations at his Upper East Side plastic surgery practice in Manhattan have shifted so drastically in the months since the COVID-19 pandemic began that the bygone era of \u201cnormal\u201d seems hopelessly anachronistic. \u201cThere\u2019s nothing not normal about this,\u201d he said. \u201cThis is just how things are.\u201d<\/p>\n\n\n\n

It\u2019s not that things aren\u2019t changing for Blechman and his practice. Just about everything has changed. It\u2019s just that he sees little chance that his business will revert to where it was, and in many ways he\u2019s glad it won\u2019t. \u201cThere are a lot of things I don\u2019t want to go back to, to be perfectly honest with you,\u201d he says. \u201cThis has been a great way to reset and pick the things I like and spend time on the things that I wanted to integrate.\u201d<\/p>\n\n\n\n

Don\u2019t call it \u201cthe new normal.\u201d The optimists speak of embracing change and their silver-lining playbooks, while their less-sunny counterparts see enormous uncertainty that is hard to get your head around.<\/p>\n\n\n\n

But July stress-tested the optimists (and many others, but maybe especially the optimists). After dipping to lows in late June and early July, the number of COVID-19-related hospitalizations and deaths shot back up as outbreaks flared up in Texas, Arizona, California and elsewhere. The Atlantic\u2019s<\/em> COVID Tracking Project counted 306 deaths on July 4. On July 29, the tally was 1,418, a roughly fourfold increase. Providers hoping for quick rebound had to lower their expectations, and payers with large profits and margins because of lower expenditures had to defend their relative good fortune.<\/p>\n\n\n\n

One analysis predicted that without further government support, half of all the country\u2019s hospitals will operate in the red this year. The New York Times<\/em> science reporter Donald G. McNeil Jr. described the U.S. as a \u201cwounded giant\u201d and characterized the mood of the 20 public health experts the newspaper interviewed as sad and exhausted: \u201cWhile once there was defiance, and then a growing sense of dread, now there seems to be sorrow and frustration.\u201d<\/p>\n\n\n\n

Telehealth\u2019s moment<\/strong><\/p>\n\n\n\n

Blechman continued normal operations until March 13. By the following week, he and his staff were working from home, inasmuch as they were \u201cworking\u201d at all. He had lots of company. A report released by Fair Health in June showed that utilization of healthcare professional services plummeted by 65% year over year in March and that revenue fell by an estimated 45%. The drop-off in April was even worse, with utilization and revenue falling by 68% and 48%, respectively.<\/p>\n\n\n\n

Telehealth has been a port in the storm \u2014 one of the few ways providers were able to provide some services and bring in some revenue amid the pandemic. Findings like those from a McKinsey & Company consumer survey are rife. In 2019, about 1 in 10 U.S. healthcare consumers reported using telehealth, according to the consulting firm. By late April that proportion had grown to about 1 in 2. On the provider side, McKinsey found the number of telehealth visits jumped between 50-fold and 175-fold across health systems, practices and other providers.<\/p>\n\n\n\n

Marlena Kane, M.P.H., associate administrator of consumer solutions and access at the University of Southern California\u2019s Keck Medicine, says the acceleration of telehealth amid the pandemic had a running start.<\/p>\n\n\n\n

\u201cIt\u2019s not that people didn\u2019t have telehealth platforms before this happened,\u201d says Kane. \u201cSystems have been trying to do this for quite some time, so most people have platforms already.\u201d<\/p>\n\n\n\n

Uncertainty about payment and a prevailing opinion that in-person visits were better in almost all domains kept telehealth in holding pattern. But amid the pandemic, CMS and private insurers shifted reimbursement policies, and provider and patient views about telehealth\u2019s inferiority changed the same way that attitudes about working from home have shifted. In late July, the COVID-19 public health emergency was extended for another 90 days, so the pandemic status quo won\u2019t be disrupted for another couple of months.<\/p>\n\n\n\n

Kane says the prospect of going back to pre-pandemic reimbursement rates for telehealth is scary. \u201cNot everyone has access to telehealth, and it does create some questions around social equity,\u201d she notes. \u201cBut for those that do and can have (access to telehealth), it has prevented a lot of gaps in care that might not have been prevented otherwise.\u201d Kane expects high levels of telehealth utilization to continue, including in ways that hadn\u2019t previously been conceived.<\/p>\n\n\n\n

Sri Bharadwaj, M.S., vice president of digital innovation at Franciscan Health, an Indiana-based health network, said one COVID-19-related change his hospitals have implemented is an overhaul of multispecialty rounding. Instead of making individual rounds, patients\u2019 teams of specialists now gather in a conference room while one care team member takes an iPad attached to an IV pole to the patient\u2019s room. Using the iPad, all a patient\u2019s specialists can \u201cvisit\u201d at the same time, cutting down patient interruptions and decreasing the odds of gaps or miscommunications. \u201cIt changes the way care is delivered to the patient on the inpatient side,\u201d he says. While this new way of rounding was born out of necessity, Bharadwaj says it is here to stay at his hospitals.<\/p>\n\n\n\n

The expanded use of telehealth for specialist care could be particularly important because specialists have seen huge drops in patient visits. Oral surgery was the hardest-hit specialty, according to the Fair Health report, with utilization dropping by 80% year over year in March and 81% in April.<\/p>\n\n\n\n

Now the question is whether healthcare utilization (and expenditure) will come back. The answer: It will because after the cliff dive of the second quarter, the only way is up.Perhapsthe better question to ask is by how much. A June report by the financial consultancy Kaufman Hall said that the operating margins of U.S. hospitals increased to 4% in May, though the report noted that the positive result was only possible thanks to government aid through the Coronavirus Aid, Relief, and Economic Security Act.<\/p>\n\n\n\n

Humana CEO Bruce Broussard said at a virtual meeting in late June that his company has seen roughly a 15% drop in inpatient and outpatient volume compared to a normal year. Consistent with Fair Health and Kauffman Hall reports, Broussard said volume dropped markedly in March and April before coming back somewhat in May. He expected volume to continue to ebb and flow in the coming months.<\/p>\n\n\n\n

\u201cWe continue to believe over a period of time that we will see the continued normality of the care,\u201d he said. \u201cI think it will go in spurts because of threats, of waves and other things.\u201d<\/p>\n\n\n\n

Broussard said he\u2019s hopeful that by the end of the year the industry will \u201cget back to normality.\u201d<\/p>\n\n\n\n

But that was in late June, before July brought a rebound of cases, hospitalizations and deaths that seemed to push the U.S. back into the throes of the pandemic.<\/p>\n\n\n\n

Into the unknown<\/strong><\/p>\n\n\n\n

But adjustment and innovation continue. At his plastic surgery practice, Blechman says he reevaluated every expense and shifted to a model of virtual pre-surgery consultations. As of early July, he had a waiting list of 75 patients. Those virtual visits have opened up new opportunities. He\u2019s considering opening a second office in California, so he can hold virtual consults with patients from his home office in New York and then fly to California to perform the actual procedures. \u201cIt\u2019s just sped along what I always wanted to do,\u201d he says<\/p>\n\n\n\n

Yet, from a revenue standpoint, Blechman is still operating in the dark.<\/p>\n\n\n\n

Asked if the streamlining, the move to telehealth consultations and potential business expansion would leave his practice financially whole, he says the question is impossible to answer. \u201cI can tell you in three months.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

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