{"id":28849,"date":"2020-09-11T18:31:26","date_gmt":"2020-09-11T18:31:26","guid":{"rendered":"https:\/\/dev.mtelehealth.com\/?p=28849"},"modified":"2020-09-11T18:31:26","modified_gmt":"2020-09-11T18:31:26","slug":"telehealth-and-the-new-choreography-of-anywhere-care","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/telehealth-and-the-new-choreography-of-anywhere-care\/","title":{"rendered":"Telehealth and the new choreography of \u2018anywhere care\u2019"},"content":{"rendered":"\n

Covid-19 has transformed the traditional doctor\u2019s office visit<\/a> as we know it, moving it away from physical offices by adding online connections. That doesn\u2019t mean virtual care is the sole future of health care. Instead, I hope it will become part of a new balance that embraces the potential of anywhere care.<\/p>\n\n\n\n

To get there, the United States will need two things: the technology to shift a greater proportion of care to the home combined with more intense collaboration among all health care stakeholders, from health systems and health plans to patients, providers, innovators, and the government.<\/p>\n\n\n\n

Exceptional telehealth is more than a one-time virtual interaction. It\u2019s part of a tightly choreographed network of care that meets patients\u2019 health needs in timely, personalized, and creative ways that align more closely with their preferences. When done right, telehealth augments traditional care and enables a more holistic experience that purposely combines digital and in-person services.<\/p>\n\n\n\n

Beyond improving the patient experience, telehealth overcomes barriers to care, from access to specialists \u2014 many of whom have newly embraced telehealth during the pandemic \u2014 to transportation challenges that keep people from needed services such as behavioral health.<\/p>\n\n\n\n

But without strong collaboration by multiple stakeholders, telehealth will be unable to move from single-visit transactions to a robust suite of virtual care services that evolve and improve in-person care. Unless we can make telehealth a more integrated part of the health care experience, the U.S. will be left with its current predicament \u2014 a health care system that is too expensive for consumers to afford or for the nation to sustain.<\/p>\n\n\n\n

Consider this: When telehealth is used as part of treatment for individuals with chronic conditions, the cost of care can improve by 2% to 3%<\/a>. While that might sound small, it\u2019s anything but small when you consider that 6 in 10 people<\/a> in America have one or more chronic diseases and about 90%<\/a> of the nation\u2019s $3.5 trillion spent each year on health care is for those with chronic and mental health conditions. Imagine the potential efficiencies if health care\u2019s key stakeholders can thoughtfully unleash digital care to become a core channel for care management and delivery.<\/p>\n\n\n\n

This is happening in pockets. Over the past few months, we\u2019ve seen momentum on the regulatory front, most recently in early August via an executive order<\/a> by President Trump that aims to permanently expand telehealth benefits for Medicare recipients beyond the public health emergency declaration linked to the pandemic. I applaud this progress, but more must be done to build on the momentum that telehealth has accumulated during the pandemic. As a collective entity, health systems, health plans, patients, providers, innovators, and the government must focus on several objectives.<\/p>\n\n\n\n

Clarity on policies around payment parity<\/h2>\n\n\n\n

As Covid-19 began to sweep across the United States, the Centers for Medicare & Medicaid Services (CMS) allowed providers to bill for telehealth visits at the same rate<\/a> as in-person visits, and many commercial providers followed suit. These changes removed many pre-existing restrictions \u2014 including those on the type of visit and the location of care \u2014 that had prevented providers from understanding and effectively adopting the use of telehealth with their patients.<\/p>\n\n\n\n

The effect was near immediate. My company, Amwell, experienced a rapid uptick in telehealth visits beginning in mid-March, which peaked at approximately 40,000 visits per day. Doctors delivering care through Amwell Medical Group hit a daily visit volume that was 240% above had otherwise been projected under a non-Covid environment. And our hospital clients\u2019 providers were delivering virtual care at 2,000% above what we otherwise would have expected, not to mention onboarding thousands of new doctors onto the platform and into the world of virtual care delivery.<\/p>\n\n\n\n

Payment parity has broadened telehealth\u2019s reach during this time of need. For the first time, providers are getting paid for their services at the same rates whether they see a patient online or in person, motivating them to use telehealth to help their patients get the care they need. Across specialties, telehealth is now being broadly and proactively offered to patients as a new way to safely carry out a visit. While this may feel somewhat overwhelming and new to some clinicians, it feels like a godsend to many patients, including those who require frequent care for chronic conditions or belong to more demographics that are more vulnerable to Covid-19.<\/p>\n\n\n\n

Some worry<\/a> that payment parity could lead to fraud and abuse of health care services. This may be true, but bad actors will try to cheat any system, as we have seen over<\/a> and over<\/a> again. As another care setting, telehealth will be no different. That said, I believe that the inherent digital audit trail of telehealth, and providers\u2019 ability to understand proper billing and coding for telehealth services, will make it easier for insurance companies to gain clarity on what care has occurred and what care should be reimbursed in the new virtual landscape, helping keep fraud at bay.<\/p>\n\n\n\n

Greater clarity around how and where virtual care will be used in the future is essential. The uncertainty over telehealth policy and reimbursement after the Covid-19 emergency has faded is waylaying its adoption<\/a> by a meaningful cohort of physicians, even those who used it and became its fans.<\/p>\n\n\n\n

Support and protect providers<\/h2>\n\n\n\n

People typically think about virtual care in the context of what it can do for patients. During the coronavirus pandemic, many providers are seeing what it can do for them as well. In addition to helping maintain work\/life balance, telehealth offers providers a much-needed lifeline during the pandemic, giving them a safe way to see, triage, and care for patients \u2014 both those infected with the virus that causes Covid-19 and those with non-Covid-19 health issues.<\/p>\n\n\n\n

Before the emergence of Covid-19, each state required every doctor who treated one or more patients living in the state to hold a medical license issued by that state. To respond to the increased demand for care via telehealth due to Covid-19, the removal of state licensure restrictions allowed physicians to practice across state lines, which played a major role in allowing telehealth to step in as a national \u201cload balancer\u201d of medical services. For the first time in history, the nation could beam in specialists from where they were available to where they were needed most.<\/p>\n\n\n\n

For example, 48% of acute care hospitals<\/a> do not have intensivists on staff, especially critical care physicians who are trained to operate ventilators. The lack of intensivists \u2014 and more broadly, a labor shortage<\/a> of emergency medicine providers \u2014 has been a major hurdle facing hospitals treating critically ill Covid-19 patients. Using telehealth, however, a surgical nurse could be virtually assisted by an intensivist in another hospital to assist in things like evaluating a patient, guiding an intubation, or learning to use unfamiliar clinical tools.<\/p>\n\n\n\n

As the government considers lifting emergency declarations<\/a>, it\u2019s likely that restrictive requirements for licensing will be reinstated at the state and federal levels. As the pandemic progresses, such a move would leave many providers without support, forced to deal with an influx in demand for health care without the help of a nation of experts available instantly via video or other telehealth platform. This could leave patients with challenging conditions to be cared for by the clinicians who might not have all the skills their patients need.<\/p>\n\n\n\n

Telehealth isn\u2019t just video conferencing. It\u2019s a powerful national distribution system for health care. Regulators should take notice: We can use telehealth to democratize the availability of health care around the country.<\/p>\n","protected":false},"excerpt":{"rendered":"

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