{"id":32545,"date":"2021-07-23T16:17:39","date_gmt":"2021-07-23T16:17:39","guid":{"rendered":"https:\/\/dev.mtelehealth.com\/?p=32545"},"modified":"2021-07-23T16:17:39","modified_gmt":"2021-07-23T16:17:39","slug":"telehealth-is-here-to-stay-2","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/telehealth-is-here-to-stay-2\/","title":{"rendered":"Telehealth Is Here to Stay"},"content":{"rendered":"\n\n\n

After a year of change, how will homecare adapt online?<\/p>\n\n\n\n

by Hannah Wolfson Tuesday, June 1st, 2021<\/p>\n\n\n\n

In the earliest days of the emerging COVID-19 pandemic\u2014in a news story published on March 16, 2020, to be exact\u2014we reported that homecare companies were facing a new problem: denials of service. Patients and customers were increasingly refusing to let providers into their homes out of fear of infection, and professionals were declining to go out into the field for the same reason.<\/p>\n\n\n\n

\u201cPatients are increasingly hesitant to let nurses into their homes for in-person visits,\u201d Synzi CEO Lee Horner said at the time in an interview that ran on homecaremag.com<\/a>.<\/p>\n\n\n\n

There was an easy solution, however. The past year saw a massive application of telehealth, something homecare had been slowly working toward for decades. Suddenly, virtual visits weren\u2019t just a nice add-on, they were the only way to reach some patients.<\/p>\n\n\n\n

That\u2019s been a catalyst for long-term change, says Horner, who has been in the telehealth industry for about a dozen years, at Synzi and elsewhere.<\/p>\n\n\n\n

\u201cWith COVID-19 hitting us, health care delivery has changed, especially on the post-acute side, forever,\u201d he said in a recent interview. \u201cI think there was a lot of uncertainty about how video and telehealth would be delivered but I think over the last year it\u2019s been proven to be wildly successful.\u201d<\/p>\n\n\n\n

Speedy Adoption<\/strong><\/h2>\n\n\n\n

It\u2019s rare in health care to be able to pinpoint the adoption of a new practice to a single year, much less to a single week. But according to the Centers for Disease Control and Prevention, telehealth visits took off during the last week of March 2020, jumping 154% compared to the same week in 2019. Those virtual visits were mostly patients seeking care for something other than COVID-19.<\/p>\n\n\n\n

That was just the beginning. Telehealth services grew by more than 1,000% in March of 2020 and more than 4,000% in April of that year, according to a study of almost 7 million privately insured people that was published in JAMA Network Open.<\/p>\n\n\n\n

However, a recent report from the nonprofit Fair Health found that telehealth usage dipped 16% from January 2021 to Febraury 2021, indicating a possible slowdown in demand for virtual care as vaccinations increase and health practices reopen.<\/p>\n\n\n\n

That doesn\u2019t worry Janet Dillione, CEO of Connect America, which recently doubled down on connected health with its purchase of Philips\u2019 Lifeline business.<\/p>\n\n\n\n

\u201cI have been in healthcare IT my whole career,\u201d Dillione said. \u201cThe past year has done for this pre-hospital virtual care space what the HITECH Act did for electronic medical records.\u201d<\/p>\n\n\n\n

\u201cThe pendulum has swung,\u201d she continued. \u201cIt perhaps won\u2019t stay this far, but it\u2019s not going back.\u201d<\/p>\n\n\n\n

On the broader spectrum of health care, Dillione said, much of the systemic change was driven not just by the existence of the coronavirus pandemic but also by the fact that clinicians were suddenly able to be reimbursed for virtual visits in a way they hadn\u2019t before. In-home care providers, however, have been partly or entirely left out of that\u2014and the pandemic-spurred waivers allowing broader use of telehealth will likely expire along with the public health emergency.<\/p>\n\n\n\n

There are three main bills in Washington at press time that would permanently remove the paused restrictions that keep most Medicare patients from using telehealth services from their home or outside rural areas; one of them would require rulemaking to establish other originating sites, another would also give the Centers for Medicare & Medicaid Services (CMS) the authority to establish newly eligible sites, such as a community center or clinic.<\/p>\n\n\n\n

There\u2019s still an incentive to adopt, however, Horner said, if only to keep up with the competition.<\/p>\n\n\n\n

One Case Study<\/strong><\/h2>\n\n\n\n

Before the pandemic hit, the seven adult day centers run by Element Care PACE in Massachusetts were full each day with seniors visiting their doctors, nurses, physical therapists and other clinicians or enjoying enrichment activities. Then, in March, it all shut down.<\/p>\n\n\n\n

\u201cWe closed and we had to pivot very quickly,\u201d said Dr. Joanna Duby, medical director at Element Care PACE, which serves about 1,000 older adults. \u201cOur nurses had to go out even before we had personal protective equipment; we would go do home visits but we would screen people first. We would call people on a daily or weekly basis to see if they were okay or if we needed to go out and see them.\u201d<\/p>\n\n\n\n

That wasn\u2019t a sustainable system, so the organization provided tablets designed for senior engagement and used it for connected activities as well as for virtual care. Element Care is currently testing a pilot that connects the tablet to a scale so patients\u2019 weight can be tracked, and they\u2019re looking at other things it might expand to, including measuring blood pressure, oxygen saturation and body temperature.<\/p>\n\n\n\n

Right now, about 350 of the group\u2019s clients are using the tablets and spend an average of three hours a day on them.<\/p>\n\n\n\n

PACE organizations like Element might provide an example of what telehealth could look like in the future. Because PACE acts as both caregiver and payer, the programs tend to take a holistic view of care management for participants, who are usually dual eligible for Medicaid and Medicare. Rather than going into institutional care, they stay home, visiting a PACE day center to get care from an interdisciplinary team including proactive physical therapy, a dietician and behavioral health. There\u2019s even a driver that takes them to the center if needed.<\/p>\n\n\n\n

Duby said they were surprised to discover that appointment compliance\u2014especially in behavioral health\u2014actually increased with the switch to virtual, so they expect to continue with a hybrid model.<\/p>\n\n\n\n

It\u2019s an investment, she said, but it\u2019s worth it if keeping better in touch with a member keeps them active and avoids a life-threatening fall, or if someone\u2019s not feeling up to traveling to the center, even with transportation provided.<\/p>\n\n\n\n

\u201cWe don\u2019t see this going away now that we\u2019ve started it,\u201d Duby said. \u201cWe also are using for enrollment purposes to communicate with potential enrollees.\u201d<\/p>\n\n\n\n

What Patients Want<\/strong><\/h2>\n\n\n\n

As the push for consumers to age in place increases\u2014another trend that\u2019s been catapulted into overdrive by the pandemic\u2014so, too, will connected health care in all its forms. After all, telehealth can include telemedicine (that is, clinician visits performed by video or by phone); remotely monitoring patients\u2019 vital signs, activity levels and medication usage; and personal emergency response systems, which signal when something has gone wrong.<\/p>\n\n\n\n

\u201cIf you think about some of the trends the pandemic ended up accelerating, a lot of us stayed home and ended up ordering groceries from Amazon or whoever and you could see the status of your order,\u201d said Nick Knowlton, vice president of strategic  initiatives for ResMed. Telehealth encounters were similar\u2014an encounter with a primary care provider via a video app could lead to a prescribed medicine, a then to a notification from a pharmacy app when it\u2019s ready. Going forward, consumers will want the same ease of use for all their care.<\/p>\n\n\n\n

Virtual care and remote monitoring can also be a boon to providers, especially as demand for already-scarce skilled caregivers continues to grow. Virtual visits don\u2019t just save the patients time and hassle, they save companies staff travel time and expense and can also protect vulnerable employees from exposure to contagious disease in someone\u2019s home or threats of violence in the field.<\/p>\n\n\n\n

\u201cPeople are going to stay at home, but there aren\u2019t enough caregivers,\u201d Dillione said. \u201cHow do you deliver virtual care? How do you provide that 24\/7 stewardship in terms of safety?\u201d<\/p>\n\n\n\n

Nevertheless, the experts say, it\u2019s best not to approach telehealth as a replacement for in-person care.<\/p>\n\n\n\n

\u201cThat\u2019s the wrong mindset,\u201d said Dr. Kurt Merkelz, senior vice president and medical officer at Compassus. \u201cTelehealth should be an additive service\u2014and this is the case with all of health care. Say they\u2019re recovering from a hip fracture and we come into their home and they have chronic diseases, then we look at how we deal with their COPD and their cognitive impairment.\u201d<\/p>\n\n\n\n

Rather than try to fix everything at once\u2014or entirely virtually\u2014Merkelz said care teams should develop a new, post-acute focused methodology that blends hands-on and telehealth. A home check would be face to face, but a medication reconciliation meeting can be virtual, as can wound review. And then clinicians can send clients reminders or even interactive video tutorials to educate them on their condition.<\/p>\n\n\n\n

\u201cThis is how we can leverage telehealth,\u201d Merkelz said. \u201cThis is where telehealth has such an opportunity, not as a replacement, but as an additive service. That\u2019s what I\u2019m excited about.\u201d<\/p>\n\n\n\n

And Duby said providers should remember one important thing even as the technology accelerates, especially when working with an older population.<\/p>\n\n\n\n

\u201cThere is still some use in picking up the phone,\u201d she said.<\/p>\n","protected":false},"excerpt":{"rendered":"

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