The Future has Come Early: What COVID-19 Means for Remote Healthcare
In order to offer accessible healthcare amidst COVID-19, regulators have moved quickly to loosen regulations on telemedicine and incentivize providers to deliver remote care. Restrictions around the types of technology a clinician is limited to, when a clinician can offer telemedicine to a patient, the minimum distance a patient must live from the clinician's office to qualify for telehealth, and so forth, have been lifted.
Here's the Medicare Telemedicine fact sheet for providers if you want to know the "ins and outs."
Although we saw healthcare trending towards a wider-spread adoption of telemedicine, the velocity of this paradigm shift---a direct effect of the global pandemic---was unexpected. For the first time, several impediments that prevented many clinicians from wanting or being able to use telemedicine evaporated. In this sense, the future of telemedicine and digital healthcare has come early.
Here's a round-up of why CMS' new regulations around telemedicine mean major change:
- Telemedicine billing is now "apples to apples". Until now, providers could not bill at the same rate for telemedicine visits as in-person visits. This means that most physicians were financially incentivized to see patients at a physical office. As such, bothering with telehealth appointments was not a priority.
- Technology is no longer prohibitive. Physicians, clinics, or hospital systems that did not want to invest in specific telemedicine software, no longer have to. Now, custom solutions aren't required for clinicians to meet with patients. In most cases, existing two-way communications technology that "use interactive audio and video" like Zoom, FaceTime, or Skype are allowed. Although security restrictions may tighten after the pandemic emergency has lifted, for the foreseeable future, mainstream tech is permitted.
- Loosening of other restrictions. Prior to CMS' new billing around telemedicine, most patients had to be seen in-person for a physical assessment before having subsequent telemedicine visits. Today, new patients, regardless of where they live (it doesn't have to be rural), can have first appointments hosted over phone and video.
- Overcome skepticism by clinicians and patients. Regardless of the preference of patients and providers, non-emergency healthcare appointments have forcibly shifted to distributed telemedicine. Whether or not virtual visits would be either parties choice of delivery, doesn't matter. Having the general population receive telemedicine helps to overcome any resistance and lets patients experience the benefits firsthand.
Is Telemedicine Here to Stay?
When we say the future has come early, we don't mean telemedicine has just come to say 'hello'. We're of the mindset that although COVID-19 has fast-tracked the rollout of telehealth and remote healthcare, it's here to stay. This isn't to say that some of CMS' looser regulations won't be reeled in or some providers won't return to primarily in-person visits. However, as we rebuild a new normal, widespread use of telehealth and greater adoption of remote healthcare solutions will continue trending.
The prevailing sentiment from healthcare leaders is that telemedicine's "moment" isn't really a moment at all. With regulations and initial skepticism lifted, barriers that stood in the way are taken out of the equation and telehealth's rise could be meteoric.
Less than a year ago, adoption of telemedicine was "slow", with just 1 in 10 patients having used telehealth in lieu of a doctor's office, urgent care or emergency room visit in a 12 month period. Today, healthcare providers, hospital systems, telehealth software solutions are seeing exponential growth.
As reported by The Washington Post, in their article "Coronavirus means Americans are finally embracing virtual health care", "Banyan Medical Systems, a virtual-care provider that partners with 800+ hospitals reported a 900 percent increase in patients using telehealth services; Novant Health in North Carolina said that video visits have gone from 200 to 12,000+ per week; and New York University's Langone Medical Center went from having 20 virtual-care clinicians to 1,300 in less than a week. Other headlines across major publications like the Economist, Stat News, and The WallStreet Journal read: "Telemedicine is essential amid the covid-19 crisis and after it", "Doctors discover telehealth's silver lining in the Covid-19 crisis", and "Virtual Doctors Are Here to Stay".
So Why is TeleMedicine and Remote Healthcare Poised to Last?
Accessibility: Telemedicine, paired with subsequent remote patient monitoring and evidence-based care, can mean high-quality care for more people. Those who live in remote areas, who don't have access to specialists, who could be sick, at-risk, or hesitant to walk into a hospital or clinic, can receive care with fewer barriers.
Fear of the Hospital: During and after SARS, a novel coronavirus epidemic from 2002-2004, people were afraid to go into hospitals or visit clinics. Simply, people sought less medical attention than they did prior to the outbreak. In Toronto, the North American epicentre of SARS, the number of non-urgent ER cases went down by about 60 per cent. In the three years following SARS, non-urgent appointments across departments were down significantly. It took two years for Toronto hospital ER visits to hit pre-SARS levels. History shows that patients will be reluctant to go to in-person healthcare visits and could turn to telehealth instead.
High-quality care: Telehealth isn't synonymous with poor quality healthcare, nor are in-person visits synonymous with high-quality care. Telemedicine is a vehicle to treat patients, triage who needs to be seen in-person, and create a plan of action and treatment. As Dr. Nima Mehran, a busy LA-based orthopedic surgeon explains, a lot can be accomplished during telemedicine appointments. Dr. Mehran explained that, "During a phone call, I am a much better listener. Because I don't have the access to a physical exam, I am paying much closer detail to the words they're using, how they're describing their condition and the types of pain they're experiencing. On the other side, some of my medical advice seems to land better...".
Convenience: For non-emergency visits, follow-ups, or general appointments, patients can see their providers with fewer barriers, less costs, and no travel time. Across the board, telehealth offers great convenience to patients who may be in pain, be feeling unwell, have mobility issues, or may need assistance leaving their homes.
As Dr. Mehran pointed out, "There's so much that patients can be doing at home. Through video chats and phone calls, we have a patient history of their ailments. We can let the patients describe pain and symptoms, and offer advice and non-operative management from home."
Behavioral Change: After 'breaking the ice' and experiencing telehealth, both patients and providers are more likely to continue this method of care delivery. After all, breaking habits and changing behavior often doesn't happen voluntarily. Oftentimes, external factors force this change and pivot our trajectory.
Looking Forward: Telemedicine and Remote Digital Healthcare
Increased virtual telehealth appointments with clinicians is here to stay, but what happens next? If a patient has a telemedicine visit with their provider, what are their takeaways? Of course, prescriptions can be filled, exercises can be recommended, risk-altering behaviors can be taught, but what about really activating the patient?
With telemedicine, there's the potential for patients to play a larger role in their healthcare journey. We're at a turning point where the expectation and type of healthcare a patient receives has shifted. Patients are limited in their ability to just walk into an emergency room, hand-off their treatment, and play a passive role.
We've seen time and time again that when given the opportunity and the right tools, patients are empowered to become active participants in their own care. On the flip side, in the absence of guidance and follow-up care (like in-person physical therapy or visiting specialists), patients seek out and absorb misinformation, or become overwhelmed and inactive.
While telehealth appointments are critical today and moving forward, so is the need for continued care, progress tracking, and evidence-based medical guidance from home. As telemedicine is widely adopted, the missing piece to solving for will be how to properly engage and treat the patient from home. With the recommendation and adoption of proven digital healthcare solutions, patients are given a path to symptom management, trackable progress, safer medical intervention, and even complete recovery from home.
If you are interested in what's next after telemedicine and want to discuss new methods of providing evidence-based remote care to you, please reach out.