The COVID-19 pandemic is fundamentally changing healthcare delivery in the United States, from the acceptance of virtual physician visits to payment reform, and from the consolidation of integrated delivery networks to the very survival of independent physician practices. The resultant healthcare environment will be one that is more integrated into daily life with provider reimbursement tied to value-based, patient-centered care.
Telehealth is playing an unprecedented role in healthcare delivery during the COVID-19 pandemic, advancing its capabilities years ahead of its previous trajectory. It will become an integral part of a patient’s journey as the industry finds its new normal.
Providers, patients are calling for continued coverage, reimbursement parity
On Aug 3, 2020, citing the benefit and unprecedented expansion of telehealth, President Trump signed an executive order proposing to expand telehealth permanently for Medicare beneficiaries beyond the COVID-19 pandemic and increase access to care in rural areas. During the public health emergency, the Centers for Medicare and Medicaid added 135 services that would be paid under telehealth.
Federal and state action will be needed to incentivize providers to continue telehealth usage and remote patient monitoring programs. One incentive could be including a telehealth program in MACRA’s Quality Payment Program, the federal physician payment model, under the MIPS Improvement Activity metric and require telehealth for all APM participants (Carrie Nixon Law Group, June 15, 2020).
Telehealth capabilities accelerated
Andrei Zimiles, co-founder and chief executive officer of Doctor.com, said in July 2020 that the industry has accelerated telehealth 10 years in just six months (Crain’s New York panel discussion on “How Telemedicine is Transforming Health Care”). The focus now is on improving technology and integrating telehealth into a healthcare ecosystem. He indicated the number of physicians offering telehealth nearly doubled since last year.
A recent DRG survey found 80 percent of U.S. physicians surveyed in June and July reported having conducted a virtual patient consultation in the past 3 months (DRG, Re-Taking the Pulse® U.S. 2020). That was up from 39 percent of physicians surveyed in late March and April and 9 percent of those surveyed in early March.
The regional IDNs with large, aligned physician bases and telehealth capabilities saw virtual visits increase dramatically as the pandemic set in. Northwell Health, New York City’s largest IDN, treated more COVID-19 patients than any other health system in the nation between March and June – 55,000 overall, including approximately 17,000 hospitalized patients. Northwell, working with national telehealth provider Amwell, saw virtual visits go from a few hundred per day to more than 5,000 daily. The Cleveland Clinic saw 58,000 virtual visits in all of 2019; the IDN had more than 200,000 virtual visits in April 2020 alone.
What’s next for telehealth?
“We need to meet our patients where they are, home, phone, computer, extended hours,” Geraldine McGinty, MD, chief strategy officer and chief contracting officer at Weill Cornell Medicine in New York City said during the Crain’s New York How Telemedicine is Transforming Health Care panel in July 2020. “We can now take our specialized providers and make them accessible to people – there is some real opportunity there. But how can we get this innovation and technology to all of our patients? Where does it add value? We don’t want to overuse the service. What is meaningful to patients and where do we see it tie into positive outcomes for patients?”
Those are important questions yet to be answered. Reimbursement parity and regulation changes are crucial, and technology and devices are advancing quickly. But access to telehealth remains a significant challenge for lower income residents and seniors who may not have internet access, don’t know how to use it, or they can’t understand or hear the physician. And physicians without the financing or capabilities to provide telehealth will lag behind and may look to other groups for backing.
“It’s quite remarkable what’s happened in the last six months,” Zimiles said during the same Crain’s New York panel. In addition to extensive patient care, telemedicine is being used as growth opportunities to garner new patients, provide second opinions, and in marketing campaigns in geographies not targeted before.
Key takeaway: As the industry applies lessons learned from COVID-19 into healthcare delivery, look for the patient journey to begin and continue online through innovative telehealth technology. Expect IDNs and physicians to adapt to this model by providing care and securing revenues in multiple care settings, including in-person and online.
In order for healthcare delivery to continue its fast-paced evolution forced by COVID-19, the federal government will have to make regulatory and reimbursement changes, specifically for telehealth. In the meantime, look for industry leaders to continue to develop creative ways to utilize telehealth to ensure patients have access to care wherever they are.