“Our CEO stated all along that we’d like to be doing that type of medicine by 2030.
During COVID, we really did it all in six to eight weeks.”
~ Kevin Fitzgerald, MD
Chair for Outpatient Practice
Mayo Clinic Health System
La Crosse, Wisconsin
According to Becker’s Hospital Review, COVID-19 pushed the implementation of telemedicine ahead by at least a decade. Although medical practices were devastated by the drop in patient visits, most were unprepared to fully implement a viable virtual care alternative. But adapt some did and were surprised to find they were able to provide a high quality of virtual care and continue to focus on chronic care management for their most at-risk patient populations.
Most astounding, perhaps, was the fact that patients were comfortable enough with telehealth procedures that the practice was able to continue functioning. Now independent practices can build on the fact that telehealth increased acceptance during the COVID-19 pandemic and use those lessons to help them stay alive and thrive.
COVID-19's Intense Impact on Independent Practices
In January 2021, the American Medical Association reported that COVID made it precipitously worse for already struggling private practices. COVID piled financial worries on top of overwhelming administrative burdens, ever-changing government regulations, and complicated reimbursement protocols. In May 2020, 97 percent of practices had experienced a negative financial impact directly or indirectly related to the drop in patient visits and loss of cash flow. By August, the average drop in revenue was 32 percent, forcing 2 percent of primary care practices to already close, with another 2 percent considering bankruptcy.
In response to these dire circumstances, AMA released 14 tips for keeping practices in business during the pandemic. Included among these suggestions was an increased reliance on digital tools, such as telehealth and remote patient monitoring, to enable practices to function effectively outside the confines of a traditional physical office setting. Telehealth can encompass a variety of services including:
- Live patient visits
- Patient portal communications
- Check-in services
- Internet consultations
- Remote patient monitoring
Telehealth Use During the Pandemic
Prior to the pandemic, physician feelings about telehealth were mixed. Although some forms of chronic care management were required under federal guidelines, reimbursement was often not as substantial as it was for in-person visits. Providers believed patients were more comfortable in face-to-face situations, and thought they were able to elicit more substantial health histories. However, as in-person visits fell by almost half, weekly telehealth visits increased approximately five-fold, and continued at levels over three times as high as that prior to the pandemic.
In July 2021, AMA President, Dr. Gerald E. Harmon, recommended that the expansion of telehealth services must be sustained by making permanent the temporary easing of restrictions and payment parity with in-person visits that had been implemented during the pandemic. Benefits he cited for improved health care through telehealth included:
- Strengthened continuity of care
- Extended access outside normal clinic hours
- Easing the impact of clinician shortages for rural areas and underserved populations
- Ability to provide care for homebound and immunocompromised patients
- Increased quantity and quality of communication between patients and physicians
- Better management of chronic care cases
- Improved patient satisfaction
Telehealth Pandemic Lessons
Although most of 2020 and 2021 have been calamitous, there are some lessons to be culled from these experiences, which might help independent practices rethink their healthcare provider protocols as a method of finding their way out of the COVID doldrums.
Lesson One: Patients and physicians are finally becoming more comfortable with remote care
The Telehealth Impact Study from the COVID-19 Healthcare Coalition was last updated in May 2021. In it, researchers found that patients are not only pleased with their telehealth experiences during COVID, but they are also anticipating (and pretty much even expecting) they will see more of this approach to doctor-patient communication in the future. Many appreciated not searching for transportation, worrying about mask and social distancing requirements, or sitting in a waiting room with other patients. After having learned to use online communications with family and friends, they are comfortable enough with the technology to benefit from the interaction. Among those surveyed:
- 79 percent were very satisfied with the care received during their last telehealth visit.
- 81 percent said the provider was thorough.
- 84 percent were confident their personal information was secure and private during the visit.
- 83 percent believed the quality of the patient-physician communication was good.
- 73 percent feel comfortable with the prospect of continuing to use telehealth services in the future.
Also key to provider comfort with the telehealth experience are survey responses which revealed that telehealth is positively influencing four important telehealth goals:
One: Clinical outcomes
- More than 75 percent of clinicians indicated that telehealth enabled them to provide quality care in the areas of COVID-19-related care, acute care, chronic disease management, hospital/ED follow-up, care coordination, preventative care and mental/ behavioral health.
- 60 percent of clinicians reported that telehealth has improved the health of their patients.
- Of those using telehealth, 80 percent are conducting live, interactive video visits with patients and 67.9 percent are doing audio-only visits.
- 68 percent (agree and strongly agree) of respondents are motivated to increase telehealth use in their practices.
Two: Patient experience
- More than 80 percent of respondents indicated that telehealth improved the timeliness of care for their patients. A similar percentage said that their patients have reacted favorably to using telehealth for care.
Three: Cost
- Respondents indicated that telehealth improved the costs of care for their patients (61 percent either agreeing or strongly agreeing) and improved the financial health of their practices (56 percent either agreeing or strongly agreeing).
Four: Professional satisfaction
- A majority of respondents indicated that telehealth has improved the satisfaction of their work (55 percent).
These statistics alone should be enough to convince the telehealth-hesitant to begin exploring their options. After the pandemic ends, and even if it extends indefinitely, the top services physicians can envision providing through telehealth include: chronic condition management, medical management, care coordination, preventative care, and hospital or emergency department follow-up. The main concerns providers have in terms of implementing these changes include reimbursement, technology challenges, medical liability, and integration with their EHR.
Lesson Two: High levels of patient care are possible
In May 2020, AMA compiled a wide-ranging summary of case-study examples of the comprehensive value that virtual care can provide in its Return on Health research report. One case in particular focused on Viridian Family Practice and its experience with primary care telehealth visits. The practice relied on a decision matrix to help office staff determine the types of patient issues for which a video visit would be offered as an alternative to an in-person appointment. Examples include: medication adjustments, chronic disease management, and assessment of conditions where a physical exam is not necessarily required.
Independent practices can now realize the same benefits as large health care centers by adapting telehealth as a daily part of the care routine. Digitally-enabled care models based on the telehealth foundation offer these practices the opportunity to provide high access to care, high quality of care, lower cost, and a thorough care experience.
Lesson Three: Telehealth can peacefully co-exist with in-person care
Because telehealth took on such a prominent role, some independent care providers may worry that telehealth will eliminate in-person care altogether, but that does not appear to be the case at all. Instead, telehealth can supplement and support the care provided in the office environment. It enables the physician and medical staff to maintain a higher degree of patient contact, while following-through on routine care tasks such as blood tests and lab reports.
Lesson Four: Independent practices need to move from video visits to virtual care
After providers and staff held millions of video interactions across the United States during the pandemic, Physicians Practice reports that there is now an emerging difference between video visits and virtual care. Video visits were seen as a quick, fix-it solution to an immediate problem. Little attention was paid to best practices or technical requirements. Physicians now realize that they need to pivot toward forming a long-term, enterprise-wide virtual care strategy, by partnering with a knowledgeable technology provider. This research showed that using an end-to-end solution does indeed save time and labor costs and has the potential to deliver a higher gross margin per visit — as high as 75 percent.
Lesson Five: Telehealth works for various populations
Although the benefits of telehealth are most widely appreciated in the adult population, Jennifer Brumm, MD, a pediatrician at Mayo Clinic Health System in La Crosse, found that telemedicine also worked especially well with pediatric patients. The video capability took the child out of the sometimes inhibiting parameters of a doctor’s office, and instead allowed the physician to just observe their patient’s behavior, growth, and social development.
Lesson Six: Telehealth supports the move to value-based care
Telehealth is playing an even more vital role as the medical industry moves from a fee-based foundation to value-based care. Remote care supports providers in their efforts to maintain the health of individuals with chronic conditions. They can use telehealth to keep in touch with patients between office visits and provide higher levels of education and monitoring.
Lesson Seven: There are solid business reasons to incorporate telehealth
If “feel-good” reasons are not enough to motivate the increased drive toward telehealth, there are solid business benefits to be realized as well:
- Less office space and personnel requirements to provide same levels of care.
- Ability to see more patients without moving from room to room, scrubbing up, or sanitizing.
- High efficiency of the telehealth visit increases the ability to see more patients.
- Using telehealth as a triage service enables the practice to better assess in-person visit needs.
- Opportunity to increase offerings through remote care.
Lesson Eight: Telehealth is expected to continue after the pandemic
In December 2020, CMS permanently expanded some telehealth services. More than 60 services that will continue to be covered post pandemic have been added to the Medicare telehealth list. Numerous states are assessing the reimbursement of telehealth services.
“The term telehealth won’t exist in 2050. It won’t exist in 2025. It will just be health.
It won’t be virtual care, it will just be care.
The lines between remote treatment and in-facility treatment will become so blurred
that any distinction will become vestigial.”
~ Miles Romney, co-founder and CTO at telehealth company eVisit, as reported in Healthcare IT News
Lesson Nine: It’s time for independent practices to begin implementing an integrated telehealth solution
During the pandemic, decisions had to be made quickly and systems were put together without much thought as to overall efficiency. Some practices resorted to holding Zoom calls with patients, and manually entered chart information. Emails, texts, and voice messages prevailed. Now, however, it is time to realize that these approaches might not be the most effective or cost-efficient option. In their place, practices need to team up with HIPAA-compliant and secure telemedicine providers to benefit from improved telehealth solutions that provide the ability to:
- Remotely deliver in-home patient care.
- Instantly and easily initiate secure text conversations to patients.
- Initiate telehealth video visits with the click of a button.
- Maintain logs of chats and videos for billing and audit purposes.
Make no mistake about it, whether the pandemic continues, the benefits of telehealth will continue well into the future. It will form the foundation of the newer way of providing care to patients and will dramatically alter the way medical providers interact with their patients. By implementing a quality telehealth solution, the independent practice will not just survive, it will also thrive.
Healthcare Technology Solutions Designed By and For Independent Practices
Amazing Charts was founded in 2001 by a practicing family physician to help medical practices thrive. We have grown consistently since then by creating easy-to-use solutions for delivering patient care. Today, we offer a variety of additional capabilities designed to help independent practices succeed, including Electronic Health Records, Practice Management, Billing Services, Population Health and Remote Care. Call 866-382-5932 to learn about our products, schedule a practice consultation, and learn more about telehealth pandemic lessons that can help your independent practice grow.
