On March 17, 2020, the Centers for Medicare and Medicaid Services (CMS) announced it would expand Medicare virtual health services so that program beneficiaries could access a wider range of offerings from their doctors without having to travel to a healthcare facility – and without worrying about who would pay for their visits.
At the time, the move was a necessity.
With a global pandemic bearing down on the country, emergency departments facing a flood of critical patients and most states shutting down all but the most essential services and activities, the healthcare industry needed a way to ensure America’s senior citizens could access routine care.
Virtual health services have been expanding and improving for almost two decades, but because of patient and practitioner concerns about payment and reimbursement, before COVID-19, the country had not realized the full benefits of telehealth.
Now, a year into COVID-19 crisis, federal and state officials, hospitals and health systems, primary care physicians and specialists – and consumers – are convinced: virtual health is an essential tool for everyday life and health. Especially since this important healthcare innovation can help preserve limited personal protective equipment.
What Is Virtual Health?
Virtual health services, often called telehealth or telemedicine, is the interactive, electronic exchange of information for the purposes of diagnosis, intervention or ongoing care management between a patient and healthcare provider who are not situated at the same location. It is a major step forward in healthcare innovation.
More simply: virtual health is the 21st century version of the house call. Whether the patient is at home, on vacation, or in a remote facility, two-way audio/visual technologies enable them to get in touch with the provider and the care they need, at the moment they need it.
Virtual health services go far beyond real-time smartphone consults. This healthcare technology enables clinicians to monitor patients' heart rates and other vital signs remotely, to use artificial intelligence and augmented reality to provide innovative care and even to incorporate robotics into surgery.
Telehealth benefits and possibilities are endless, and the excitement about technology in healthcare is growing.
Envision Virtual Health Services can help you deliver better outcomes and patient experience by keeping care within your community. Want to learn more?
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Pre-COVID Payment Barriers Kept Americans from Accessing Telehealth
Even before the COVID-19 pandemic, openness to innovation in healthcare was rising. Certain specialties were incorporating virtual health services and technology into their practices at a rapid pace.
A 2017 American Telemedicine Association survey, for example, found 83 percent of healthcare organizations were “highly likely” to invest in virtual health and, of those, 88 percent planned to do so that year. Additionally, according to REACH Health’s 2018 U.S. Telemedicine Industry Survey, the majority of acute care facilities (58 percent) had incorporated virtual health programs. The top applications at that point for virtual health were psychiatry, neurology, radiology and pediatrics.
Patients also were eager to try the new technology even before the pandemic. According to research released by the Advisory Board in 2017, 77 percent of consumers would consider seeing a provider virtually, and 19 percent already had. The Advisory Board tested 21 primary and specialty care scenarios and with each one, the majority of the nearly 5,000 survey respondents reported that they would be willing to consider a virtual visit.
Despite the openness to new innovation in healthcare, utilization remained low. Patient and physician concerns about payment were a significant barrier that kept many practices and hospitals from fully realizing the benefits of telehealth. According to American Well’s 2019 physician survey, more than three-quarters of physicians (76 percent) who said they were skeptical of virtual health said worries about reimbursement were the cause of their anxiety.
As a result, according to a 2018 Health Affairs review of American Medical Association survey data, only 15 percent of U.S. physicians routinely were using virtual health as of 2016. The Advisory Board concluded, “The results suggest that the health care industry has largely underestimated and, to date, failed to meet consumer interest in virtual care.”
Then COVID-19 hit.
Unleashing the Benefits of Telehealth
With approximately 97 percent of Americans under strict stay-at-home orders by April 2020, and millions of physician offices shuttered, federal and even state policymakers began to relax virtual health rules for their constituents. They eliminated geographic limitations, instituted payment parity between in-person and virtual visits, allowed Emergency Medical Screening Examinations to occur virtually instead of face to face, waived “pre-existing relationship” requirements and eased technological requirements.
Americans and their healthcare providers responded almost immediately.
By late April, nearly three-quarters of private practices were offering virtual health services. According to McKinsey & Company, providers were able to serve almost twice the number of patients they saw on a daily basis because of the expansion of virtual health.
These healthcare innovations kept less severe cases out of the emergency department, helped patients to keep current on routine visits and allowed clinicians to consult with one another across health systems and facilities.
As the nation faced shortages of masks, surgical gowns and disposable gloves, there was another important benefit of virtual health adoption: the preservation of personal protective equipment (PPE).
Major Telehealth Benefit: Conservation of Personal Protective Equipment
Between March and December 2020, we provided nearly 250,000 virtual health visits, an exponential increase from pre-pandemic levels.
Not only did this expansion help our partners continue to provide quality, compassionate and continuous care to their patients, it helped them conserve personal protective equipment (PPE) – a costly asset that was in low supply at the beginning of the pandemic, and still is in some areas today.
We have been providing virtual health services for more than a decade. As a result, our clinical team was able to quickly identify virtual health’s potential to lessen the need for traditional PPE. We worked to coordinate with our providers to stand up virtual triage services, or ePPE as they came to be known, at no additional cost to their practices. This happened in one of two ways: we either physically introduced new healthcare technology into facilities that did not yet have it, or we plugged into existing systems that met our virtual health program’s minimum viability standards for compatibility.
Using a direct point-to-point video solution, we were able to provide an ePPE safety net for both clinicians and patients – one that empowered clinical staff to physically distance themselves from patients while also expediting triage and assessment processes. In total, we introduced this healthcare technology in 290 locations, providing protection for more than 1,300 clinicians in the process.
Beyond COVID-19: Healthcare Technology to Address Clinician Shortages
With clinician shortages rising around the country, and the cost of keeping specialists on staff increasingly prohibitive for many facilities, virtual health services present an opportunity for hospitals and health systems to enhance their staffing at a sustainable cost.
In a survey conducted by the Children’s Hospital Association and released in 2018, children’s hospitals were asked to name the areas where pediatric specialist vacancies persisted for more than a year. Nearly half said it took a year to find child and adolescent psychiatrists. Thirty-five percent said they had trouble finding neurologists while one-quarter had vacancies that persisted more than a year for specialists who deal with child abuse cases.
We also know:
- There are 11.4 neurologists per 100,000 residents in Washington, D.C. and only two per 100,000 in the state of Wyoming;
- 25 percent of patients use out of network mental health specialists versus 10 percent who use out of network medical specialists, indicating a dearth of psychiatrists and psychologists; and
- One in three physicians will be age 65 or older by the year 2030.
Data released by the American Association of Medical Colleges in June 2020, indicate the U.S. healthcare industry will have a shortage of up to 55,200 primary care physicians by 2033. In surgical specialties, the deficit will be up 28,700; in medical specialties, it will be as high as 17,800 physicians; and in other specialties, including pathology, radiology and psychiatry, the United States will need an additional 17,100 to 41,900 physicians by 2033.
By incorporating virtual health services into their operations, hospitals and health systems can offer greater access to multiple service lines. These healthcare innovations also can be used to support community paramedicine, a relatively new and evolving discipline that utilizes advanced practice professionals, paramedics and nurses to provide in-home services such as post-discharge follow-up to prevent readmissions, chronic disease management, injury prevention and on-scene treatment to reduce the need for 911 transports to hospitals.
Particularly for patients in medically underserved locations, both rural and urban, virtual health applications promise to enhance access to specialty care across multiple disciplines.
The potential benefits of telehealth are significant:
- Program and hospital support, including regular participation in hospital initiatives;
- Start-up training and continuing education for all relevant stakeholders;
- Development and utilization of protocols;
- Comprehensive quality-metric tracking;
- On-call coverage by all clinicians under the supervision of a medical director; and
- Tailorable coverage based on facility needs – the ability to choose supplemental, nights and weekends only or service that extends 24 hours a day, seven days a week and 365 days a year.
Interested in the benefits of Envision Virtual Health?
Virtual Health: the Future is Now
Last May, less than three months into the COVID-19 pandemic in the United States, McKinsey & Company researchers concluded “the integration of fully virtual and near-virtual health solutions brings care closer to home, increasing the convenience for patients to access care when they need it…”
That statement was correct before the pandemic. It was correct during it – and it will be true after it. This important healthcare innovation is here to stay.