07 Jan TELEHEALTH: COVID’S Healthcare Superstar
If there’s a silver-lining that’s emerged from the past nine months of our collective misery, it’s been the rapid embrace of telehealth by physicians, therapists, pharmacists, and patients alike. And, based on the feedback from the provider Members in Wednesday morning’s ABL Healthcare ZOOM Table, it’s never going back to its limited pre-COVID norm. In fact, according to a Medical Economics industry survey, “83% of patients expect to use telemedicine after the pandemic resolves.”
Major Health Systems Have Come Far with Telehealth
A prime example of how far we’ve come with Telehealth was revealed in my recent exchange with Artie Southam, MD, EVP of Health Plan Operations and Chief Growth Officer at Kaiser Permanente, who is also the co-national executive sponsor of Kaiser’s Telehealth activities. Although, as Artie said, “we were fortunate to have a head start going into COVID” – pre-pandemic, they were already conducting 15% of scheduled outpatient visits virtually. “And we are fortunate that our economic model [flat, monthly payments] supports sustained investment in these types of services.”
Nonetheless, when COVID struck, the organization shifted dramatically to telehealth; as Artie confirmed, they ended 2020 having provided 30.5 million (synchronous, voice or video) telehealth visits to their members, equaling 49% of all their outpatient encounters for the year – including an 80% highpoint in the early spring. These televisits are above and beyond the 400 million visits to kp.org, where “about 40 million [asynchronous] secure visits took place, and members exchanged secure ‘emails’ (including attachments) with their KP providers.” And, while Kaiser’s telehealth percentage is currently ~50% of all outpatient visits, Artie is focused on always improving “the telehealth experience – the waiting room, and the start, and the finish – [so it’s] a really good consumer and clinician experience.”
MedStar, Ascension, Providence
Other providers and systems that didn’t have Kaiser Permanente’s head-start – or prepaid “economic model” – were thrown into catch-up mode using whatever technology was at hand; sometimes Facetime, and certainly Zoom. In a recent Modern Healthcare feature: “How hospitals are building on COVID-19 momentum,” nationally telehealth sprang up from “less than 1% adoption before the pandemic,” to 50% of patient encounters in April, to just under 20% today, according to the Chartis Group.
Like other major systems, MedStar Health in Columbia, MD, was using telehealth for fewer than 100 patients in early 2020, then jumped up to 10,000 to 12,000 televisits a week.
Similarly, pre-COVID, the St. Louis-based Ascension system had conducted “a fraction of a percent” of their visits via telehealth, then it jumped to 10% to 20% of all their patient visits. Like Artie Southam at Kaiser Permanente, Ascension’s EVP of Clinical and Network Services, Joe Cacchione, MD, is working on improving the patient experience, so they can “make it more efficient to have a virtual visit.”
And at Providence, in all of 2019, they connected about 70,000 patients with specialists within their system, via video visits. By April of 2020, their telehealth visits jumped to 70,000 a week, primarily connecting patients at home with doctors who might also be in their home. Of course, in addition to the CDC’s aim of using telehealth to “flatten the curve” of ICU, ventilator, and intensivist utilization, other “adjustments” were made to incentivize providers to embrace telehealth: primarily, “granting payment parity between telehealth and in-person clinical care for Medicare,” which most private payers followed.
CMS Issued Waivers for 135 Telehealth Services, Approved Additional Practitioners, Allowed “Cross State Lines”
Additionally, CMS issued waivers that added coverage for 135 services not previously on the Medicare telehealth services list, expanded the types of practitioners who could provide telehealth services, and allowed providers to “cross state lines.” While still others, like PAs and Nurse Practitioners, were encouraged (and enabled) to work to the full scope of their licenses. The result was, in Medicare Fee for Service, telehealth adoption increased by nearly 50% in primary care, at the peak.
Another study, published in the Journal of Medical Internet Research last month, found that the largest increases in Doctor on Demand’s telemedicine visits during the COVID-19 pandemic were attributable to scheduled behavioral health appointments, such as therapy and psychiatry visits, and chronic illness visits.
Virtual Visit Reimbursement Rates
Interestingly, even though the actual telehealth visit is reimbursed at a rate equivalent to one that’s in-person, at Ascension, for example, “a virtual visit tends to generate between two-thirds to three-quarters of the comparative in-person visit,” according to Cacchione. Why? Because when the patient’s in the building, their physician can order and do a blood draw, EKG, and “some other code that‘s billed for,” building up the total revenue per in-person visit. (Which does beg the question, how many of these “extra billable codes” are really medically necessary anyway?)
Clearly with the convenience and efficiency that telemedicine provides, coupled with the lower cost of a visit without a lot of “extra billable codes” tacked on, once we’re past COVID, we might finally start seeing America’s $4 trillion cost curve bend down.
By Mimi Grant, President, Adaptive Business Leaders (ABL) Organization – Round Tables and Events for CEOs of Healthcare and Technology Companies