Telehealth Services Thriving at Providence Health System

Last year, Providence launched or expanded several telehealth services, and service volumes surged.

As long as there is a payment model, telehealth utilization will be robust at health systems, hospitals, and physician practices, the chief medical technology officer at Providence health system says.

The Centers for Medicare & Medicaid Services (CMS) expanded reimbursement for telehealth services at the start of the coronavirus pandemic. The expanded reimbursement, which is set to continue during the pandemic's Public Health Emergency, has fueled an unprecedented level of growth in telehealth services.

At Providence, telehealth has flourished since the beginning of the pandemic, according to the Renton, Washington-based health system's Telehealth Annual Report for 2021. Since the start of the pandemic in March 2020 through 2021, Providence's COVID-19 home monitoring reached nearly 30,000 patients and ambulatory virtual visits surpassed 3 million encounters.  

Providence operates more than 50 hospitals in seven states: Alaska, California, Montana, New Mexico, Oregon, Texas, and Washington.

After a significant drop-off in the beginning of 2021, video visits at Providence stabilized at about 100,000 encounters per month last year. Chief Medical Technology Officer Todd Czartoski, MD, expects that level of utilization to continue this year.

"In 2022, we are right around 100,000 encounters per month. In January, we were at nearly 200,000 because there was another surge of COVID. But since then, it has come back to around 100,000 and has stayed consistent at that level. My expectation for the remainder of 2022 is that video visits will stay around 100,000 per month. The main driver that is facilitating that level of utilization is the Public Health Emergency. The biggest predictor of what will happen with volume over the long-term is what will happen with CMS reimbursement. As long as the payment model is there, video visits at Providence will hover around 100,000 per month," he says.

The country's healthcare system would benefit from making the expanded CMS telehealth reimbursement permanent, Czartoski says. "Right now, we know the Public Health Emergency will extend until the middle of July, and we believe it will extend until the end of the year. Hopefully, they will put something permanent in place."

Telehealth growth at Providence in 2021

Providence launched or expanded several telehealth programs in 2021, according to the Telehealth Annual Report.

• Providence Hospital at Home launched in July 2021. The hospital at home program includes a technology-enabled virtual MD and RN command center.

• The health system's Behavioral Health Concierge program, which provides counseling services to employees and their family members at Providence and several large companies, experienced explosive growth in 2021. Behavioral Health Concierge's virtual visits grew 167% and the number of the program's licensed clinical social workers doubled to 17. At the end of 2021, the program served 500,000 lives.
   
• Tele-EEG services were expanded through a partnership that features Cerribell EEG technology.
   
• The health system's telepsychiatry program, which provides virtual behavioral health expertise to emergency departments and inpatient units, added Harbor Regional Medical Center in Aberdeen, Washington. The program now serves 34 hospitals in Alaska, California, Oregon, and Washington.
   
• Providence's TeleHospitalist program, which primarily supports hospitals with nighttime telehospitalist services, continued to expand. In 2020, TeleHospitalist providers were enlisted to cover Providence Covid Home Monitoring alongside nurses. In 2021, telehospitalists started serving as command center physicians for the Providence Hospital at Home program.
   
• The Providence TeleStroke program added 16 sites across five states.
   
• Several new telehealth services launched in 2021, including TeleTransplant at Providence St. Joseph Hospital Orange, TeleVascular Surgery Consults in Spokane, Washington, and TeleOncology visits and patient support groups in several regions.

Two factors loom large in future telehealth growth at Providence and nationally, Czartoski says.

"It is tied to the payment model. Growth of telehealth depends on how long the Public Health Emergency stays in place or CMS acts to make reimbursement for telehealth permanent. That will predict how broadly you will see utilization in the United States. The second factor is risk. If we are moving from Medicare fee-for-service to Medicare Advantage, that will be another driver of telehealth utilization as we see more commercial, value-based contracts," he says.

Embracing remote patient monitoring

Providence is planning to expand its use of remote patient monitoring (RPM), and the health system is looking for an RPM platform partner, Czartoski says.

"We have had great success with our COVID home monitoring program—more than 30,000 patients have been monitored. Going forward, our RPM efforts depend on the use case. The platform of choice has to have flexibility. Sometimes, you need Bluetooth connectivity, which tends to be more expensive for medical grade equipment. Sometimes, you just need something that the patient can self-serve such as checking their oxygen level with a pulse oximeter and self-reporting. The current rules around CMS reimbursement require RPM to be automated, not self-reported by a patient. So, for that type of a requirement, you need Bluetooth connectivity," he says.

The move from fee-for-service reimbursement to value-based care is a driver of RPM utilization, Czartoski says. "As we are taking care of populations of people—particularly those who have diseases that can exacerbate such as congestive heart failure and require vigilance over a long period of time—it makes a whole lot of sense to be monitoring at home and keeping people safe, so they do not end up in the emergency department."

Providence has a vision for RPM, but the ultimate mix of services is uncertain, he says. "Our primary focus, at least initially, will be on a handful of diseases such as congestive heart failure, chronic obstructive pulmonary disease, and diabetes. That's where our plans are now, but the ultimate platform we choose will have to be flexible as our needs change going forward. We have hospital at home now, but we expect to expand that to other low-acuity conditions that we will monitor in the home. A platform that is scalable and flexible is important to us."

Related: American Telemedicine Association Touts the Next Phase of Virtual Care