Experts point to areas of potential growth and improvement in the telehealth landscape.
This article appears in the July/August 2020 edition of HealthLeaders magazine and is a companion piece to 3 Ways COVID-19 Transformed Healthcare Delivery Through Telehealth.
While telehealth has accelerated in popularity, it is far from reaching its zenith. Tremendous innovation is needed to help it reach its potential. BDO USA, part of BDO International, an accounting network, published the 2020 Healthcare Digital Transformation Survey earlier this year. HealthLeaders spoke with Deb Sheehan and Chris Cooper, both managing directors of the BDO Center for Healthcare Excellence and Innovation who were involved with the study, to obtain their insights regarding where opportunities for improvement exist in the virtual care arena. Among their recommendations:
- EMR enhancements: During in-person visits, physicians have time to check in with staff members and orient themselves to the patient outside of the examination room. As physicians conduct virtual care, that dynamic changes. They need to be able to quickly reference the EMR on demand. Enabling technology is needed so providers can easily access necessary screens to enhance workflow and reduce time needed to navigate through the EMR platform.
- Balancing virtual and in-person visits: As patients begin returning for in-person visits, new workflow issues exist with the current need for social distancing and the inability to keep multiple patients in the waiting room. Coupled with longer patient turnover rates due to the extra time it takes to sanitize rooms between visits, physicians may design their workflow to alternate between virtual and in-person visits throughout the day. Data is needed to help physicians determine the optimal mix.
- Moving beyond a single provider in an episode of virtual care: With most current virtual visits, the entire episode of care occurs with a single provider. There is no way to pass patients back and forth between different members of the physician's office team, such as medical assistants, nurses, and schedulers, forcing busy providers to take on additional roles or diminishing the patient experience. Also, the technology has not yet evolved to enable the multidisciplinary team-based care that the healthcare industry has been moving toward. Bringing specialists into the appointment for a virtual consult also would be ideal.
- There are some early ventures into solutions that would make this possible (see virtual rounding at UW Health in the main story), and consumer-facing solutions, such as Zoom®, already offer the infrastructure for this concept, but security issues and reimbursement must be addressed for this type of technology to flourish in the healthcare sector.
- Legislation to provide incentives for adoption: Telehealth involves new procedures for providers and patients. Sometimes there are technology and connectivity issues, and providers spend part of their encounter helping patients troubleshoot those problems. As a result, some providers have yet to experience the promise of efficiency that telehealth is supposed to deliver.
During the pandemic, providers received the exact same reimbursement for telehealth from CMS as they would for an in-person visit. That practice is unlikely to continue, and it is not apparent what commercial payers plan to do. Reimbursement for certain codes may be reduced because the virtual encounter is considered a less intense form of care. As a result, providers may be unlikely to provide certain services virtually if it takes them more time to perform a telehealth consultation and they get paid less for it.
The BDO experts suggest that perhaps a new form of legislation could be enacted to encourage adoption of telehealth that would work similarly to the way meaningful use provided incentives for providers to adopt EMRs. During the transitional phase, incentives would be provided to close the reimbursement gap between in-person and virtual visits.
Mandy Roth is the innovations editor at HealthLeaders.
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