Researchers have found that telehealth performed better than in-person care in 11 of 16 HEDIS quality performance measures, but that doesn't mean virtual care is superior to the office visit.

New research published in the Journal of the American Medical Association (JAMA) finds that telehealth was superior to in-person care in 11 of 16 quality performance measures for primary care.

The study, conducted by researchers at the Robert Graham Center in Washington DC and Pennsylvania-based Wellspan Health, focused on more than 526,000 patients receiving healthcare services at roughly 200 Wellspan Health outpatient sites between March 1, 2020, and November 30, 2021, and used HEDIS (Healthcare Effectiveness Data and Information Set) measurements.

The researchers, led by Derek Baughman, MD, of the Robert Graham Center and Wellspan Good Samaritan Hospital in Lebanon, Pennsylvania, and Yalda Jabbarpour, MD, and John Westfall, MD, MPH, both of the Robert Graham Center, said the results don't mean that health systems should close their clinics and focus on virtual care. Rather, they should offer telehealth as a part of the overall care plan, particularly for those who face barriers to accessing in-person care.

The study noted that in-person care showed better results for all medication-based measures, while telehealth offered better results in testing and counselling measures, such as vaccinations, chronic disease testing, and cancer and depression screenings.

"Notwithstanding the statistical significance, the clinical relevance of these findings is perhaps more meaningful at the population health level for evaluating the outcomes of adding telemedicine as a care venue," Baughman and his colleagues noted. "Moreover, telemedicine exposure (especially blended office and telemedicine care) likely simulates a likely real-life scenario for the health consumer."

"Practically, these findings provide reassurance for health entities seeking to add telemedicine to their care capacity without reducing quality of care," they added. "And as we found, embracing telemedicine for enhancing certain aspects of care might be an avenue for enhancing quality performance in primary care."

Baughman and his team said it wasn't clear why telehealth outperformed in-person care, though they noted that a telehealth platform offers better opportunities for care providers to reach out multiple times to patients to "engage in quality measure-promoting intervention." They also noted that some treatments, such as the initiation of a lifelong or life-changing medication program, are best begun in person,  and perhaps shifted to virtual platforms for follow-up.

"Future studies could provide more granularity on optimizing the specific role of telemedicine in clinical scenarios, eg, understanding whether there is an association between stages of hypertension and effect modification attributable to the management venue or an association between venue and number of blood pressure medications," they wrote. "This would provide insight on where to invest in health care infrastructure and what clinical venue would be most valuable. This could also guide venue selection for patients initiating antihypertensive therapy vs patients requiring a third antihypertensive. Such insight would promote win-win environments to increase value: improved health outcomes for patients and incentive for clinicians and health systems operating in value-based care models."

The Jacksonville health system is deploying two life-sized (and selfie-capable) robots designed to perform tasks for staff and care providers that would otherwise take them away from the bedside.

Jacksonville, Florida-based Baptist Health is using a robot to improve clinical workflows and give patients and visitors 'someone' to snap selfies with.

Baptist Medical Center Jacksonville and Wolfson Children's Hospital have deployed Moxi, developed by Austin, Texas-based Diligent Robotics, to help staff and care providers with tasks that might otherwise take up time away from patients, such as transporting equipment and lab samples and even picking up items left for patients at the front desk.

“Today, our team members spend time retrieving and gathering supplies, medicine and patient items,” Tammy Daniel, DNP, Baptist Health's senior vice president and chief nursing officer, said in a press release. “Moxi’s support will allow them to focus on people as opposed to tasks, and on what they do best: patient care.”

The adult-sized robot, equipped with a gripper at the end of an arm, uses AI technology and an array of sensors to navigate busy hallways without bumping into objects or people, can maneuver through doors and elevators, and learns as it goes. Hospital officials also describe it as "intelligent, dedicated to its job, has expressive eyes, and is happy to pose for selfies."

“We are continually looking for innovative ways to support our team in caring for our patients, which is why I am so pleased to see this project begin,” Michael A. Mayo, DHA, FACHE, the health system's president and CEO, said in the release. “Artificial intelligence combined with robotic process automation in a tool like Moxi provides a way to improve hospital functions – giving our team members time back in their day to work where they are most needed.”

Once called COWs (Computers On Wheels), robots have been used for years for various functions within the hospital setting, ranging from manual pickup and delivery to providing audio-visual communication between patients and care providers in other locations. As the form factor and technology have improved, they've been assigned other duties, and are even being used in remote locations like health clinics, assisted living communities and homes.

[See also: Baptist Health's New Tower Offers the Latest in Critical Care Innovation for Kids.]

Baptist Health is using two Moxi robots, one in Wolfson Children's Hospital and the second in the adjoining J. Wayne and Delores Barr Weaver Tower at Baptist Jacksonville, and officials expect to evaluation their performance in six to eight months. The project is supported by the Reid Endowment for Technology at Baptist Health, established in 2008, and the Miller Electric Technology Endowment at Baptist Health, established in 2014.

The Detroit-based federally qualified health center is using digital health tools to improve care outcomes.

A Detroit-based federally qualified health center (FQHC) is using digital health technology integrated with its electronic health record platform to improve care management for patients living with high blood pressure.

The MicroMD electronic health record software in use in three clinics at the Institute for Population Health (IPH) was integrated in less than four weeks with Carium, a leading virtual care platform, in a partnership with Smartlink Health Solutions.

A private nonprofit, IPH took over Detroit's public health functions in 2012 as the city was approaching bankruptcy. Although most such services transferred back to Detroit in 2015 after the city emerged from bankruptcy, IPH continued to offer clinical outpatient services at three locations in the city.

The Health and Human Services Department's Health Resources and Services Administration (HRSA) has continued to fund IPH operations to the tune of $650,000 per year in 2020 and 2021. IPH provides general primary care and health screenings including mental health, prenatal care, telehealth, and adult dental services.

Prior to Carium's integration, the IPH team was manually notifying clinicians of patients with abnormal vital readings captured through remote monitoring. Now, Carium-supplied blood pressure cuffs report data directly into IPH's EHR.

The integration creates a more complete patient record, incorporating data from within the patient's daily routine, such as blood pressure or weight.

With this data, the IPH care team can better monitor, assess, alert, intervene, educate, coach, and communicate with patients.

The integration between MicroMD and medical devices deployed and supported by Carium allows physicians at IPH to click-to-order virtual services like remote patient monitoring directly through their MicroMD EHR, seamlessly enrolling patients to Carium.

IPH went live with this integration on June 10.

"The integration between Carium and our EHR allows us to be there for our patients every day," says IPH Chief Operating Officer Anthony Harris, MSW. "Our patients know we care and are keeping an eye on them, and it's also a great tool for accountability. Before, we didn't know if they took their medication until they come in the next time for a follow-up. Now we take their blood pressure twice a day, so we have an accurate account of what they're doing."

Anthony Harris, MSW, chief operating officer for the Institute of Population Health. Photo courtesy IPH.

"The integration process was easy, straightforward, and the project team was very responsive," adds Mark Lynn, IPH's chief information officer for technology services. "By incorporating the timely data from patients' daily life into our clinicians' workflows, they're able to communicate more efficiently, and make recommendations or adjustments in real-time when necessary."

In addition, discrete data automatically flows from Carium-managed devices to the connected EHR, enabling the IPH team to easily run required quality reports.

Harris has served health departments during a 25-year career, starting out managing HIV and STD patients, then moving on to IPH when it formed in 2012.

"People still kept coming here, so we stayed open," Harris says.

In his role as COO, "I have 10 hats here," he says.

So far, IPH has enrolled 30 patients in the remote monitoring program, but the funding provides for up to 80 patients, so recruitment continues to fill the remaining spots.

The Carium platform also allows for tracking more conditions over time, and Harris says the organization will expand its base to monitor chronic conditions like diabetes.

The EHR used by IPH did not have a complete set of application program interfaces (APIs) required to fully integrate the Carium platform, which is where the partnership with Smartlink Health Solutions enters the picture.

"Smartlink has the ability to automate some user interface procedures, where we can then interface with Smartlink's APIs to drive the pushing of the data in the EMR using the user interface and a set of automation technology that really does mouse clicks and button pushes within the EMR," says Scott Pradels, Carium's chief operating officer and co-founder.

Carium provides a range of connected remote monitoring devices from various manufacturers, using both cellular and Bluetooth connectivity. The platform is also able to support connectable devices supplied by patients.

Carium charges a small monthly fee for each connected patient, Pradels says.

With Sutter Health Chief Design and Innovation Officer Chris Waugh leading the way, health system executives attending the HealthLeaders Innovation Exchange learned how to bring compassion and empathy back into healthcare.

Healthcare providers may be able to bring care to the patient, but do they really care for the patient?

Roughly two dozen chief information officers and other health system executives charged with setting innovation strategy gathered in Boston recently for the HealthLeaders Innovation Exchange, where they were told that the industry often lacks empathy for the people it's supposed to treat. And that connection to the patient will be vital as the industry shifts to value-based care.

"What's happening in healthcare is we peg patients by condition and we have absolutely no idea who they are," said Chris Waugh, vice president and chief design and innovation officer for California-based Sutter Health. "We know that precision medicine will be amazing [and] we know about precision genetics, but what about precision care?"

An expert in human-centered design, Waugh was vice president of design at the San Francisco-based One Medical Group and held an entrepreneurial leadership role at IDEO, a Bay Area design and innovation firm, before joining Sutter Health. His accomplishments there include the development and launch of Tera, the health system's virtual visit platform.

At the Innovation Exchange, he gave the attendees a Master Class on human-centered design, which focuses on thinking about the person you're treating as you plan the treatment. While in other businesses it's designed to make the customer happy and support return engagement, in healthcare the strategy is vital to not only boost engagement but improve clinical outcomes.

[See also: Healthcare Executives Plot a Path Forward With Digital Health Transformation}.

As an example, he detailed how Sutter Health creates baby books for new mothers that detail the baby's journey from the hospital to the home. Those books include interviews conducted by Sutter Health staff with the new mother on everything from Mom's emotions to the weather, and are given to the mother 30 days after discharge—at a time when family and friends usually drift away to leave the new family alone, post-discharge care plans with the hospital or doctor tail away, and post-partum issues like stress and depression creep in.

The book, Waugh said, not only gives new mothers an emotional link to the hospital, it helps to reconnect them with the hospital to seek additional care, a strategy to tackle high rates of depression and improve outcomes for both mother and child over the long run.

Waugh then split the audience into groups, gave them a profile of a patient or care provider, and asked them to develop a care management plan (or, in the case of the provider, a workflow) that would meet their needs and boost engagement.

The purpose of the exercise was to encourage healthcare executives to look beyond traditional care management pathways and identify other ways to deliver care, including using digital health tools that allow patients and providers to access more resources. In doing so, they were compelled to look at care delivery from the patient's point of view, identifying the gaps and challenges that affect patients and their families, that might be overlooked by providers.

James McElligott, MD, MSCR, executive medical director for telehealth and an associate professor at the Medical University of South Carolina's Children's Hospital, pointed out that the delivery of healthcare may be a business to clinicians, but it's personal to their patients, and clinicians need to find or reinforce that emotional connection.

The concept isn't new. The American Telemedicine Association focused on the idea of bringing humanity back to healthcare at their annual conference this past May in Boston. But as the pandemic eases and healthcare organizations redirect their energies to the shift from episodic care to value-based care, those in charge of innovation need to focus their investment on new technologies and strategies that highlight the value in care delivery.

That focus will also help health systems as they deal with post-pandemic challenges ranging from workforce shortages, stress and burnout, and pressure from non-traditional healthcare resources that include telehealth providers, payers and health plans with their own provider services, and retail giants like Amazon, Walmart, CVS, and Google.

With those pressures, Waugh and others noted, health system leaders will need to be innovative to keep their patients engaged and attract consumers to their brand. That will include incorporating services that address the social determinants of health, such as ride-sharing, nutrition and exercise, and housing and financial assistance. It might also include childcare services or coupons for a night out for new parents or stressed-out staff.

And that, attendees at the Innovation Exchange learned, is what makes healthcare intriguing right now.

"I'm excited about building the foundation of better [healthcare]," noted Saad Chaudhry, MSc, MPH, CHCIO, CDH-E, chief information officer at Maryland's Luminis Health.

The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Follow the community on LinkedIn. To inquire about attending a HealthLeaders Exchange, email us at exchange@healthleadersmedia.com.

Revenue cycle leaders share the best technology they use to optimize the revenue cycle.

This article appears in the September/October 2022 edition of HealthLeaders magazine.

It's already too late for healthcare leaders to start thinking about adding technology to the revenue cycle. The industry is forging ahead.

The healthcare industry is constantly changing in ways that revenue cycle leaders find it essential to keep up with. Changes in billing requirements, clinical criteria, payment models, and patient access can cause struggles for organizations with lagging processes.

A recent survey published by ModMed also adds urgency to the need for optimized technology. Sixty-one percent of patients surveyed placed importance on how easy it is to make payments when considering whether to continue with a health system. On top of this, 60% of patients surveyed were more likely to select one organization over another if appointments could be made online.

Successful organizations enhance their revenue cycles and create the bandwidth to address these changes with technology to streamline revenue cycle processes.

All areas of the revenue cycle must function at their best to achieve overall success. In this cover story, we hear from revenue cycle leaders on how they have used the best in technology to optimize their departments.

Tech to ease the good faith estimate burden

One of the biggest changes that has affected the front end of the revenue cycle is the implementation of the No Surprises Act on January 1, 2022. Within the No Surprises Act hides a new, burdensome regulation for healthcare organizations: the good faith estimate (GFE).

Under the law, healthcare organizations need to give patients who don't have certain types of healthcare coverage—or those who are paying out of pocket—an estimate of their bill before services are provided.

Not only do these GFEs need to be created, but they also need to be created quickly as patients have the right to receive a GFE for the total expected cost of items and services as soon as they schedule an appointment (the items can include costs of tests, drugs, equipment, hospital fees, and more).

The GFEs also need to be accurate since patients can dispute final medical bills if the charges are at least $400 more than what was presented on the GFE.

It's easy to see how much work this regulation is for front-end revenue cycle staff. The American Hospital Association (AHA) agrees.

According to the AHA's March letter to CMS, GFEs regularly take revenue cycle staff 10–15 minutes to produce.

Because of this time constraint, an AHA member hospital reports that their staff can only process 75 estimates per day, which is barely meeting the GFE demand. A member health system with several locations reports needing to do 1,500 per day across the system, the letter said.

It's clear that operationalizing processes to generate reliable, accurate GFEs is necessary and has pushed many organizations to enhance their technology to ease this burden.

Ochsner Health, a nonprofit health system based in New Orleans, had price transparency initiatives already in place for years prior to the No Surprises Act implementation—including an online estimator tool on its website. But when January 1 came around, enhancements in technology still needed to be made to streamline its GFE process.

Since the organization already had some programs in place to adhere to GFE requirements, when looking to optimize their front-end revenue cycle, Ochsner Health decided to look internally at their preexisting software while filling in any gaps with a third-party vendor.

Melissa Woods, CPC, assistant vice president of revenue cycle financial clearance at Ochsner Health, calls this the organization's hybrid approach to its GFE technology. 

"Most of our estimates generate automatically. Within our EHR system there's real-time eligibility that runs behind the scenes to verify insurance and coverage. We have batch processes that run nightly and some that run a certain number of days in advance of a scheduled service," Woods says.

Pictured: Melissa Woods, CPC, is the assistant vice president of revenue cycle financial clearance at Ochsner Health. Photo by Jonathan Bachman/Getty Images.

"We can also manually trigger an eligibility query if we need to have the latest benefit information on the patient from the insurance company. From this we get a plethora of information including what deductible amount is left, how much they have left on their max out of pocket, and the coinsurance or copay for that particular service," Woods says.

This takes a lot of the burden off staff as roughly 85% of these estimates generate automatically through Ochsner's preexisting Epic EHR system. This is invaluable since the organization now runs about 50,000 estimates a month on average.

However, Ochsner found that not all estimates were auto-finalizing using Epic. Auto-finalizing was important for the team since it would replace the manual work of employees correcting service prices.

So the organization added automation to address gaps in the current technology.

The team worked with the AI vendor Olive to help auto-finalize the estimates. For Ochsner, its third-party vendor auto-finalizes about 20% of the estimates now, massively streamlining the process.

Additional AI was an important part of a streamlined GFE process for Ochsner's revenue cycle staff, but the entire GFE process was built and centered around the patient financial experience, and the added AI helped to improve this.

Since implementing this new technology, the moment a GFE is finalized, it automatically goes to the patient's portal, and the patient is notified that there is a new estimate available. The patient can then pay for the service immediately. Getting this information to the patients quicker and more accurately greatly improves Ochsner's patient financial experience.

"Our financial clearance call center will contact patients up to three weeks prior to their appointment to verify demographics, insurance, and communicate the upcoming expected out-of-pocket amount. Patients can pay in full right then or we can talk to them about payment arrangement options. We have internal payment plans, external payment plans—all interest-free to our patients. We work with our patients to give them plenty of options to try and pay for their care."

Adding a third-party vendor for automation on top of its existing software was the key to success for Ochsner and is the reason why this is the best in technology for the organization right now. Since being able to streamline the process and autofinalize more GFEs, the patient financial experience has greatly improved, and front-end staff are less burdened. 

"My advice is to take a comprehensive look at your overall revenue cycle needs. For us, the hybrid approach worked best. We have gaps to fill with the No Surprises Act and pricing transparency requirements which are expanding faster than we can keep up with current technology and resources. That's why evolving our technology through a variety of vendors works for us right now," Woods says.

For Ochsner, having a good pricing transparency model and GFE process in place has played a large part in its preservice collections, which is no small feat as Ochsner is consistently considered one of the top performers of Epic preservice collections in the nation, says Woods.

A lot of the organization's success with preservice collections comes from their hybrid use of technology for GFEs as well as patient education.

"We have so many resources available to our patients on our website regarding the estimate process, understanding their insurance, and what to expect on their financial journey.  And auto-finalizing our GFEs allows us to provide so many estimates to our patients up front so that they can ask questions and get help understanding what their costs are going to be before they even have services," says Woods.

Tech to improve CDI and physician workflows

At the heart of the middle revenue cycle you'll find the CDI and coding departments. This area of the revenue cycle is not new to technology as it is generally seen as an area within an organization that is closely tied to reimbursement.

In fact, according to the Association of Clinical Documentation Improvement Specialists' 2022 Industry Overview Survey, 74.82% of respondents said their CDI departments are directly involved with reviewing clinical validation denials, proving the CDI departments' direct link to reimbursement.

That's why it was so important for Tami McMasters Gomez, director of coding and CDI services at UC Davis Health, to implement the best technology for her CDI and physician teams to improve CDI and physician workflows to ensure maximum reimbursement for the organization's middle revenue cycle.

Photo credit: Tami McMasters Gomez is the director of coding and CDI services at UC Davis Health. Photo taken by: Don Feria/Getty Images.

The first step, even before implementing technology in these areas, was to build what they considered to be the perfect organizational chart to support the mid–revenue cycle.

After reworking departments and adding to various revenue cycle teams, McMasters Gomez says UC Davis Health was able to get the teams to a place where they were performing optimally.

"We were demonstrating a return on our investment with staffing and physician education. Once that was in place, I thought, ‘Well, we've accomplished what we set out to do by increasing our staffing, touching every patient, educating our providers. What can we do now?' And the next step was bettering technology," she says.

At the time, UC Davis Health was using computer-assisted coding with natural language understanding (NLU), but McMasters Gomez wanted to take its technology to the next level.

"We then embarked on a journey of investigating where we wanted to go and researching what products existed out there," she says.

For the CDI team, UC Davis Health decided to deploy the 3M™ M*Modal CDI Engage One™ software, which uses advanced AI and NLU technology to embed proactive clinical intelligence into front-end and back-end CDI workflows.

This has been the best in technology for UC Davis Health's CDI team, and according to McMasters Gomez, "it has what I like to call all the bells and whistles for enhancements and workflows. It has a prioritization list that we've been able to customize to ask, ‘What are the cases we want to prioritize for review?'"

For example, if a case has already been optimized from an MS-DRG perspective or severity of illness and risk of mortality and has accurate documentation for reimbursement, UC Davis Health is not interested in having its CDI team continue to follow that case and look for enhancement opportunities.

"We want a case like that to be on the CDI team's radar in case there are any unforeseen events or quality outcomes that may occur during the hospitalization, but our CDI teams shouldn't be spending their time on cases like that," she says.

This is why UC Davis Health created specific and deliberate prioritization lists for the CDI team to work from. Each team member has their own prioritization list, and those cases pop up with an established priority number (one through four) next to them—one being the highest priority for review and four being lowest in priority for review. This helps the CDI team to utilize their review time more efficiently.

"We also have what's called ‘evidence sheets.' As the CDI teams are reviewing their cases, there is artificial intelligence that will pop up and say, ‘There's evidence in the record that this patient may need further specificity on a diagnosis, or there's evidence in the record that the patient may have a diagnosis that hasn't been documented.' This prompts the team to further investigate," she says.

When it came to enhancing the technology for the physician teams, McMasters Gomez looked toward 3M's computer-assisted physician documentation.

"The computer-assisted physician documentation is a physician-facing tool that we were very specific about," she says. "We did a lot of physician engagement, socialization, training videos, face-to-face meetings, you name it, to get physicians familiar with this technology. We didn't want this to replace the CDI team—we wanted it to enhance the overall program."

Adding computer-assisted physician documentation had several benefits for UC Davis Health. First and foremost, McMasters Gomez says, it allowed physicians to engage in real time as they were documenting during the patient care episode and allowed physicians to put their focus back on patient care. Its physicians were able to deliver more efficient care without being pinged after the fact or after discharge.

"As the physicians are engaging and documenting the patient's encounter, there's also NLU that's reading the documentation in real time and is asking for things like specificity of the documentation, such as, ‘Why are we treating this patient with this medication?' " McMasters Gomez says.

When it came to choosing technology and a vendor, McMasters Gomez says customization was key. UC Davis Health has since embarked on customization with various nudges with the vendor, which McMasters Gomez says is the key to successful adoption of technology.

UC Davis Health needed to be more sophisticated and deliberate about its technology enhancements, as it didn't want to lose physician engagement by pinging physicians for things that they already knew and documented well.

"When implementing technology, we wanted to be very deliberate about how we engaged with our teams. They are the customers and their voices matter to us. Listening to your revenue cycle teams' needs and putting patient care as the priority makes all the difference," she says.

To that point, McMasters Gomez says that technology deployment and enhancements are great, but technology can only be successful if your revenue cycle team is using it.

This is why UC Davis Health conducts extensive piloting and onboarding practices when implementing technology.

"Getting a large-enough pilot group and representation from various types of service lines is the key to success. Make sure you get a full pilot group that can provide you candid feedback, listen to what they have to say, and make sure that you actually hear them. Your revenue cycle staff and providers are your customers and if they don't engage with the technology, it's useless," McMasters Gomez says.

Since implementing these new technologies for CDI and physician teams, UC Davis has seen overall improvement of physician workflows, improved documentation accuracy, and an almost 5% increase in comorbidity capture rates.

"When it comes to implementing technology, making sure you stay flexible and willing to pivot and change is a huge takeaway," she says.

"You also have to make sure to hold the vendors accountable to product development. There may be technology that you need that the vendor is not equipped to give you, but if you had it, it would make all the difference for your organization," McMasters Gomez says. "Never stop asking them for more."

The federal oversight agency recommends CMS adopt new coding procedures to compare care quality to in-person visits.

With pandemic-fueled temporary waivers on telehealth leading to a surge in telehealth visits in 2020, especially on audio-only platforms, the practice is overdue for its own exam for effectiveness and privacy, according to a new Government Accounting Office (GAO) report.

The use of telehealth services topped 53 million visits in the period between April and December 2020. During the same period in 2019, only 5 million such visits occurred. Many of those were conducted by phone or non-video telehealth, which was rarely allowed prior to the pandemic.

[See also: CMS Proposes to Cut Audio_only Telehealth Coverage.]

The Centers for Medicare & Medicaid Services has monitored some risks to program integrity related to these telehealth waivers, but the GAO report found that CMS "lacks complete data on the use of audio-only technology and telehealth visits furnished in beneficiaries' homes," in part because no billing mechanism exists to identify all these telehealth visits.

"Providers are not required to use available codes to identify all instances of audio-only visits," the GAO reported. "Moreover, providers are not required to use available codes to identify visits furnished in beneficiaries' homes."

The GAO said this coding is important to monitor the quality of these telehealth services as compared to equivalent in-person services.

"CMS has not comprehensively assessed the quality of telehealth services delivered under the waivers and has no plans to do so, which is inconsistent with CMS' quality strategy," the GAO said. "Without an assessment of the quality of telehealth services, CMS may not be able to fully ensure that services lead to improved health outcomes."

The GAO offered three recommendations for CMS going forward:

1. Develop a new billing modifier or make clearer how to bill audio-only office visits for better tracking;
2. Require providers to use existing site of service codes when beneficiaries receive Medicare telehealth services at home; and
3. Assess the quality of telehealth services delivered during the public health emergency.

Finally, the GAO urged the Health and Human Services Department's Office of Civil Rights to offer additional education, outreach, and other resources to providers to help them explain risks to privacy and security that patients may face during telehealth visits.

Healthcare organizations are using augmented and virtual reality technology to give doctors and nurses better insight on challenging treatments.

While augmented and virtual reality is seeing success as a clinical treatment for issues like pain management, some healthcare organizations are using the technology to improve training and education for doctors and nurses.

The technology gives providers an immersive experience, allowing them to see and even act in typical—and not so typical—situations, learning how to act under normal circumstances as well as in an emergency. According to one study profiled in the Harvard Business Review, providers using a VR platform to train on a surgical procedure saw a 230% improvement on the Global Assessment Five-Point Rating Scale when compared to providers receiving traditional training.

"Today’s rapidly evolving surgical landscape requires new ways to provide access to experiential surgical education," Gideon Blumstein, an orthopedic surgery resident at UCLA's David Geffen School of Medicine and the author of the HBR story, concluded. "In addition, we must formalize our approach to technical assessment in order to more objectively measure surgeons’ capabilities to ensure a consistent level of quality and standardized skill set of our surgical workforce."

At the Johns Hopkins University School of Medicine, AR and VR are used to give future clinicians a better idea of what they'll be facing when they begin their healthcare career.

"As part of our resident education curriculum, virtual reality, used in conjunction with physical models, provides our junior residents an immersive training environment to learn a variety of procedures," says Dawn Laporte, MD, vice chairman of education and a professor of orthopedic surgery. "Our residents can practice and assess their learnings both collaboratively and independently."

"From a residency program perspective, reporting and analysis from surgical VR platforms can be an outstanding tool to benchmark individual performance, proficiency and progression of residents across various programs, and can also detect areas of weakness or improvement in the curriculum," she adds. "Any time you can decrease the learning curve and increase the opportunity for residents and fellows to learn, train, and repeatedly practice outside of the operating room, will lead to improved procedural competence and performance–translating directly to better care quality and outcomes."

Laporte says the technology platform is quite different from the traditional routine of working with cadavers or Sawbones simulation training models.

"There was a learning curve for those unfamiliar with the technology," she says. "As with the integration of any new technology there are going to be challenges, so apart from the unexpected technical issues, [there were a few problems with] encouraging utilization of VR and making sure there are enough headsets available."

"It’s important to note that virtual reality is not a replacement for hands-on training, but rather an enhancement," Laporte adds. "Particularly, VR gives nuanced and aspiring surgeons the unique ability to practice both independently and repeatedly, for continuous skills training, with minimal utilization of risk or resources."

Laporte notes that the school published a study this past April in the Journal of the American Academy of Orthopedic Surgeons (AAOS) which found that the use of VR technology developed by Osso VR "offers a more convenient and favorable method to surgical training over traditional reading materials and videos, and had similar performance outcomes compared with physical simulation training."

She says Johns Hopkins will be analyzing how the platform compares to other training methods in ease of use, comfortability, and performance, as well as confidence in a simulated VR environment.

"As we continue to integrate more VR training modules into the curriculum, we’ll explore offering tailor-made courses that meet the individual and residency program requirements," she adds. "We also look forward to the ability to introduce variability through VR modules to see how residents think on their feet or adapt when faced with unexpected events to develop the skills to anticipate and react to intraoperative complications.

At Texas A&M University's College of Nursing in Corpus Christi, administrators are using a combination of VR and patient simulation technology developed by Gaumard to help nursing students learns the nuances of assisting in childbirth and post-partum care.

"It's very difficult for students to visualize what's happening," says Lisa Snell, the school's nursing simulation laboratory supervisor. Students use a VR headset and holograms to not only virtually experience the delivery of care, but to also see what goes on inside a woman's body when she gives birth.

"Textbooks are flat, one-dimensional and often revised," says Catherine Harrel, an assistant clinical professor at the school. "This gives [students] an opportunity to see what actually happens in a normal birth as well as in an emergency. They learn how to think and respond quickly [to emergencies] they might not see that often" but which might save lives.

Snell says the program has proven its value in preparing nursing students for the real world and will soon be used in local hospitals to help nurses there improve their capabilities and stay up to date on the latest treatments.

"Teaching tends to be technical, and that can lead to some bad habits," Harrel adds. Nursing students "not only learn how to deal with different types of situations [through VR], they also learn how to communicate with patients. Sometimes that's the hardest thing to do when you walk into a [patient's] room."