After a spike in telehealth during the public health emergency, a study suggests that virtual care appears to be leveling off.
Telehealth visits are leveling off for health systems in the year since most providers lifted COVID-19 restrictions on non-emergency care, a new survey shows.
More than 80% of the 96 healthcare executives responding to the Center for Connected Medicine survey this spring said telehealth represents about 20% of their non-emergency visits.
A smaller number of hospital executives said telehealth represents about 30% or more of their patient volumes, but they expect those percentages to decline in the coming months as the COVID-19 pandemic ebbs.
Even though telehealth volumes are expected to decline in the coming months, the survey found that many health systems are planning to expand their telehealth services to monitor and manage patient populations, lower readmissions, and reduce costs.
Chronic care management, behavioral health and urgent care were the top three service lines cited by survey respondents for future expansion of telehealth.
"Telemedicine is an important technology for advancing care and improving value at health systems," said Rob Bart, MD, CMIO at UPMC and a founding partner at CCM.
"While utilization has declined compared with pandemic highs of 2020, we continue to invest in our telehealth capabilities because it is the right thing to do for our communities," he said.
The survey also found that 92% of respondents were measuring telehealth use by patients to better understand the technology's value, up from the 77% of respondents to the same question in a survey taken in 2020.
In addition, about 25% of respondents reported measuring health outcomes for patients using telehealth in the latest survey, up from 12% who said they were doing so in the 2020 report.
Even with temporarily loosened regulations and higher reimbursement for telehealth services during the PHE, health systems identified ongoing obstacles for telehealth, including patients' inability to access the technology and broadband and provider uncertainty around reimbursements.
Hospitals gained 3,200 jobs in August, a significant slowdown from the 18,000 new jobs created in July.
The healthcare sector shed 4,900 jobs in August, with slight gains by hospitals more than offset by job losses in ambulatory care and nursing homes, preliminary federal data released Friday show.
While the 3,200 jobs created by hospitals in August marks the second straight month of job growth, the pace of growth is a fraction of the 18,000 hospital payroll additions in July. And those slight gains were negated 1,200 job losses in ambulatory care – normally the job-producing engine of the healthcare sector -- and 6,900 job losses in residential care and nursing homes, the Bureau of Labor Statistics reports.
The BLS report accounts for employment in mid-August and can be subject to considerable revision.
The healthcare sector has shed 513,400 jobs since the start of the pandemic in February 2020, with hospitals accounting for 84,800 job losses, and nursing homes accounting for 383,200 job losses. Ambulatory services sector lost 45,300 jobs in that span.
There were 15.9 million people attached to the healthcare sector workforce in August, BLS said.
The larger economy created 235,000 new jobs in August, down from the 943,000 new jobs created in July, the unemployment rate ticked down to 5.2% from 5.4% in July, and the number of unemployed people fell to 8.4 million, BLS reported.
Nonfarm payroll employment is up by 17 million since April 2020 but down by 5.3 million, or 3.5%, from its pre-pandemic level in February 2020.
Stakeholders are urged to take proactive steps to protect patient data, provide perinatal staff with anti-implicit bias training.
California Attorney General Rob Bonta is reminding healthcare providers of their obligations to protect patient data and to provide anti-implicit bias training for perinatal care staff.
In a bulletin sent to the California Hospital Association, the California Medical Association, and the California Dental Association, Bonta said state law requires stakeholders to notify the California Department of Justice when the health data of more than 500 Californians has been breached.
"Entities entrusted with private and deeply personal data, like hospitals and other healthcare providers, must secure information against evolving threats," Bonta said, pointing to the recent and worrisome spate of ransomware attacks on hospitals.
Bonta urged stakeholders to take proactive steps to protect patient data, including:
Keeping operating systems and software housing health data updated with the latest security patches;
Installing and maintaining virus protection software;
Providing data security training for staff that includes education on avoiding suspicious web links and phishing;
Restricting users from downloading, installing, and running unapproved software;
Maintaining a data backup and recovery plan for all critical information. .
"I implore all entities that house confidential health-related information to be vigilant and take steps now to protect patient data, before a potential cyberattack," Bonta said.
"Implicit bias is present in all aspects of life, but when it comes to healthcare, it can be the difference between life and death," Bonta said. “In California, Black women account for 21% of total pregnancy-related deaths, but only 5% of all pregnancies. The number of deaths is even more concerning when we account for the fact that the majority are preventable."
"Implicit bias is unconscious, but training has been shown to help providers become aware of their biases and work to intentionally minimize their effects when working with patients," Bonta said.
The AG has asked perinatal care providers to submit by mid-September data that includes:
Dates of any implicit bias trainings providers have completed;
Dates of implicit bias trainings planned for the future;
Lists of attendees at each training;
Copies of all written training materials used;
A list of the perinatal healthcare workers at the facility who have yet to participate in any training; and
A description of efforts to reduce implicit bias among the facility’s perinatal healthcare providers.
Consumers in counties under a state of emergency have 60 days from the date the emergency was declared to sign up for coverage.
Covered California has opened a special-enrollment period for people in 11 counties ravaged by historic wildfires.
"The wildfires have disrupted the lives of thousands of people across the state, and we want to make sure those affected know they can get financial help to have quality healthcare coverage," said Peter V. Lee, executive director of Covered California. "Providing this path to coverage will ensure that those who have been affected by the fires have an opportunity to get quality coverage through Covered California or Medi-Cal."
The affected counties are: Alpine, Butte, El Dorado, Lassen, Nevada, Placer, Plumas, Shasta, Siskiyou, Tehama, and Trinity.
Consumers in counties under a state of emergency have 60 days from the date the emergency was declared to sign up for coverage.
The new enrollees can take advantage of subsidies provided under the federal American Rescue Plan for health insurance offered by Covered California. The new law ensures that eligible enrollees will pay no more than 8.5% of their household income on their health insurance premiums. Lee said recent data shows that nearly 700,000 enrollees now have quality coverage through brand-name health plans for $1 per month.
Nevertheless, Sutter warned that "financial challenges remain considerable and more difficult decisions lie ahead."
Sutter Health second quarter financials show that the Sacramento, California-based integrated health system had a prosperous second quarter, with reported total income of $636 million, nearly three times the $220 million banked in Q2 2020.
For the three months ending June 30, Sutter reported $106 million in income from operations, up from the COVID-related loss of $321 million in Q2, 2020. Total operating revenues were $3.5 billion and operating expenses totaled $3.4 billion.
Most of total operating revenues -- $3.02 billion – were attributed to patient services, up from $2.16 billion reported in Q2, 2020. Another $407 million came from premiums paid to Sutter's integrated health maintenance organization. The health system also reported $251 million in investment income, with the value of its investments increasing by another $270 million.
Nevertheless, Sutter warned in a press release that "financial challenges remain considerable and more difficult decisions lie ahead."
"Despite the improvement, Sutter Health's balance sheet remains vulnerable and, as such, we continue to stay the course on our plan to stabilize our system's financial health to help ensure fiscal resiliency and sustainability going forward," Sutter said.
Over the next year, Sutter said it must repay about $1 billion in pandemic relief funds, such as temporarily deferred payroll taxes. The health system says it is also adjusting to skyrocketing labor costs, which were more than $3.2 billion in the first half of 2021, and state seismic mandates.
Sutter said it's in the middle of a "sweeping financial review" that will identify efficiencies, close unprofitable services, reduce "our real estate footprint," and redeploy employees.
Rural hospitals with low patient volumes cannot easily absorb the upfront costs of establishing a telehealth network and potentially see no financial benefit from it.
Writing this month in JAMA Health Forum, researchers from Harvard Medical School said that smaller, rural hospitals with low patient volumes cannot easily absorb the upfront costs of establishing a telehealth network and potentially see no financial benefit from it.
A separate 2015 study found that telehealth upfront costs can rage from $17,000 to $50,000, with annual subscription fees of up to $60,0000 and annual maintenance costs of up to $8,000.
"Whether telemedicine is associated with a reduction in the number of transfers at smaller hospitals is less clear because a transfer may still be required after a telemedicine consultation (ie, for additional diagnostic testing and treatment)," the JAMA researchers said. "Reimbursement for a handful of consultations does not cover the full operating expenses of telemedicine."
Low volumes are also an issue for the consulting telemedicine organization, be it an academic medical center or a private company, because it's difficult to recuperate the upfront costs, such as contractual expenses, credentialing, maintenance, the analysis said.
Another barrier is the reimbursement system, which pays the telemedicine provider, even though emergency departments pay for the telemedicine service.
"While EDs can bill on behalf of clinicians, which would defray subscription costs, few do so because the administrative barriers of credentialing and licensure are prohibitive across multiple insurers, especially given the low volume of consultations and the amount of reimbursement per visit," the analysis said.
Another barrier is the lack of experience and comfort with telehealth technology by rural clinicians.
"Although telemedicine equipment (eg, the camera, software) is becoming more user friendly, if only 1 (or fewer) telemedicine consultation is necessary per month, clinicians may be less inclined to use the technology," the analysis said.
Solutions
The researchers offered a handful of suggestions to fix the problem.
"First, for acute care services, reimbursement could be made directly to the ED where the patient was seen," they write. "This payment model is more consistent with how hospitals pay for programs and would enable a more straightforward cost-benefit analysis for sites that are considering deploying telemedicine."
"Second, payment for telemedicine consultations at smaller hospitals could be increased," they said. "Given that many costs are fixed, the average cost per patient of a given telemedicine consultation at a small rural hospital is much higher than at a higher-volume center. Expanding on existing programs, smaller hospitals could also receive subsidies to defray costs of infrastructure and contracting."
The researchers also suggest that smaller hospitals could pool demand and consolidate their telehealth initiatives, copying the strategy used by vaccine-purchasing groups.
"The upfront costs of the technology would remain for each site; however, contracting services as a collaborative may generate a cumulative volume and demand that would be a more worthwhile venture for the telemedicine-providing organization," they write.
The coordination model could be built in consultation with academic medical centers and built into the Health Resources and Services Administration's 12 regional resource centers.
To access the service, telephone Teladoc directly at 855-225-5032.
Teladoc Health announced this week that it will provide free, 24/7 non-emergency telehealth access to residents, first responders and other people in Mississippi and Louisiana who are displaced or adversely affected by Hurricane Ida.
The Category 4 storm packing sustained winds of 150 mph slammed into the Louisiana coast on Sunday, causing at least one fatality, widespread flooding and wind damage, and leaving nearly 1 million people without power.
"As communities seek to navigate the impact of this hurricane along with an active pandemic, we want to make sure that those faced with devastation and displacement from Ida are keeping their health front and center and know how to get care," Bimal Shah, MD, CMO at Purchase, New York-based Teladoc, said in a media release.
"Virtual care is a proven solution that supports community health during these times, as residents from evacuated areas seek to stay healthy when healthcare facilities and providers may also be affected and unable to meet all care needs," Shah said.
Teladoc Health has offered similar services this year to communities dealing with forest fires in the western United States, and with parts of the northeast that were affected by Tropical Storm Henri.
The no-cost, virtual care offerings are for common maladies such as sinus problems, respiratory infections, allergies, cold and flu symptoms, and many other non-emergency illnesses. People needing physician-authorization for prescription refills of non-narcotic drugs can also get help.
People who think they may have been exposed to COVID-19 or have symptoms from the virus can be screened and triaged for care as needed.
The new funding from Heritage Group will support the expansion of acute care telehealth and staffing services.
Acute care telehealth and teleICU provider Equum Medicalannounced Tuesday that it has raised $20 million in growth equity from Heritage Group, and will use the funds to expand its service model and broaden the reach of its clinical staff.
"As a physician-run company, we are able to understand and meet our clinicians' needs," said Equum Medical CEO Corey Scurlock, MD. "Combined with our approach of customizing offerings to meet the specific needs of our hospital system clients, Equum Medical is well positioned to become the preeminent player in the acute telehealth market."
Lauren Brueggen, a partner at Heritage Group, said the Nashville-based portfolio has a history of investing in telehealth companies, including MDLive, Vivity Health, AvaSure, and now Equum.
"Equum Medical's physician-led and partnership-driven approach is exactly what is needed to address physician imbalances across the healthcare system," she said. "We believe that Dr. Corey Scurlock and Dr. Brian Rosenfeld are two of the most renowned pioneers in the teleICU industry and we are thrilled to partner with them to build a dominant acute care telehealth company."
The visits have provided access to primary care for communities of color, which have been disproportionately harmed by the COVID-19 pandemic.
Federally qualified health centers in Massachusetts have logged more than one million telehealth visits since the start of the pandemic in March 2020, the state's consortium of FQHCs announced Tuesday.
Massachusetts FQHC Consortium telehealth data between May 2020 and May 2021 show that telemedicine visits have provided access to primary care for communities of color, which have been disproportionately harmed by the COVID-19 pandemic.
Of the 767, 234 Massachusetts health center patients who accessed primary care via telemedicine visits during that year-long period, more than 52% were white, nearly 21% were Black/African American, more than 6% identified as more than one race, more than 5% were Asian/Pacific Islander, and 1% were Native American. Of those identified by ethnicity, nearly 31% were Latinx/Hispanic, the consortium said.
Of the total number of patients taking part in behavioral health telehealth visits during the same span, nearly 56% were white, more than 23% were Black/African American, more than 5% were of more than one race, 4.65% were Asian/Pacific islander, and less than 1% were Native American. By ethnicity, 31% again identified as Latinx/Hispanic.
"While telehealth played an essential role in maintaining continuity of care throughout the pandemic, our health centers see its continued popularity among low-income communities and communities of color, even as in-person visits are now available," said Christina Severin, President and CEO of C3.
"As we pass one million telemedicine visits, the numbers validate what we’ve seen: telehealth provides opportunities for increased access to care and diminishes health inequities faced by Medicaid patients as a result of institutionalized racism in our health care system. We thank our donors who are supporting our efforts in addressing this injustice," she said.
The milestone comes as the consortium passed the halfway mark of its Phase II $12 million fundraising goal – thanks to an $878,000 grant from the Gordon and Betty Moore Foundation – to attain sustainable telehealth capacity at health centers and address health disparities in the communities they serve.
"The digital divide disparately impacts poor communities and communities of color," said Michael Curry, President & CEO of the Massachusetts League of Community Health Centers.
"Access to broadband and other technology is a social determinant of health that must be prioritized in order to avoid the deepening of existing racial health inequities," he said.
The county and the health system will now shift to build a working plan for the partnership, which they hope to launch within the next nine months.
San Joaquin General Hospital and Dignity Health have signed a letter of intent to pursue a long-term affiliation to improve services at the safety net hospital.
Tom Patti, chairman of the San Joaquin County Board of Supervisors, said the partnership "will allow San Joaquin General Hospital to remain viable as a provider of cost-effective quality health care."
"Due to the pandemic and a variety of other fiscal considerations, SJGH will require access to clinical, operational, educational and financial assistance that could only be provided by entering into an agreement with an established, successful health care system," Patti said. "We believe this affiliation will be significantly beneficial to all parties, but especially to patients and staff at SJGH by providing a more financially-secure hospital setting which offers more sustainable care over the long term."
The county and the health system will now shift to build a working plan for the partnership, which they hope to launch within the next nine months.
