Telehealth and next big hurdles: integration and payment

01 July 2020


telehealth

Four experts with the VA, Providence St. Joseph Health, Microsoft and One Medical shared what is needed for continued adoption of telehealth. Most pointed to better integration with clinical workflows and new payment models as future drivers for growth.

In the past few months, many health systems have jumped forward years in developing their telehealth programs. Within a matter of days, Seattle-based nonprofit system Providence St. Joseph Health saw virtual urgent care visits jump from 50 per day to 1,500 per day. The Department of Veterans Affairs retooled its telehealth system to be able to handle more than 15,000 patients in the system at any one time. Before, it could only handle 3,000 at once. But after soaring to peak heights, telehealth visits at both facilities have started to plateau, as patients begin venturing back into the office for appointments.

How can health systems keep the momentum going for further adoption of virtual care tools? Integration into existing workflows and competitive payment structures will be needed, four experts said in a panel the American Telemedicine Association’s annual conference. “I think we’re going to see increased simplicity and more integration,” said Kevin Galpin, executive director of telehealth for the Department of Veterans Affairs.“The key is putting this in the provider workflow so it doesn’t feel like something else.”

According to a recent survey of more than 1,000 health executives by health IT company Innovaccer, 57% of hospitals used technology to screen and triage patients, and 89% offered telehealth appointments. But the majority of them were using standalone telemedicine solutions that are not connected to their health record systems. With better integration, Galpin expects to see an uptick in the use of remote monitoring tools in the future. The VA already has some remote monitoring programs in place that it was able to expand during the pandemic.

A few years ago, the VA launched a program to send out connected iPads to patients that have limited internet connectivity at home. More recently, it added the ability to send patients stethoscopes, scales and pulse oximeters. The VA also launched a remote monitoring program for patients with Covid-19, based on existing programs for patients with diabetes and COPD. Providence St. Joseph Health, which combatted the first U.S. outbreaks of Covid-19, also developed a framework to monitor patients remotely. The health system purchased thermometers and pulse oximeters to send to patients — though not “smart” devices with Bluetooth connectivity.

“We didn’t have to deal with any of the Bluetooth connectivity issues or frankly the expense of distributing devices that are hundreds of dollars to each of our thousands of patients,” said Sara Vaezy, Providence’s chief digital strategy and business development officer. Instead, patients would be prompted three times per day to input their temperature and oxygen saturation readings through a secure web form created by a startup called Twistle. A group of tele-ICU nurses would be able to simply view that data in the patient’s health record, thanks to an integration through another startup, Xealth. “Prior to putting this in place, our nurses were calling folks several times per day,” Vaezy said.

In this lull where health systems are beginning to offer more in-person care, but patients are still hesitant to come into the office, Vaezy sees an opportunity for continued adoption of telehealth. But future expansion will depend on the “…degree to which we integrate it and make the experience for our providers and our patients frictionless,” she said. “We’re all very excited we’ve overcome some of the (onboarding) folks onto these new technologies. But we have some work to do on the experience side of things to drive maintaining and sustaining the progress that we made.”

How much to pay?

The other big question looming over virtual care — whether in the form of video visits or asynchronous chats — is how to reimburse for it. Prior to the pandemic, reimbursement for telehealth was less than optimal, the panelists agreed. But emergency regulations changed that, with most physicians getting paid the same for telehealth visits as in-person visits. Should that continue?

“I’ll say something which might be kind of controversial. I don’t think over the long run, reimbursement should be the same,” Vaezy said. “When you convert something to digital, it should help the cost of that thing and the price of that thing go down. That’s not to say it should be reimbursed at historical rates, either.” Fatima Paruk, chief medical information officer for Microsoft Health and Life Sciences, said she expected to see more companies ensure financial incentives are in place for virtual care to be a success. At the same time, the opportunity for reduced overhead costs could be a big selling point for telehealth.

“You don’t have to turn around patient rooms and outpatient clinics. If you can deliver this stuff virtually and a heck of a lot more efficiently so you can get to the next patient on time, I think all of a sudden there’s a whole additional value proposition here that has not been quantified,” she said. Others advocated for throwing out traditional payment models altogether, especially as virtual care begins to encompass a wider variety of services than just video visits. Dr. Tom Lee, founder of One Medical and his newest primary care venture, Galileo, said the conversation needs to shift from measuring telehealth services as a proportion of in-office visits.

“We have this arbitrary unit called the office encounter. How does that get micronised into a text message, a voice mail, an asynchronous video?” he said. “It’s a challenging thing. Do we really want to go in the direction of measuring every CPT (code) associated with every single activity?”


Published by medcitynews.com on June 22, 2020
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