As the COVID-19 outbreak keeps spreading globally, health system leaders, clinicians on the front lines and others have emphasized the use of telehealth during a time when in-person care increases the risk that others—including those who are delivering care—could get the virus.
Indeed, there has been no shortage of reports and stories in the mainstream and trade media that have touted virtual care as a way to help triage the sick and keep the worried well out of already-crowded medical facilities. One prominent company in this space, Teladoc, which provides virtual health services in more than 130 countries, recently reported that it’s received as many as 15,000 requested visits per day.
Both public and private sector stakeholders are working to do their part in making telehealth visits more accessible as well. Leading commercial insurance companies have said they will cover the cost of coronavirus testing and telemedicine services for patients.
Meanwhile, the Centers for Medicare & Medicaid Services (CMS) on March 17 said it would temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country. Going forward, a range of healthcare providers will be able to deliver telehealth services in any healthcare facility including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes, according to CMS. For the time being, this removes a historical barrier that limited telehealth visits from occurring only at certain locations designated by Medicare.
It remains to be seen what impact these developments will have on the future telehealth market, but already, requests for virtual visits are surging across the U.S. However, as reported in this recent STAT piece, clinicians and telehealth companies now are now actually facing large backlogs since healthcare systems are typically used to having just a few virtual care consults per day.
To discuss the recent telehealth surge across the healthcare community, as well as the clinical impact that virtual care will have on COVID-19 diagnosis and treatment, Healthcare Innovation spoke to multiple leaders in this space to gauge their thoughts on these new developments. Those thought leaders are: Jay Backstrom, vice president at consulting firm Impact Advisors; Jane van Dis, M.D., OB-GYN and medical director at Maven Clinic, a New York City-based telemedicine network focused specifically on women’s and family health, and Peter Alperin, M.D., practicing physician and vice president at Doximity, an online networking service for medical professionals. Below are excerpts of their comments.
Telehealth is clearly now being seen as a valuable option in the COVID-19 response toolset. What kind of uptick have you seen on the ground as it relates to its use during this pandemic?
van Dis: Maven is the largest telemedicine provider for women’s and family health with 24/7 on-demand access to more than 20 healthcare practitioners including OB-GYNs, internal medicine physicians, and many more. With demand for virtual appointments nearly tripling, Maven’s providers have increased their availability for appointments by 5x, and even more in the states that are hardest hit by COVID-19.
Backstrom: Healthcare organizations are leveraging telehealth to meet the urgent demands for virus screening, patient triage, and care coordination services for at-risk patients. It also reduces unnecessary physician office visits and the potential spread of the virus to other patients, providers and office staff.
One of the biggest risks of COVID-19 is eventually overloading our acute care facilities due to a shortage of healthcare providers and workers. Telehealth is being used to protect the valuable healthcare professionals in several ways, including: tele-consults within and across facilities to enhance internal, non-face-to-face consultations between healthcare professionals; tele-hospitalist services for virtual patient rounding of patients to minimize caregiver exposure to infected patients; and tele-ICU services for virtual monitoring of the most critical patients to help reduce the threat to on-site ICU care providers.
There are obviously some clinical elements related to the virus that telehealth cannot help with. For which symptoms/aspects of COVID-19 do you see telehealth helping most?
van Dis: Symptom trackers serve as a first triage point. From there, telehealth is a great way to have a follow-up discussion regarding any health issues patients are experiencing. Specifically, if patients are experiencing symptoms associated with COVID-19, they can speak with a provider who will obtain their health history to determine whether or not the patient needs to get tested or seek emergency care.
Alperin: Like any severe lung problem, more severe cases of COVID-19 require physical evaluation, but telehealth can aid in the initial screening process as well as any post-diagnosis consultations. Virtual check-ups allow physicians to check in on patients with COVID-19, monitor their status and ensure they are recovering properly from a safe distance.
Healthcare professionals are at great risk due to having in-person contact with infected patients. How are providers on the front lines taking to telehealth now—especially given that some have been previously skeptical?
van Dis: This outbreak has posed a significant risk to healthcare professionals. According to a study recently published in The Lancet, 20 percent of Italian healthcare professionals working on the front lines of the COVID-19 outbreak have become infected and, sadly, even die from this virus. Telehealth is a necessary component to combat the virus, while keeping medical professionals safe. Providers everywhere are embracing the opportunity to connect with patients via telehealth appointments.
Additionally, the American College of Obstetricians and Gynecologists released a practice advisory saying OB-GYNs and other prenatal care practitioners should implement a telehealth platform given an expected decreased availability of the healthcare workforce, shortage of protective equipment. This is especially important as hospitals may face a shortage of the necessary medical supplies to protect healthcare workers.
The WHO shared a study in 2015 that showed healthcare workers were 21 to 32 times more likely to be infected with Ebola than the general adult population, depending on their occupation. Although we are still learning about COVID-19, it’s important to realize how common it is for healthcare workers to become infected as they are on the front lines of battling the virus. Telehealth can help mitigate unnecessary doctor’s visits in the wake of this pandemic and lower the overall risks.
Backstrom: Protecting healthcare providers and workers from this virus is just as important as protecting patients during this crisis. Healthcare providers are definitely aware and have been rapidly adopting telehealth in their practices. At one client [organization], last week there was a >200 percent increase in providers requesting telehealth training so they could immediately offer services to their patients. Many providers are working remotely whenever possible and using telehealth to see their patients.
Alperin: Clinicians working on the front lines may feel that these tools cannot help with certain aspects of diagnosis, but they can reduce the volume of patients coming into a hospital or health system to seek treatment. They can also support patients without COVID-19 who need their routine medical issues addressed. But, ultimately, increased use of telehealth services protects providers from being exposed to more cases of the virus or other illnesses. Telehealth can help keep more hospital beds open and providers available for patients in need. Ultimately, if telehealth is found to be beneficial, it will reduce skepticism among those who have been resistant.
In the end, when we look back on it, what impact do you believe this outbreak will have had on the telehealth market?
van Dis: As the public is being reminded, hospitals have limited capacity and are overwhelmed (or soon to be) with the sheer volume of patients in the wake of this crisis. Patients, clinicians, health systems, and insurers will apprehend the important role that telehealth plays in increasing access to care, improving outcomes, increasing patient satisfaction, and lowering cost.
Backstrom: I believe the outcome will be very positive for the telehealth market, especially in the areas of provider adoption and payor reimbursement. Many providers who have been previously slow to adopt telehealth are now effectively using it with their patients.
The current momentum with telehealth reimbursement will be a catalyst for change that should continue and be sustained post COVID-19. Establishing these capabilities now will provide greater resilience for any future crisis and will create a platform for improvements in patient care going forward.
