TEN TRANSFORMATIVE TRENDS 2020
Telehealth, COVID-19, and a Suddenly Rearranged Future
No area of U.S. healthcare delivery and payment has been revolutionized more rapidly because of the COVID-19 pandemic than telehealth—with major implications for the future of care delivery nationwide By Mark Hagland
TEN
TRANSFORMATIVE TRENDS
I
f there’s a single marker that speaks to what a shattering development the COVID-19 pandemic has been in the first half of 2020, it’s what’s happened in the area of telehealth in the U.S. healthcare system, transforming the landscape of care delivery within weeks. In February, the Chicago-based Ameri- can Medical Association (AMA) published the results of a comprehensive study of the area of digital health, including of the development of telehealth in U.S. patient care. That study, entitled “AMA Digital Health Research,” found that the adop- tion by physicians in practice of televisits and virtual visits doubled between 2016 and 2019, while the use of remote moni- toring and management for improved care increased from 13 to 22 percent. Given how
“More has happened in the past few weeks with tele- health than in the past 20 years…It’s been a real stimu- lation for telehealth, in an un- fortunate crisis—the greatest thing to happen to telehealth, for the worst reason. But COVID-19 will create a new normal, and telehealth will be a big part of that...” -- Jay Backstrom
limited the actual adoption, healthcare system-wide, of telehealth was before February 2020, those numbers seemed noteworthy. But then, the COVID-19 pandemic hit
the United States, as well as the vast major- ity of countries around the world, and 22 percent was simply no longer going to cut it any longer. And as hospitals, medical
groups, and health systems began shifting as much patient care to remotely based as possible, to protect everyone’s health and safety, and to minimize the use of personal protective equipment (PPE) in hospitals and medical clinics, the federal Centers for Medicare & Medicaid Services (CMS) on March 17, announced a temporary but sweeping change around the approval of and reimbursement for telehealth services for Medicare beneficiaries. Following up that policy change, which temporarily abolished most of the interstate physician and nurse licensing restrictions previously inhibiting telehealth-based care delivery, within a few weeks, huge numbers of hos- pitals, medical groups, and health systems had shifted vast portions of care delivery, including both routine primary care and specialist physician-patient visits, and initial triaging of patients prior to hospi- talization, to tele-based formats. What’s more, CMS on that date not only opened the floodgates to telehealth-based care delivery for primary care and for triaging purposes, but also to preventive health screenings and to mental health counsel- ing, nationwide.
Most industry observers believe now
that the lifting of most licensing restric- tions will inevitably be maintained, mean- ing that all those bureaucratic obstacles to telehealth’s expansion will finally be eliminated, hopefully for good. Among those industry experts is Jay
Backstrom, vice president and telehealth practice leader at the Naperville, Ill.-based Impact Advisors consulting firm. Back- strom says, “More has happened in the past few weeks with telehealth than in the past 20 years. And that includes the policy and reimbursement side. It’s been a real stimulation for telehealth, in an unfortu- nate crisis—the greatest thing to happen to telehealth, for the worst reason,” he says. “But COVID-19 will create a new normal, and telehealth will be a big part of that, going forward.” Backstrom not only confirms the scale of the sudden transformation; he also
2020
notes its breadth. “Usually, when I talk about telehealth, most people focus on the ambulatory/outpatient side, with video visits for physician offices, clinics, and urgent care centers,” he says. “Each client was in a little bit different situation; some had already established a telehealth solution that had been adopted at a cer- tain level, and then exponentially went up to 90 percent or more of their visits. But, he notes, much needs to be put in place, around training, support, and clinical pro- tocols. In other words, he says, “There’s a whole lot of operationalizing that has to occur.” Indeed, the COVID-19 pandemic has
forced innovation along a number of dimensions, including on the inpatient side of care delivery, where the need to do everything possible to minimize infec- tion, as well as to minimize the overuse of PPE, has led to pioneering work in hospitals worldwide. For example, lead- ers at the 1,700-bed Sheba Medical Cen- ter in Tel Aviv, Israel, have been making major advances in treating patients with COVID-19 or who might have COVID-19, leveraging a range of telehealth-capable and telehealth-related technologies to keep clinicians and hospital staff mem- bers safer, while also enhancing the patient experience.”
As Eyal Zimlichman, M.D., a practic- ing internal medicine specialist and the chief medical officer and chief innova- tion officer of the hospital, and who has helped lead the telehealth initiative, told Healthcare Innovation in late March, Sheba Medical Center clinicians and administra- tors have been working hard and fast to set up telehealth as a fundamental strat- egy for safely delivering care to patients suspected of having COVID-19 and those who have been diagnosed. They have been
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