While there is very little good to be said about the ongoing COVID-19 situation, we can only hope that we recover from this pandemic while also making the healthcare and food systems better and stronger than they were before.
Because, if there’s any upside to this situation, it’s the fact that it has acted as an unprecedented pressure test on how to incorporate technology into different aspects of care — how to keep in touch with patients when they can’t come into the clinic, how to treat cases when resources and equipment are running low, and how to make complex decisions that require coordination between different specialists in real time with uncertain data.
In order to better understand these potential implications, we recently sat down with a panel of experts including Jared Glasscock, CEO of Cofactor Genomics, which is using genomics to develop a new generation of diagnostic tools; Dr. Chris Palmer, with Barnes-Jewish Hospital and co-medical director of its Tele-ICU; Sean Thompson, CEO of Psigryph, which is using nanotechnology to redefine the way researchers bioactive molecules across the cell membrane; and Kim Wagner, founder of pharmaceutical advisory firm, TBGD Partners.
The following is a summary of their comments on this topic.
Telemedicine is finally taking center stage.
Telemedicine isn’t new. It’s actually been around for about 25 years. But it seems like every year the industry has predicted that this year is going to be the one when it really takes off, though it hasn’t happened yet.
Turns out, 2020 is that year.
Historically, the problem is that it hasn’t been fully accepted by patients, providers, or payers. But with this crisis, obviously things have changed. Importantly, some regulations have evolved, including the announcement in March that the Center for Medicare and Medicaid Services would pay for virtual visits at the same rate as in-person visits as long as the coronavirus emergency continues. Many private insurers have followed suit.
Ascension Health, with facilities in 20 states says, that usage of its online care system increased nearly 2,000% to about 10,000 visits in March, up from about 500 in earlier months. Common Spirit Health, which operates in 21 states, says its virtual care doubled about every seven days up to 33,000 tele-visits for the week ending April 3rd.
“What we are seeing are telehealth visits, in the clinical setting, are up over the course of the past six weeks certainly in the many, many thousands,” said Dr. Palmer. “And there is now a robust telehealth presence for our outpatient clinics. It’s certainly never going away. We’re never going back to how we used to practice healthcare. We’ve really launched into the digital health era and, as we’ve been starting to focus more on value based healthcare instead of fee for service, which is really more patient centered, telehealth really delivers on that.”
Telehealth might change the doctor’s office forever.
Corollary to the rise of telehealth you’re going to see regular doctor’s offices start declining, disappearing and being acquired by larger hospital systems, which is a trend that was already happening. This might lead to broader infrastructure changes and labor force changes to enable telemedicine while accommodating for the loss of these other ways of providing healthcare.
“I honestly see hospital staffing for standard clinics and emergency medicine being significantly de-escalated,” Dr. Palmer said. “[At my hospital] we’re furloughing and some providers are being laid off currently. It’s ironic during a pandemic that hospital systems themselves are hurting, but we’re not seeing the volume in the physical space of the clinics or the hospital. So, that is going to change the workforce because telehealth is a force multiplier. Now I’m able to see more patients than I previously was so technically we need less providers, which is more cost effective for the hospital.”
But hospital operations still need attention.
Telehealth is one thing, but key issues remain within hospitals themselves. For instance, in a pandemic situation with limited access to PPE and you’re trying to limit staff exposure to a pathogen, access matters more than ever.
“My reason for being a little bearish on telemedicine in general is partly because it takes a lot for me to go to a physician in the first place,” said Kim Wagner. “So if I’ve already done the initial triage and anything that I could imagine I would need a physician for, they’re going to have to physically touch me in order to help. I can’t show them something or describe it. And, so I think [telehealth] is not going to totally replace the in-person visit with a physician. You can’t stitch up a finger or set an arm over the phone.”
And we can’t overlook underserved populations.
In the face of all this, what happens to underserved populations where internet and other electronic technologies are not available either due to poverty or distance issues in rural areas?
It’s a challenge, but smartphones and internet connectivity are more broadly distributed than they seem. The real challenge is in rural areas. They are seeing more coverage, and providers are getting interested in rural telehealth services. Per Dr. Palmer: “Rural America is a big focus of what we do at Barnes. With our tele ICU we cover over 300 patients in rural areas within Missouri and provide and get as best as we can out to those patients who don’t necessarily have access to the specialists in their area. And if there is no connectivity for those patients, if they can go to their local clinic or emergency room where there is connectivity, they can still then get access to those specialists in urban centers. It is not a perfect solution, but with the ubiquitous nature of smartphones and the improving connectivity of internet connections every year, it is becoming less and less of a challenge in my opinion.”
