While providing care via telehealth is not new for local health systems, its use amid the COVID-19 pandemic has exploded.
That’s attributed to quick moves to reduce regulation on such visits by the Centers for Medicare & Medicaid Services and the Missouri Department of Social Services, along with social distancing efforts and stay-at-home orders.
“The COVID-19 pandemic launched video visits really 10 years ahead where it would have been otherwise,” said Dr. Jennifer McNay, president of Mercy Clinic Springfield. “COVID really turned on its ear our standard approaches to care.”
At Mercy, depending on the region and specialty, video visits post-coronavirus account for between 3% and 30% of all visits. That’s a jump from less than 1% pre-coronavirus, McNay said.
The trend is nationwide. According to a report by McKinsey & Co. Health Care Systems & Services, providers are seeing 50 to 175 times the number of patients via telehealth. And that’s translating into big business. Pre-COVID-19, telehealth accounted for roughly $3 billion in health care revenue, according to the report. Post-coronavirus, that could shoot up to $250 billion in 2020.
Burrell Behavioral Health President and CEO C.J. Davis said the behavioral health system has invested $1.3 million in recent years to strengthen its telehealth offerings, including video and telephone visits. Late last month, Burrell received an additional $767,000 in funds for infrastructure from the Federal Communications Commission, which was authorized by the federal coronavirus relief bill.
Before the COVID-19 pandemic hit in March, Davis said 10%-15% of the behavioral health provider’s visits were done virtually. Now, that volume is 70%-85%.
“Although COVID has been the driver for us to move in both virtual care platforms, telehealth and telephonic, the entire behavioral health industry is transforming our delivery system to include virtual service delivery in the future,” he said. “We’ve learned a lot as a result of COVID.”
CoxHealth TeleHealth Services Manager Bridget O’Hara said that, before the pandemic, CMS was restrictive on what they would reimburse related to telehealth. Patients had to be at an “approved originating site,” she said, like a hospital or clinic, and not their homes, to receive care virtually.
“When COVID started, they changed that very quickly,” O’Hara said. “We’ve been doing telehealth for a number of years now, and the adoption rates have just skyrocketed in terms of usage.”
In addition to Medicare and Medicaid providing reimbursements to health systems, O’Hara said most private insurance companies are now reimbursing costs of virtual visits to health care systems as if they were in-person. And during COVID-19, she said many have waived copays altogether for patients, along with CoxHealth making all virtual visits free for patients experiencing COVID-19 symptoms.
CMS leaders have said they anticipate telehealth coverage for seniors to continue post-pandemic. A permanent expansion of telehealth reimbursement through Medicaid, which is determined through the state, is unclear.
“You can’t put the genie back in the bottle at this point, and it really wouldn’t be smart to,” O’Hara said.
While CoxHealth has provided virtual visits for years, she said the expansion to allow them with established primary care providers and specialists has been quickly adopted. Since the rollout in March, the health system has conducted 20,000 visits.
That’s on top of the 8,300 on-demand virtual visits, which O’Hara said is comparable to urgent care. In March, the health system’s largest month yet for telehealth, visits jumped 320% year over year.
“In March, [CEO] Steve Edwards came to us and said we need telehealth at the forefront of this crisis as a way to keep people at home,” O’Hara said. “We literally rolled it out within four days.”
That included establishing a new scheduling system for primary care and specialist providers through Microsoft Teams, and investing around $300,000 in hardware like laptops and webcams.
“Your younger demographic has already started to demand it. No one wants to come in the building. They want to text you. They want to book their appointments online. … Now, we’re just getting everybody else on board,” she said.
O’Hara said changes to telehealth regulation provide cost savings to the health system by reducing overhead costs.
“There’s a delicate balance in that,” she said. “We still need health care providers in a building. To be the most cost efficient is having your providers doing both.”
McNay noted that one of the greatest expenses to health systems providing virtual care is the electric medical record, which has already been established.
Davis said being able to deliver services virtually has eliminated some of the biggest barriers to mental health care – transportation and cancellations – which keeps patients receiving treatment more consistently.
“What the telephonic and virtual services have allowed us to do is remain more connected to people above and beyond when their appointment times are,” he said.
Telehealth also provides a cost savings to the patient with reduced or eliminated travel costs, as well as to the health system and insurance companies through better patient outcomes. When patients are consistent in their care, he said, that reduces costly hospital stays.
“We hope that our payers over the course of time are seeing the same data that we’re seeing and agree that some kind of telehealth or virtual health platform moving forward is important,” he said.
But he said virtual behavioral health care can’t be the only solution, adding post-pandemic he thinks a 50/50 mix is the sweet spot. Part of that inability to move fully virtual is related to access. Davis said not everyone has a phone or the internet, and not everyone has a private space in their home to access confidential therapy. Burrell has provided what it calls Zoom rooms to patients who cannot or choose not to access virtual care at home. While it’s an in-office solution, Davis said it allows for social distancing and also to have more doctors available on call for walk-ins, since providers don’t have to be in the same building.
“We’ve had people tell stories of disclosing information to their virtual provider that they never would have disclosed seeing them face to face,” he said. “We’ve delivered services to people driving in their car.”
Now, Burrell’s patient load is above what it was pre-pandemic. Comparing May 2020 with May 2019, the health system is treating 1,500 more clients. Davis said there also has been a significant increase in the number of calls with concerns over self-harm and suicidal ideation, which he attributes to the COVID-19 pandemic.
Dr. Shahid Kaous, an adult psychiatrist in Texas, has provided virtual care through Burrell for two years. He previously worked out of the Springfield office.
“I’ve practiced medicine for 30 years and my thought was it will be very different when you don’t have a patient there,” he said via Zoom while demonstrating a telehealth visit. “I was pleasantly surprised, 99.99% of my patients didn’t have any problems and those who did didn’t have any problems adjusting to it. It’s working so well.”
McNay, who was an internal medicine provider before joining Mercy’s leadership team, said she’s used virtual visits to monitor some of her most compromised patients.
“Our virtual processes allow us to monitor closely within their homes and monitor their vitals,” she said. “During COVID, those are the patients at the highest risk if they should contract the virus.”
McNay said health care systems must remain consumer-centric.
“Our patients run the gamut from newborn to end of life,” she said. “The key is to be able to offer the right care at the right time to the right person at the right place. The video visit allows us another avenue to do that.”
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