Industry finds virtual visits more than just pandemic trend, along with other new approaches
Northwest Indiana health care professionals are embracing the increased use of telemedicine and the benefits it offers both consumers and providers.
While around for years, the use of telemedicine has grown exponentially during the pandemic caused by the novel coronavirus. Region health care providers and insurers say telemedicine is here to stay.
The Centers for Disease Control in February advised consumers and health care providers to adopt social distancing practices, recommending virtual clinical services.
During the first 13-week period of 2020, telehealth visits increased by 50% over the same period in 2019. By the end of March, that rate increased to 154%, according to the CDC.
Dr. Mustafa Nakawa, a Methodist Physician Group family medicine practitioner, said telemedicine is the big movement now even though the concept is not new.
Nakawa said the increased usage of telemedicine during the pandemic emerged as the insurance industry elected to pay for those visits the same way it would for regular in-office doctors’ visits.
Before the pandemic, use of telemedicine was primarily by younger and more tech-savvy people. Conventional patients were more concerned they would not receive adequate care virtually.
“When the pandemic hit, they didn’t have any other option,” Nakawa said. Patients reluctant to use telemedicine overall are now embracing the option.
“I’m getting from the patient that it makes their life and care much easier,” he said. At the beginning of the pandemic, Nakawa said his office was asking patients to move to telemedicine. Today many of his patients are requesting it.
Nakawa said, as a physician, he recognizes the difficulty some of his patients have, especially senior citizens and the disabled, just to get into his office for a traditional visit. Once at the office, patients can spend an hour or two in the office for the visit, time spent waiting their turn, filling out paperwork and checking out.
Telemedicine creates a simpler more efficient and convenient way to see patients and get them the care they need.
“It’s a win-win for everybody,” Nakawa said. He expects telemedicine’s use to grow even after the pandemic subsides. Nakawa said the future of health care will involve telemedicine and some sort of new “concierge”-type medical care.
“In five years, the hope with telemedicine is getting more connectivity between patients and physicians,” Nakawa said.
Evolving care delivery
Dr. Joseen Bryant has found the concierge approach to providing health care services to her patients is the way to go. Bryant said the model reduces costs for both her and her patients while improving client services and access.
Bryant, who does not accept insurance, charges a monthly fee for membership in her practice. That fee allows the member unlimited health care visits, virtually, in person or, if necessary, in their homes. Any necessary testing not included in the membership is provided at cost, Bryant said.
She started her new Valparaiso practice before the initial wave of the pandemic and also increasingly has used telemedicine, which already was a part of her practice, instead of in-person member visits.
“I’m doing a lot more virtual visits, telemedicine and teleconferencing,” Bryant said.
The doctor said patients can text her or call and employs teleconferencing tools and video calling. She said the pandemic has helped patients see the value of the ability to virtually meet with a health care provider.
“They’ve been very receptive,” Bryant said. “I think the convenience of it a lot of people appreciate, (and) there hasn’t really been a downside with this pandemic.”
Bryant compares herself to the “old-school family physician.” Each of her patient members have her direct line and can call or text with questions or concerns.
“You have that familiarity,” she said. “You see your physician go that extra mile.”
If the practice were more of a traditional insurance fee-for-service-type practice, it would have a huge impact on the bottom line and keep the clinic from embracing new technologies like telemedicine, Bryant said. Being a cash-based direct service provider represents a significant cost savings to members. It also means patients no longer wait days or weeks for appointments.
“A lot of folks come to like the membership model when they understand what it is,” Bryant said.
While some of her clients do have traditional health insurance, she advises those who do not to consider a catastrophic insurance plan that would cover costs associated with an unexpected illness or accident.
“I can’t take care of a heart attack in the clinic,” Bryant said. She can, however, perform cutting-edge ultrasound-guided injections used often in sports medicine.
Bryant said people can expect to see more options for concierge medicine as time goes on.
“This is definitely the way health care is going to turn eventually,” Bryant said. “The winds of change are definitely coming.”
By cutting out insurance, the practice cuts out the overhead and complexities that go along with billing and coding for insurance purposes.
Bryant said that alone is the equivalent of three employees her clinic does not need to hire. Those savings are passed on directly to patients.
“It’s just a simpler model,” Bryant said.
The model also stops those “surprise bills” to patients for costs or services that may not be covered by their insurance, or that were once covered at a certain rate and that rate has been reduced. She said it is difficult to walk into a traditional doctor’s office and find out up front what your portion of the fees will be because it depends on how the doctor codes your case.
“I was part of that system, (and) I was trained to up-code everything as much as possible to squeeze the most out of each patient (visit),” Bryant said. “I just love direct primary care, (because) it just eliminates that.”
Bryant describes the direct-service model as a “breath of fresh air.” As a doctor, she believes she can build relationships with her clientele.
“I get to treat people and practice medicine the way I thought I was going to do when I left medical school,” she said.
Dr. Randall Moore, senior vice president and COO for Franciscan Health and Care Solutions with the Franciscan Alliance, said he has a passion for redesigning models of care and putting people at the center. Telemedicine will be part of the system’s future.
“This is where we’re heading at Franciscan,” Moore said. The onset of the pandemic was a significant accelerator to what the organization wants to happen anyway: a complete system transformation. A month into the pandemic, Franciscan went from a handful of virtual visits a day to 3,000 telemedicine visits a day systemwide.
“We are going from a provider hospital-centric model to a full patient-centric care health continuum,” Moore said.
Experts say navigating the current health care model is complex because there is a lack of real coordination of what occurs. Moore said the question is “how do we make it so it’s a seamless care experience?”
During his 30 years as a physician before joining Franciscan 18 months ago, Moore said the effort to focus on health began involving more telemedicine.
“It’s not that I was a techie, but I saw telemedicine as part of the effort to put the consumer at the center,” Moore said.
Interdisciplinary teams can collaborate to consult with a patient without being in the same geographic locations. Before telemedicine, if a patient wanted to access team care, they had to come to physical sites and hope the specialists were present at the same time.
While Franciscan was planning for increased use of telemedicine, COVID-19 expedited the move. Now various interdisciplinary doctors and pharmacists can come together in the same meeting and be connected to the hospitalist and nurses tending to a patient bedside.
“They are all seeing the patient at the same time,” Moore said. During the pandemic when patients are not allowed visitors, a family member overseeing the care of their loved one also could be looped into the call.
During a traditional hospital stay, patients could have five different doctors coming into their rooms at five different times, sharing what could be perceived as five different messages. By having all the disciplines needed together at the same time, the message to the patient is more direct. The different physicians can work together to set a patient’s care plan.
Having that type of continuum of care and the access to telemedicine also helps patients get out of the hospital a day or two earlier and remain fully connected with hospital caregivers. For example, COVID-19 patients can be sent home with a tablet and a pulse oximeter to finish their last few days of recovery and remain connected to hospital staff.
Telemedicine also improves the care patients need after a hospital visit. Moore said providers can never guarantee a patient released from the hospital will make the appropriate follow-up appointments. Keeping them connected through telemedicine helps them get the necessary care.
“We can quickly escalate their care if the need is there, and 99 times out of 100, they won’t end up in the hospital (again),” Moore said.
Telemedicine takes the burden off the hospital stay.
“The hospital itself doesn’t have to be used as much as it used to be,” Moore said. Staying out of the hospital then negates the high costs while improving value and improving safety.
“Forget COVID, this is going to continue and focus on the most common causes of hospitalization: COPD and congestive heart failure, which in non-COVID years trade places (as) the No. 1 and No. 2 reasons for hospitalizations,” Moore said. “Both conditions don’t deteriorate in minutes or hours, (because) it’s usually a day or more.”
Historically, insurers have not paid for telemedicine but will pay for hospitalizations. With the coronavirus, they are seeing the value of change.
“I would say again, all of us wish (the coronavirus) never came,” he said. “But you look for the silver linings. It has forced us to move into models that are actually more valuable.”
Moore said, because of the pandemic as part of the CARES Act, Medicare created parity in payment for telemedicine visits, which helped to fuel its acceptance among health care providers. Early on in telemedicine, those reimbursements were not there for health care providers.
At some point, Moore said the thought of telemedicine will simply become medicine, like how virtual banking progressed.
“We don’t think about virtual banking, it’s just banking,” Moore said. “That’s how we are approaching virtual medicine, (and) many believe the success will come when we make it disappear into the comprehensive health system.”
Tom Kunst, CEO for UnitedHealthcare of Illinois and Northwest Indiana, agreed virtual care has been around for a while, but the utilization has been very small.
“COVID really has been an accelerant,” Kunst said.
Kunst said telemedicine visits reached their peak during the pandemic around April, but demand for virtual care remains high.
“Virtual care is going to be part of how we interact with patients going forward,” Kunst said
While most people still might want to go to a traditional provider, some national telemedicine providers can fit the bill for many telemedicine needs.
Kunst said one of the bigger positives of COVID-19’s impact on telemedicine is the increase in tele-behavioral services. Kunst said often people do not feel comfortable going to the office of a mental health provider. That reluctance can mean conditions are left untreated, potentially leading to greater problems.
“We really have a suite of solutions to meet consumers where they are at,” he said.
Kunst said there is a perception that younger people feel more comfortable with telehealth. But UHC has learned during the pandemic that telehealth utilization has been across all age groups.
“Consumers are pleased,” Kunst said. Telemedicine can expand access, manage chronic conditions and improve outcomes, which benefits patients, providers and insurers. “We could be two or three years out from uses of virtual care we haven’t even thought of yet,” Kunst said.
Consumers and the health care industry overall are slowly embracing virtual care.
“United’s view on this is we believe this will be part of those benefit packages going forward,” Kunst said.
Some terms regarding reimbursements may require revisions, but Kunst said there is an opportunity for telemedicine to expand.
Consumers still want that personal relationship with their local physician but can turn to virtual health providers for minor conditions such as pink eye. Employees are going to begin demanding this type of care.
“My prediction (is the) entire industry is going to embrace it,” Kunst said. “I view this as industry moving (because) COVID to me really has been an accelerant, (so) it’s not going away, (and) it will be a mainstream part of the system going forward.”