Telehealth comes with a number of important challenges. COVID did teach us that none of those challenges can’t be overcome. However, it’s not hard to see that many healthcare organizations are slipping back into old habits. You’ll often hear me talk about the powerful force that is “how we’ve always done it.” However, in the case of telehealth, the real key for me is the telehealth value equation.
The cliff notes version of the telehealth value equation is that telehealth is better for patients (often dramatically better), but it’s not for doctors. In fact, as payment parity has been slipping away, telehealth can often be much worse for a doctor. However, even if payment is the same, telehealth does very little to relieve the doctor from what they’re required to do during a visit. That’s not a good recipe for success.
While these are challenges, they are challenges that aren’t technically hard to overcome. Just pay doctors more for telehealth (or at least the same). However, even with payment parity, telehealth still faces other challenges that I keep hearing about. It’s hard for many of us that are largely affluent and live in big cities to understand, but many people don’t have access to broadband internet. No internet makes telehealth a real challenge. In fact, there’s no telehealth value equation without connectivity.
Deanna Larson, President of Avel eCare in South Dakota, recently testified about this challenge at the Senate’s telehealth hearing. Larson shared something really amazing about the role telehealth has played during COVID:
Take for example our work with COVID-19 patients. One life-threatening symptom that requires immediate care is the shortness or loss of breath that can often accompany a severe case of COVID. This can be an unsettling and traumatic experience for patients and caregivers. By having access to video telemedicine services, clinicians can more fully assess the severity of illness to determine the best course of treatment. They can reassess frequently throughout the day if needed. Patients have direct visual contact with a trusted clinician who can talk through the treatment options, discuss alternatives, and provide a calming presence. The ability to effectively manage significant COVID illness at home has been invaluable to patients, the health care system and to payers. But, access to reliable, fast internet is critical to the availability of these types of programs.
In another federally funded initiative, the National Emergency Tele-Critical Care Network, or NETCCN, we are working with HHS and the DOD to provide critical care expertise to hospitals and municipalities struggling with COVID-19 surges. Over the last year, we have been deployed a dozen times to support the care of thousands of patients in community ICUs, COVID hospital units, and at patients’ homes. We know we have saved lives, supported the healthcare system, and alleviated burnout of our vulnerable clinical workforce. The ability to deploy this telemedicine support to communities in stress requires speed, regulatory relief, and importantly, reliable broadband even during times of high network demands.
First, I’d never heard of the NETCCN effort, but sounds like an amazing group of people at the front lines of the pandemic. What a great effort!
However, the larger message here for me is the value of creating a direct channel from patients at home to clinicians in the hospital. Anyone who’s been at a healthcare organization that’s being overrun by COVID patients knows the value of being able to remotely monitor a patient. This remote monitoring is great in identifying patients that need to come into the ED. However, more importantly, it identifies patients that don’t need to come in and be seen by person.
Think about how impactful it is to keep patients out of the hospital. It’s great for the patients. It’s great for the doctors who don’t have patients taking up beds that don’t need to be seen physically. It’s great for the health system that doesn’t have to pay for the patient’s visit to the hospital. It’s great to help relieve the hospital from caring for patients who don’t need that level of care. Plus, it frees up the healthcare organization to care for those who do need it.
Thinking back to the telehealth value equation, this is great for everyone involved. Even the doctors working in the ED. Of course, when you think about many people’s lack of broadband internet connectivity, that’s where this falls apart. Yes, a lot of things can be done via a phone call. However, we all know a video visit with a patient is more powerful.
While it’s great that it seems like every other day money is being invested in a new telehealth company and we keep adding more and more of them to our telehealth video visit list and our remote patient monitoring (RPM) list, we won’t have the impact we need from these companies if patients don’t have access to broadband internet.
