Telehealth: It’s going to get worse, before it gets better
At the beginning of the lockdown and spread of social distancing due to the Covid-19 pandemic, Telehealth was quickly turned to as a valuable tool to safely deliver care at a distance. Physicians both wanted their patients to stay home in order to stay safe and also to preserve the supply of personal protective equipment (PPE) which was (and still remains) in short supply.
Vendors of video chat and telehealth solutions were initially overwhelmed with demand and while a few vendors fumbled, within a few weeks things were going smoothly. The internet was not coming crashing down and telehealth finally had its heyday.
Many healthcare organizations who had either already started working on some telehealth services in the years prior or who worked with experts like the Ingenium Digital Health Advisor team quickly closed the visit volume gap, with some even seeing more patient visits per day than before the Covid-19 health crisis.
Yet many other healthcare organizations sadly did not seek or even accept help. Rather, some closed down completely while others began to “dabble” in live audio/video visits by simply buying licenses for telehealth tools and allowing physicians to work from home with whatever technology the physicians could find.
Many providers we talked to found themselves without technical support and even without administrative support; some scheduling their own video meetings with patients themselves, troubleshooting patients’ technology and making sure that their billing was correct. But many providers were not as dedicated to making it work and as soon as commercial payors, Medicaid programs and Medicare opened the loophole of paying for telephonic visits, many quickly abandoned the dismal user experience (for both physicians and patients) and resorted to phone-only calls. Mind you, that all payors strongly declared that telephonic visits ought to be the exception if video technology is not available AND if the visits can clinically be conducted via phone only.
One healthcare organization we talked to was at 70% pre-covid volume with 90% of the visits being “telemedicine” — albeit 99% of those visits being telephonic. Even though I’m not a clinician, this can’t be good clinical care. Maybe for a few weeks or one visit. But not over the long term. This is not “practicing medicine at a distance” but only “connecting with patients at a distance” at best.
Telehealth is inevitably here to stay – for now
With almost 8 weeks into the full-fledged use of distance technologies and realistically no real end to voluntary physical distancing in sight (who wants to sit in a waiting room these days??), the frustration and burnout on the clinicians’ side is becoming more and more evident. Healthcare workers have always been admirable in making the best out of the worst, making things work with very little in order to serve their patients.
The solutions for structuring the processes and customizing the technology to enable stellar telemedicine are simple to the expert eye, so it’s painful to watch how so many organizations are suffering the financial losses and are taking their ignorance about doing it right out on the frontline healthcare workers. Simply put, with all their energy spent on getting the best care possible with the tools they’ve been given, there is no energy left to fight for a betterment of their working conditions.
In the past years the majority of physicians had only heard about telemedicine conceptually, in passing and most had been wary about it’s real-life application. And now, thrown into the use of telehealth to preserve their own and their patient’s health from a Covid-19 infection, they are quickly finding confirmation that telemedicine is not the solution for them. Because the majority of them simply don’t know it could be better. Their administrators don’t know it could be better. Their technical support staff don’t know it could be better.
The Future is already here, it’s just not evenly distributed
Well before Covid-19 many renowned healthcare organizations had built high-performing, financially sustainable telehealth programs with stellar provider satisfaction and wonderful patient health outcomes. But those programs’ successes did not come overnight. Some had the magic input of experts to avoid the most painful lessons. Many had to go at it alone for years and achieved success through many hard lessons.
At the beginning of the crisis we contemplated whether Covid-19 could be the worst thing that happened to telehealth. For the past weeks, it didn’t seem that way. Patients are seemingly embracing it, the media covers it and many healthcare organizations are doing a fine job enabling their clinicians to practice medicine at a distance.
But across the nation many healthcare organizations continue to suffer financially. Within those organizations most providers are becoming increasingly frustrated with telehealth. Already some articles have written about the impending exodus of exhausted healthcare workers into retirement when the worst of this health crisis is over. And their experience with telehealth will only accelerate this exodus.
There is hope, and it is us
As current and future healthcare consumers, it is in our best personal interest to ensure that our “traditional” care providers are equipped to do telehealth well. While telemedicine-only providers can provide an intermittent superior consumer experience, the long-term fragmentation of care and erosion of the business models that allow many health systems to stay alive, bear a far greater risk.
The solutions, and I’m not talking about technology here, are out there. There are proven ways to do telehealth well. I’ve used them for 12 years to launch dozens of telehealth services. But like with any profession that requires expertise, the little tips and tricks are not as obvious to the inexperienced eye.
Over the next 8 weeks, I’m fully expecting an increasing backlash against “distance care”, first by the providers, then by the patients frustrated by the limitations of phone-based or poorly executed video visits; and then the payors when studying health outcomes (or lack thereof).
And only when we share our best practices with those that are stumbling and fumbling, will we ensure that telehealth is indeed here to stay as a viable way to deliver extraordinary care.
So, please, share my Telehealth Tuesday articles with healthcare administrators and clinicians. Or contribute to the building of a Telehealth Community (telehealth.community) where we all can share our best practices with others who are struggling.
This is not about consultants winning business. This is about saving access to good, affordable care.
Here’s to the future of telehealth, accessible to and loved by all!
Christian Milaster and his team optimize Telehealth Services for health systems and physician practices. Christian is the Founder and President of Ingenium Digital Health Advisors where he and his expert consortium partner with healthcare leaders to enable the delivery of extraordinary care.
Contact Christian by phone or text at 657-464-3648, via email, or video chat.
Christian Milaster optimizes Telehealth Services for health systems and physician practices as the interim Telehealth Program Director. He serves as a Digital Health & Telehealth Advisor to startups and established Health IT firms.
Christian is a Master Builder of Digital Health and Telehealth Programs and the Founder and President of Ingenium Digital Health Advisors, a boutique consultancy focused on enabling the effective delivery of extraordinary care through workflow optimization and the judicious use of technology.
Born, raised, and educated as an Engineer in Germany, Christian started his career at IBM Global Services before joining the Mayo Clinic in Minnesota, where he worked for 12 years in various roles before launching Ingenium in 2012.