Telehealth became a necessary tool for health systems and patients across the U.S. during the COVID-19 pandemic to access needed healthcare remotely.
A major contributor to the success of telehealth over the past few months was CMS and commercial payers lifting restrictions and boosting pay rates for telehealth visits. While some of those benefits may roll back in the future, health systems are planning how to continue scaling their telehealth programs and turn them into revenue generators.
Here, 12 top health system executives outline their strategic approach to telehealth post-pandemic.
John Lewin, MD. CEO of Emory Healthcare (Atlanta): The rapid expansion of video telehealth visits at our facility, increasing from a few dozen to over 3,000 per day, or 30 percent of our usual in-person visits, in just weeks, and has been a disruptive transformation in the way that we interface with our patients. In a very short time, video telehealth visits have seen tremendous adoption and satisfaction for both our clinicians and our patients. Clearly, this model has many benefits for all involved, and our great hope is that we will be able to continue to see reimbursements from both governmental and commercial payers commensurate with the value this brings to patients and society.
However, understanding that reimbursement may drop to the point at which many of the services we currently are providing will become cost-prohibitive to continue, we see several areas that will likely remain across many of our service lines. One area that predated the COVID-19 related acceleration of our telehealth activities that will undoubtedly continue is our work providing consultation to assist physicians managing their patients in distant or rural hospitals; for example, our Emory nephrology program enables dialysis in rural Georgia hospitals without local nephrology coverage and prevents urgent transfer of renal failure patients, benefiting the patient and their family along with the local hospital and clinicians.
We also will continue our preoperative evaluations in patients who live significant distance from our facilities, along with follow up postoperative care when appropriate. There are many patients with chronic conditions who will benefit from ongoing telehealth video visits. Psychiatry consultation, allowing patients to receive care in their residence, will also be an ongoing offering. Lastly, we have, and will continue to, use video visits when providing care for patients who cannot travel to Atlanta.
While excited about the prospects, it is too early in telehealth adoption and experience to fully understand what long-term rates should be. Additionally, the same professional clinical expertise is being provided under most circumstances regardless of care setting. We therefore encourage CMS and other payers to extend waivers as currently authorized with extension of equivalent reimbursement between in-person and telehealth visits.
Martin Doerfler, MD. Senior Vice President of Clinical Strategy and Development and Associate Chief Medical Officer of Northwell Health (New York City): To start, we do not think that coverage is at risk in New York outside of the possible loss of the CMS waiver regarding geographic limitations to coverage under current law. That however is a big risk in the face of dysfunctional federal government. If that coverage waiver is not made permanent, telehealth to fee for service Medicare patients will become a non-covered service. We will have no choice but to notify FFS Medicare patients and offer telehealth services as self-pay.
The law is the law and there is no way around it. As for Medicaid and commercial coverage (excluding ERISA covered plans), New York State has coverage parity in place. This does allow payers to reduce rates below payment parity with office based services but our experience, with a limited denominator, in the latter part of 2019 and beginning of 2020 was that we were getting paid at our negotiated rates for office-based services for similarly coded telehealth visits. Were this to change we will make this part of our rate negotiations with our major carriers. Medicaid pays parity in New York State.
Rob Tonkinson. CFO, Healthcare Division and Vice President of Finance at Baptist Health Care (Pensacola, Fla.): We had a significant, rapid expansion of telehealth service in response to COVID-19, and we have found it to be an effective tool for addressing many patients' health concerns and needs in a safe, effective and efficient way. We are hopeful that reimbursement rates will be maintained at current levels. We will be monitoring the situation with all payers and will need to address accordingly if reimbursement decreases are implemented.
Nikki Harper. Vice President of Revenue Cycle at HSHS System (Springfield, Ill.): Pre-COVID we had an active strategic plan at Hospital Sisters Health System to continue to grow telemedicine. During the past few months that was escalated quickly on our timeline to swiftly provide telehealth where we didn't before (e-visits in OP hospital departments for example). In order to continue serving our patients, we responded by offering those services to keep our patients and staff safe and healthy. We have been fortunate that these solutions and visits are covered currently.
In our strategic plan, we will continue increasing our utilization of these services. We have built reports to monitor payments. We have worked with our contracted payers to talk through reimbursement and coverage for these services. We are hopeful the expanded reimbursement will continue. If the coverage and reimbursement returns to pre-COVID, we will continue to provide what we do now since it's the right thing to do for our patients. We have already secured the technology and have the resources to adequately perform these services. This will continue to be an extension of HSHS in-person services provided. In addition, we are very fortunate to have Dr. Gurpreet Mander, chief medical officer, serving in our system. He has been very active with Illinois telehealth to lobby for expanded telehealth services.
We are hopeful that his time and energy working on various committees and many capacities will have a positive impact towards helping CMS and payers continue to pay at the rates they are; and that they will see the benefit to patients in addition to positive financial impact. After reviewing the data, we know it’s by far less expensive to provide care in this setting so it's a winning situation for the providers, payers and patients.
Tim Robinson. CEO of Nationwide Children's Hospital (Columbus, Ohio): Even after this emergency is behind us, telehealth will continue to play an important role in providing care. We must take advantage of the resources we have created and the lessons we have all learned. It will be the responsibility of healthcare, governments, insurance companies and many others to make sure we use our new technologies to help the people we serve in a post-pandemic world.
Nationwide Children’s Hospital will continue to respond to the new telehealth frontier that is already here and that makes accessing care easier for our patients and families because it is the right thing to do. However to make sustainable, long-lasting change, we all must work together. For example, state governments and private insurers should relax certain regulations and reimburse for services at rates that would make telehealth sustainable, and broadening the list of treatments and conditions that can be reimbursed has also been effective.
Tom Brazelton, MD. Medical Director of Telehealth at UW Health (Madison, Wis.): Telehealth is critical to our strategic plan moving forward, regardless of coverage and reimbursement rates. Healthcare needs to move away from a 'stimulus-response' level of functioning. The reflexive 'no payment therefore no care' is antiquated and fails to tackle the social and economic determinants (and inequities) of health and healthcare in our country. Our new normal must include the lessons learned from this pandemic. We'd be foolish not to adopt the principles we've successfully put in place, tested, and adapted to over the last three months – physical (not 'social') distancing, web-based meetings, shared workspaces, work-from-home solutions, etc. and that's just on the health system side.
From the patient's perspective, the telehealth adoption rates have exceeded expectations without a change in the standard of care for those conditions that can be managed using remote technology. Our delivery model is safer for everyone without an observable difference in quality. We are seeing the highest member satisfaction and net promoter scores than ever before since the advent of widespread video visits. With such widespread adoption, we anticipate coverage will actually go up even though reimbursement will likely go down, at least initially, as we recalculate the actual costs associated with telehealth. Telehealth requires a different calculus than brick-and-mortar clinics, the cost for telehealth will be up to health systems to establish fair recompense with payers but we do see telehealth as an opportunity to bring down the costs of healthcare.
Hal Paz, MD. Executive Vice President and Chancellor of Health Affairs at the Ohio State University and CEO of the Ohio State University Wexner Medical Center (Columbus): As an academic health center we have embraced telehealth as an important part of the continuum of care we provide. The pandemic forced us to rapidly accelerate our deployment of telehealth, and this has been a great experience for our patients and for those providing care.
At the Ohio State University Wexner Medical Center, just 2 percent of our providers were offering telemedicine visits at the start of March. By April, 98 percent were doing these types of visits. In that time, the Ohio State University Wexner Medical Center has completed more than 130,000 telehealth visits. This was made possible by implementing numerous technical and cultural changes in a very short time.
We certainly endorse continuing to reimburse at the current rates and creating parity between payers. But regardless of the rates, we will continue to expand our telehealth offerings. Some patients still are not comfortable returning for in-person visits for routine care and we need to meet them where they live. Expanding telehealth was a goal at the Ohio State Wexner Medical Center from the start of my tenure here, which began one year ago. Telehealth is vital not only in the pandemic, but also to modernize our care model and to bridge healthcare disparities in the community. Telehealth needs to be part of the healthcare landscape across the country and will be part of the new normal.
David Tam, MD. CEO of Beebe Healthcare (Lewes, Del.): We are very grateful that CMS made those changes. I just got to this job three months ago, right when the pandemic started, and even then I was looking at where we are at Beebe Healthcare with telemedicine and knew that telemedicine was going to be one of our cornerstones for the expansion of our platform to take care of patients throughout the county. Even if the CMS rates change back to where they were before, Beebe Healthcare is strategically focusing on continuing to expand our telemedicine functionality for the people of this county.
My goal is to expand telehealth. There are so many things we need to do in our market, which is a very diverse area of wealthy people along the coast as well as more vulnerable populations further inland as we get into agriculture, so having the ability to do more advanced telemedicine is critical to our mission of taking care of everyone in the county.
To improve our financial status as a result of addressing telemedicine, I think of telemedicine as a revenue generator as well as serving the community, especially as we advance in the technology. Number two, I think it will actually improve our ability to get secondary services and therefore enhance our revenue in terms of testing, imaging capability and other ancillary services because we are really talking about increasing our ability to see more patients. We have so many people here that live in the county that may not have transportation or may have language barriers, and that is how telemedicine can really play a significant role to reach out to patients that we have never had a chance to reach out to before and take care of. That will generate secondary revenue in a variety of different ways. This is a way to enhance our revenue generation even if the CMS reimbursement changes back to where they were before.
Parinda Khatri, PhD. Chief Clinical Officer for Cherokee Health Systems (Knoxville, Tenn.): Enhancing and building our suite of telehealth services is a critical part of our vision and strategic plan. Our patients have experienced the convenience of virtual health and it is unlikely that they will want to go back to the 'old way' of blocking an hour-plus time in their schedule for in-person visits. We plan to forge ahead with telehealth as part of our access model, and advocate strongly for permanent financial and regulatory changes to support this approach to care.
Alexa Kimball, MD. CEO of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center and President of Physician Performance LLC (Boston): We have just completed a big experiment clearly showing that the major barriers to implementing telehealth were reimbursement and regulation rather than technology. Without those barriers there was rapid and widespread adoption. But uncertainty surrounding insurance reimbursement remains one of the biggest determining factors for ongoing success in telehealth. We no doubt will be living in a world of both in person and telecare for some time since the need for social distancing will obligate us to see fewer patients in our clinical settings.
Telehealth will help providers to balance these challenges and enable better patient access. But maintaining and expanding telehealth reimbursement is absolutely imperative. Insurers must understand that telehealth visits are often longer — not shorter — than in person visits, and require a significant amount of technical and administrative support. Yes, telemedicine can be less expensive – but that's because it requires fewer buildings, not less effort. If reimbursements drop, it's likely that clinicians will offer virtual care under only limited circumstances — and that would undo all the critical progress we've made over the past few months.
Barb Lato, MS, BSN, RN, CENP. Vice President of Patient Care & CNO of Aspirus Medford (Wis.) Hospital: Aspirus has outstanding staff and processes in place to help keep our patients and employees safe, and telehealth remains an important part of our strategic plan due to our limited access to providers and resources. We are looking to expand our current telehealth solution telehealth system as a way to keep more vulnerable patients in our skilled nursing facilities safe, by eliminating unnecessary exposures linked to trips to a doctor's office or emergency room. We are also looking at ways to bring inpatient access to services such as psych and other specialties not typically found in critical access facilities.
Melissa O'Connor, PhD, RN. Director of the Gerontology Interest Group at Villanova University and Chair of the Board of Trustees for the Visiting Nurse Association of Greater Philadelphia: We will continue to include telehealth as one of our valued tools. While reimbursement is warranted and needed, our telehealth will continue as it allows us to reduce hospital readmissions among patients who suffer from heart failure, COPD, wounds, and diabetes through the daily vigilance it allows.
Our telehealth program has also been critical in allowing the VNA to care for COVID-19 positive patients who are being treated or continue their treatment at home following a hospitalization. Telehealth has allowed us daily contact while reducing exposure to our clinical staff and provides great comfort to patients who are relying on us, home health providers, to meet their healthcare needs and are often very much alone.
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