Is Telehealth the Panacea for Long-Term Financial Viability

by | Jun 11, 2020 | Blog

We hear the phrase “the new normal” bantered about a lot today. The idea that we may never go back to a pre-COVID world is a bit hard to fathom. But as much angst as the phrase instills on us, and it should also serve as an invitation to consider how our post-pandemic world could actually be better. In healthcare, one opportunity has already presented itself: telehealth.

Zero to Sixty

Just four years ago, only 16% of physicians said their practice used telehealth. Then along came COVID-19, and that number skyrocketed to an estimated 97%. Providers across the country have shared stories of their swift pivot to telehealth to maintain social distancing guidelines. One said it took just 36 hours to roll out a new program. They met about it one day and launched the next.

Many patients have welcomed the change, not just because it keeps them safer; it’s also more convenient, especially for non-urgent appointments. Because of “stay-at-home” orders, staying connected to family or coworkers via programs like Skype and Zoom has become the norm, so, for many, the transition has been fairly seamless. Many experts predict that patients will want to keep telehealth as an option even after the pandemic has gone. According to one survey, 84% of patients in the US would choose a provider who offers telemedicine over one who does not.

Where does that leave providers?

Where we go from here depends a great deal on commercial and government payers and whether they roll back to pre-pandemic reimbursement models once COVID-19 has waned. For now, cost-sharing has been waived so that telehealth visits are paid at the same rate as in-person visits. And the CMS has relaxed the majority of its regulatory requirements regarding telehealth, which were previously focused primarily on serving patients living in rural communities. But as of March 6, under the Coronavirus Preparedness and Response Supplemental Appropriations Act, Medicare began paying for all provider visits regardless of where the patient resides.

Reduced costs

Fortunately, the new telehealth guidelines cover reimbursement for: physicians, nurse practitioners, physician assistants, nurse-midwives, clinical nurse specialists, registered nurse anesthetists, clinical psychologists, licensed clinical social workers, and registered dietitians and nutritional professionals. This means provider offices can take on more patients via telehealth while lessening the burden on the physician’s time.

For home health and hospice providers, telehealth provides an exceptional opportunity to save on costs as providers have to spend less time driving, leaving them more time to take care of other work in the office. Being able to assess and triage a patient remotely also reduces unnecessary home visits and enables providers to address urgent issues without making the patient come into the office. Being able to respond to critical situations quickly can also help reduce hospital admissions and visits to the ER while improving patient satisfaction.

Increased revenue opportunities

Telehealth also supports remote patient monitoring (RPM) and chronic care management (CCM), allowing providers to take advantage of the new CPT codes. This opens up new revenue potential. Providers can get $42 per month for each patient enrolled in a CCM program. If only 50% of eligible patients are enrolled in a CCM where care is provided by an LPN, RN, or MA, providers could see $75,000 in net new revenue per provider.

Telehealth can also enhance a provider’s bottom line through increased care plan and medication adherence, which can lead to improved outcomes, leading to greater reimbursement. According to an article in US Pharmacist, medication nonadherence may be responsible for 50% of treatment failures and up to 25% of hospitalizations in the US each year. It is especially alarming for those with chronic conditions, where an estimated 50% are noncompliant. According to the CDC, nonadherence for chronic disease management is associated with “higher rates of hospital admissions, suboptimal health outcomes, increased morbidity and mortality, and increased health care costs.”

Telehealth with RPM and CCM can increase medication compliance through daily medication reminders to a patient’s smart device. Remote monitoring of daily vitals can help identify problematic trends that can indicate medication noncompliance. In this way, clinicians can take proactive action by setting up a telehealth check-in and finding out what’s going on.

Moving forward

Telehealth is poised to be a gamechanger in the world of healthcare, especially for chronic disease management. The ramifications could be significant in multiple ways: greatly reduced costs for the healthcare industry overall, better health for our population, and improved long-term financial viability for providers. A study by Goldman Sacs suggests that the healthcare industry stands to gain billions in cost savings by mass adoption of telehealth. Another report predicts the telehealth market could be worth $66 million by 2021.

Of course, we don’t yet know what’s going to happen once the pandemic has gone. Even if the new policies are made permanent, change is hard. It’s human nature to want to keep doing things the way they’ve always been done. But business as usual wasn’t working that well before the pandemic. It’s time to move forward and accept telehealth as a new way of providing care to our population and a better way of protecting the bottom line.

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