3 experts on the telehealth challenges highlighted by the COVID-19 pandemic

Health systems across the nation ramped up telehealth services this year due to the pandemic, and the rapid growth of these services has highlighted several opportunities and challenges. 

The telehealth challenges and opportunities that have been spotlighted by the pandemic were among the topics discussed during a session at the Becker's Telehealth Virtual Forum on Nov. 2. The panel included: 

  • Todd Czartoski, MD, chief executive of telehealth, chief medical technology officer at Renton, Wash.-based Providence 
  • Keith Griffin, MD, CMIO of Winston-Salem, N.C.-based Novant Health Medical Group
  • Adam Landman, MD, CIO of Boston-based Brigham and Women's Hospital 

Here's an excerpt from the conversation, edited for clarity. To view the full session on-demand, click here

Question: What telehealth challenges and opportunities have been spotlighted by the COVID-19 pandemic?

Dr. Keith Griffin: We went live on video visits within our EMR six years ago and tried for six years to figure out how to fit them into the system and did everything we possibly could. When we first went live, we had a Superbowl ad about video visits, and we had Michael Jordan on a billboard actually about video visits, and could never get any traction. Over the course of six years, we did about 1,200 video visits total, despite all those efforts. Since March 13th, we've done 500,000 video visits. In the month of April, we did like 111,000 video visits. It's literally going from zero to full speed very quickly.

Fortunately, we had all the infrastructure in place already, so we didn't have to necessarily create from scratch or figure out brand new workflows. There was a lot of effort down on the billing side. Because the big change was so many of these are paid for and that was the major thing that got everybody's interest — that and the fact that you couldn't take care of patients otherwise without them. We hope that now it goes from being chaos to being part of how we would always have perceived it to be as a way to deliver care to patients that makes sense where it can be used properly. 

Dr. Adam Landman: Keith really said it nicely, and I would say we had a similar experience. I think overall what we've shown is that we can be successful with telehealth providers, patients, practices. We can do it. Keith shared his adoption statistics. We're similar just in Brigham Health, at the peak of the COVID surge, we were doing over 77,000 video visits a month and doing that well and providing high-quality care to our patients.

I think now, there's a couple of things that are ahead of us as challenges. One is the appropriate amount of telehealth to continue doing. I think we really pushed the extremes during COVID and we were really trying to see as many, really all patients that didn't need to be seen in person, we tried to see over telehealth but we know many of them need exams and do need to be seen in person. So what is that right balance? We've got some challenges with reimbursement. I think Keith alluded to this and mentioned this but we've got to figure out a long-term plan for what reimbursement for telehealth looks like. And there are some technology issues as well that we're still struggling with. In fact, most recently webcams have been on backorder. We just got a whole bunch of webcams in and ... I've never seen providers' faces happier when the shipment of webcams arrived. I think there are a large number of opportunities to come and opportunities to really build on the success during COVID.

Dr. Todd Czartoski: If anybody tells you that they have this all figured out and it's seamless and frictionless and perfect, they're lying to you. We're all on this journey, and I would echo Keith's comments. For us, having the infrastructure in place and making that investment as an organization upfront, prior to COVID, was everything. It was critically important. We've been doing telehealth … for about 16 years. It really took off about 12 years ago with telestroke and our telestroke network. We've tried historically to try to get traction in our clinics. We do have some value-based care and capitation at risk where we're responsible for populations but for the most part, still mostly a fee-for-service system. In that environment, it's just really hard to get traction for a traditional clinic visit, particularly around CMS regulations and limitations. You just can't do it, frankly. And so that was the biggest change for us I think.

Having the experience of doing over a hundred different programs and over a decade of experience kind of piloting things and learning, set us up for success so that when things hit ... it gave us this kind of alarm bell, if you will. If you look at our overall volumes over the last seven years, between 2012 and 2019, we did about 153,000 face-to-face synchronous virtual visits, kind of like we're doing right now. And 67,000, almost 70,000 of those came last year. We saw a doubling year over year for a seven year period, 70,000 last year. Our goal was to hit a 100,000 this year. By the second week in April, we were doing 70,000 visits a week. Like Adam and Keith described, there was a paradigm shift in terms of volumes and the experience in a very compressed timeframe.

What's interesting is we saw that hump early on. This explosion of volume where I think the most we ever did in one day was something like 16,000, almost 16,000 in one day across our clinics. But we haven't seen it go away. We've seen this long, what I describe as a long tail. And we're down now to seven or 8,000 a day across all of our clinics, but we're also doing close to a thousand a day of direct-to-patient or direct-to-consumer visits as well. We're at about 1.3 million for the year, and we'll probably end up the year around 1.6 million where it lands is kind of TBD, I would say. 

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