Telehealth lessons learned, remaining questions: 2 leaders weigh in

Hospitals and health systems have offered telehealth for years but often were hindered by regulations and other restraints. When the pandemic forced regulators to loosen restrictions on technology to replace in-person care, telemedicine was thrust into the mainstream. 

What was once seen as a niche category of technology became a well-known option for patients across varying geographies, ages and health needs. The question now is how do health systems assess their telehealth programs, which have likely expanded, hosted more visits and seen changes in regulations compared to this time last year? 

To learn, Becker's caught up with Judd Hollander, MD, senior vice president of healthcare delivery innovation at Thomas Jefferson University in Philadelphia, and Bill Manzie, administrative director of telehealth strategy for Memorial Healthcare System in Hollywood, Fla. They participated in a moderated discussion as part of the Becker's Healthcare Telehealth Virtual Forum. Find their panel on demand here

The pandemic forced Jefferson to change the way it trains clinicians and patients on telehealth. When COVID-19 hit Philadelphia in mid-March, Dr. Hollander's team realized its methods for training and educating patients needed to change to meet the sharp increase in demand.

"We actually went into the film studio and created a training video that Saturday morning and trained 170 people that weekend on how to take on-demand calls," he said. 

The system also created training modules for patients.

"Before COVID, we had five telehealth coordinators who would do a practice call with the patient the day before their real call," said Dr. Hollander. "When we had 50 or 100 or 150 calls a day, they could do that. Well, when you jump to 3,000 calls a day, you can't." 

He recommends creating training materials in chapters that are easy to update since the platform may change. 

Regardless of utilization related to COVID-19 surges, telehealth leaders are preparing for sustained use of telehealth. "Our practices say they're going to see at least 30 percent of their patient population utilizing telehealth moving forward," said Mr. Manzie. "It's a silver lining, now that they have the experience of using telehealth with their patient population. It's great to see physicians in our organization looking to utilize it as part of their everyday practice." 

Questions about reimbursement remain, presenting a significant challenge for telemedicine leaders and capital strategy. "In Pennsylvania, where I am, we're one of the states that has no telemedicine legislation. I have no idea whether my commercial payers are going to pay for it; I do know most of them pay for it now," said Dr. Hollander.

"When I think of the right thing for me to recommend to our leadership, I don't know whether I'm going to be able to shed some bricks-and-mortar building, or I'm going to need to see people in person," said Dr. Hollander. "My leases aren't month-to-month, they're years at a time, maybe 99 or a 100 years. Payers are constantly saying, 'Oh, we'll [cover telemedicine] till the end of December. Oh, we'll pay up to the end of March.' 

"Telemedicine is not free. I have to pay for licensing costs, platform costs. I have to pay for people to help the patients; I have to pay for people in the solution center; I need to know where my balance and costs are. So it's really critical that the payers give us some longer-term projections so we can make smart decisions with respect to what we're doing with bricks-and-mortar buildings and practices." 

Said Mr. Manzie: "We don't have any legislation either for telehealth reimbursement." 

Thomas Jefferson continues to assess telehealth programs' ability to improve clinical outcomes among chronic condition patients, reduce readmissions and/or reduce ED visits, among other criteria, he said.

"At this time we are getting reimbursement for telehealth, but there isn't a crystal ball out there for us that's going to tell us when it's going to stop and what it's going to be like in the future," Mr. Manzie said. 

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