Telehealth on the Rise
Telehealth has been around since the late 1980s, being primarily used in rural and remote areas. However, up until now, it has not been widely used.
One of the main reasons are licensing and payment. How can a doctor in one state legally treat a patient in another state if they aren’t licensed there? How are video visits reimbursed and are they at the same rate as in-person visits?
These major obstacles have all but disappeared since the start of the coronavirus pandemic. The Health Insurance Portability and Accountability Act (HIPAA) has loosened the regulations as to cross-state licensing. Healthcare professionals can now provide virtual care to patients across the United States, whether they are licensed in that state or not.
Furthermore, the Federal Communications Commission (FCC) has recently announced that changes to the Universal Service Fund’s Rural Health Care Program will help expand access to broadband and Wi-Fi. This will help patients living in rural areas, where the signals tend to be weak, to have the ability to seek medical help from home, without needing to travel and take unnecessary risks.
The need to make rapid changes proved to be successful for Florida’s Baptist Health, who immediately managed a demand surge by putting in place a telephone hotline for their 11 sites. In doing so, they repurposed 60 staff members to answer all calls and provided them with scripts and protocols. They even went as far as to introduce chat bots online when patients frequented their website.
The use of digital health devices such as digital stethoscopes and otoscopes as well as portable ECG monitors has also provided patients with a way to monitor their health from the safety of their home while still sharing results with their doctor. When in-office visits can be avoided, especially during this pandemic, the risk of cross-contamination is reduced and shifts the point of care to the patient.
According to a McKinsey Report, this situation has led to providers seeing 50 to 175 times the number of patients through virtual means than they did before the coronavirus pandemic. This rapid adoption is projecting $250 billion of current US healthcare spend to be virtualized.
Dwindling Primary Care Doctors
The primary care fields of family medicine, internal medicine and pediatrics offered the highest number on record of positions in 2019, According to a Match report. A total of 8,116 internal medicine positions were offered, but only 41% were filled by seniors continuing their medical degrees from U.S. medical schools.
One of the reasons for the low position filling is that younger doctors are reticent to the bureaucracy from government and private payers, coupled with the fact that family medicine is among the lower paying specialties.
To add to the ongoing shortage of primary care doctors, baby boomer doctors are close to retiring and have been greatly affected by COVID-19. It’s no secret that the pandemic has resulted in a financial crisis for family physicians, some of which decided to take an early retirement or explore other professional options.
How will the coronavirus affect primary care physicians in the long run? One thing is certain, most will move towards ways of earning monthly revenues through the delivery of virtual care or other means of providing great patient experiences.
The move from fee-for-service to value-based care will certainly help keep primary care physicians afloat, but only time will tell if the pandemic will be the tipping point away from charging for individual services. If another wave hits, physicians getting paid per patient will be in a better financial situation than their colleagues getting paid per service.
The Decline of Hospital-Based Care
Since the start of the global pandemic, hospitals across the United States have been flooded with patients who have contracted the coronavirus. With the shortage of supplies, many have closed off other non-emergency services to secure and maintain resources.
COVID-19 has also put less focus on hospitals for non-emergency services, as many are staying away in fear of catching anything other than what they might already have.
This is concerning not only for hospitals that have spent millions on orthopedic centers and other high-income facilities, but for others trying to simply stay open. As many are reeling from the financial shock of the pandemic, some hospitals in rural areas could be on the verge of closing, diminishing the already scarce access to care that many people have in such areas.
An article published in the JAMA Health Forum addressed the issue of where Americans should get their care in the future. As the coronavirus has shifted the way we seek care, patterns of care are also changing in walk-in clinics and urgent care centers, among others. The article puts emphasis on social determinants of health, recognizing that there are many institutions that people can reach out to such as schools and public housing as better locations for care. They also put forth the idea of using some hospitals as hubs for services that are not just clinical.
The pandemic has made many sectors of the health care system reevaluate the way they operate. Many of these changes are likely to stick around, leading many to question the later fallout of COVID-19.