Achieving a Harmonious Balance Between Teleheath and In-Person Care

Portrait of smilling senior doctor of medicine in his ordination

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Baby Being Tossed playfullyDon’t Throw the Baby Out

Are you even blogging if you don’t use the phrase “new normal” somewhere within your writings these days? Whether you’ve grown tired of reading the phrase or not, the 2020 adage does sum up today’s Thinking Thursday TIPs topic perfectly. As the numbers in vaccinations increase and the number of COVID-19 cases decrease, it’s tempting to return to business as usual and “throw the baby out with the bathwater.” There were some major advancements made for the world of medicine thanks to the pandemic and we have to work intentionally to not lose what was gained.

In last week’s blog, we discussed the role of telehealth visits and the favorable impact telehealth has on the patient’s overall experience, leading to improved overall patient satisfaction scores. This week we’re looking ahead at the “new normal” as it pertains to caring for patients. In their essay, “Physician Requirements for Adoption of Telehealth Following their SARS-CoV-2 Pandemic,” authors write, “SARS-CoV-2 has made telehealth an essential tool to protect access to care and to respond to public health needs.” (1) Obviously, there was a huge surge in the rates of telehealth in 2020, but what about now? How do healthcare facilities achieve a balance of virtual care and in-person care operating harmoniously under the same roof while effectively meeting the patient’s needs and optimizing the facility’s resources?

man and woman at whiteboardAn Opportunity to Reimagine

I love Dr. Rachel Reid’s optimism. As quoted in a Medical Economics journal, “I think the pandemic gives us an opportunity to reimagine the ways we ensure that the care we’re delivering is high quality and easily accessible… I don’t know that anyone’s nailed exactly what that transition looks like yet, but it’s exciting to think about what could be.” (2) Kevin B. O’Reilly captures the overall success of telehealth in his blog regarding the Telehealth Impact Physician Survey. He writes, “More than 75% of respondents said telehealth enabled them to provide quality care for COVID-19 related care, acute care, chronic disease management, hospital or emergency department follow-up, care coordination, preventative care, and mental or behavioral health.” (3) Furthermore, he writes, “Sixty percent reported that telehealth has improved the health of their patients, while more than 80% indicated that telehealth improved the timeliness of care for their patients. A similar percentage said that their patients have reacted favorably to using telehealth for care.” Clearly, the increase in telehealth usage was a silver lining of the pandemic and can remain a useful tool for healthcare going forward.

physician checking a patient's backExtending the Relationship

Eric Wicklund explains in his article, “Value-Based Care Requires a Balance of Telehealth, In-Person Visits,” that health systems shouldn’t think of one type of care replacing the other. Instead, they should be complementary to one another. (4) He writes, “When we look at balancing in-person and virtual care, what we think about is extending the relationship… What we want to look at is how could we augment and enhance that relationship, so it can continue after the encounter (and) before the encounter. And what virtual is allowing us to do is work into the everyday lives in which people are living. So it’s less about (replacing) the in-person visit with the virtual visit.” This philosophy of examining the patient’s health data outside of the limited amount that can be collected during a fifteen-minute office visit points to a holistic understanding of the patient’s health. His article is very intriguing and worth a thorough read.

balanced rocks on a mountain topPrinciples and Practices

Harvard Business Review’s article, “Balancing Virtual and In-Person Health Care,” provides readers with some practical principles to consider when working to balance both types of care efficiently:

  1. “[P]ractices will need to develop criteria for triaging and scheduling patients for in-person or virtual visits. These criteria may be diagnosis- or symptom-based, or could rely on visit types (post-op, routine physical, etc.) and will likely vary across specialties depending on the clinical needs of the patient populations.” (5)
  2. “[O]nce technical functionality is established, virtual care needs to be optimized to meet other core provider and patient needs.” Consider implementing an interpreter service so as many patients as possible can participate in virtual care. Also, a diversified technology toolbox is necessary in order to perform the various necessary tasks within a visit such as live videoing, reviewing medical records, sending relevant text messages, etc. (5)
  3. “[K]ey performance indications should be designed to assess the effectiveness of virtual care models…[M]onitoring relevant metrics such as the lag times between scheduling and visit date and visit length are important, as well as payment parity compared to office visits as state and federal governments work to ensure comparable payment for virtual care.” (5)
  4. “Our success will depend on reducing the digital divide as much as we can, and making sure that these visits are provided equitably, particularly to patients with social determinants that can limit access to care.” (5)

doctor making notes at her deskSlow, Steady March

Looking back at Jeff Bendix’s previously mentioned journal for Medical Economics, he explains one of the largest hurdles to finding the balance of virtual and in-person care is out of healthcare providers’ hands. He writes, “[T]he pandemic’s full potential to transform primary care won’t be realized unless the changes the government put into effect at the start of the pandemic – allowing Medicare to reimburse for remote visits at parity with in-person visits and reducing or eliminating visit site restrictions – are allowed to continue after the PHE expires.” (2) However, there are many who see the benefit of telehealth and are lobbying to make the PHE telehealth rules permanent. The goal is for healthcare providers to be compensated for patient care regardless of the chosen modality.

Executive vice president for programs at The Commonwealth Fund, Melinda K. Abrams, MS provides a realistic, but hopeful perspective. She states, “The pandemic hasn’t been a massive accelerator to value-based payment but more of a slow, steady march. And I think it’s because making that transition requires a certain level of investment in information systems and staffing and changing workflows. And pursuing an innovation agenda in the midst of a pandemic is really hard. That said, I still believe the pandemic has demonstrated the importance of value-based payments, and we will continue the forward march.” (2)

Portrait of smilling senior doctor of medicine in his ordinationMarching Orders

Healthcare providers carry the responsibility of delivering quality care for their patients and telehealth is now a proven tool in doing so. The marching orders are clear: continue advocating for quality patient care and appropriate healthcare provider compensation. The world needs to see the beauty of the balance of both virtual care and in-person care in order to make lasting changes for the betterment of healthcare. In conclusion, I’ll leave you with a quote from the previously mentioned Harvard Business Review article: “As we enter a new era of virtual healthcare spurred on by Covid-19, these models will be judged not by their dizzying initial growth, but by their ultimate clinical quality, patient experience, technical reliability, financial sustainability, and health equity.” (5)

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Thank you!

Jerry L. Stone
MedicalGPS, LLC



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