Before the pandemic, the desire to help all patients receive the right care at the right time in the right place fueled a dramatic increase in the use of telehealth by hospitals, rising from 35% of hospitals in 2010 to 76% in 2017, according to the American Hospital Association. But prior to COVID-19, most hospitals did not have the infrastructure or the staff to support widespread use of telehealth.
Then COVID-19 changed the game. As the Centers for Medicare & Medicaid Services broadened access to telehealth and increased reimbursement—and as commercial payers followed suit—COVID-19 shined a light on the power of telehealth not just to limit the spread of disease, but also to care for vulnerable populations with greater agility. Now, CMS is considering making expansion of telehealth benefits permanent.
Can increased access to telehealth eliminate disparities in care, especially during a public health crisis? Yes—but only if providers and health plans engage specialists in delivering telehealth, convince patients of the benefits of virtual care, and ensure telehealth access for everyone, not just certain ethnic or economic groups. The experiences of two healthcare organizations point to key considerations.
Increasing Access for Medicare Patients
At Norman (Okla.) Regional Health System, a 381-bed system, strengthening access to telehealth during the pandemic not only maintained continuity in care for vulnerable populations, but also reduced the risk of exacerbating chronic conditions.
Before the pandemic, Norman Regional offered telehealth for on-demand urgent care and school-based visits as well as a weight-loss program, with two full-time employees providing care. COVID-19 demanded that Norman Regional quickly expand its telehealth program to meet the total care needs of its patients, including Medicare and Medicaid patients, who comprise half of the health system’s patient population.
Within 72 hours this past March, Norman Regional enrolled more than 170 physicians and rehabilitation therapy providers on the telehealth app and trained them to deliver virtual care using a “train the trainer” approach. The health system also aggressively marketed virtual care services to patients.
By the week of March 23, all of Norman Regional’s primary and specialty care physicians were using telehealth to meet patients’ needs. Ambulatory care providers moved online the next week, and rehabilitation services soon followed.
In April 2020, Norman Regional saw a four-fold month-over-month increase in total number of virtual visits, including a three-fold increase in scheduled visits. Meanwhile, on-demand virtual visits doubled.
The impact on care for Medicare and Medicaid patients has been outstanding. During the first months of the pandemic, Norman Regional recorded more than 4,000 virtual encounters with these patients, some of whom presented to their physicians from over 50 miles away.
The response from patients has been overwhelmingly positive. One parent who was able to schedule a same-day virtual appointment for her son wrote a letter to Norman Regional, grateful for a virtual option that limited their exposure to COVID-19 while providing high-quality, highly empathetic care. During a time of crisis, telehealth met patients’ complex care needs while protecting the organization’s financial health.
Protecting Access for Patients With Physical Challenges
For patients struggling with neurological conditions, such as Lou Gehrig’s disease (amyotrophic lateral sclerosis), traveling for treatment is often time-intensive and burdensome—for themselves as well as caregivers. Inpatient visits can last up to four hours, as treatment often requires an integrated team of providers, including neurologists, physical and occupational therapists, speech pathologists, behavioral health counselors and respiratory therapists. Driving to a clinic also presents physical challenges, given that patients often struggle with mobility.
At Penn State Health, a multi-hospital system serving patients and communities in central Pennsylvania, a telehealth program for ALS patients—now part of Penn State Health OnDemand—incorporates multidisciplinary care provided by a team of professionals. Visits vary from 30 minutes to four hours according to the number of providers the patient needs to see. Visits may be scheduled sequentially on a single day or on different days, depending on the patient’s availability, needs and tolerance.
In the first 12 months of the program, Penn State Health conducted more than 115 virtual ALS visits. The impact: Telehealth saved patients more than 8,780 miles of travel, in addition to the incidental costs associated with a visit, such as gas, food, and lodging, and patient and caregiver satisfaction were high.
COVID-19 heightened demand for virtual care for ALS patients, who are at high risk of developing respiratory complications from the virus. Prior to the COVID-19 pandemic, approximately 20 percent of ALS clinic visits were conducted using the virtual ALS platform. Beginning in mid-March, 2020, the ALS clinic transitioned to a completely virtual model. As many as 10 patients were seen by members of a multidisciplinary team on a single day, followed by a virtual “wrap-up” session at the end of the day.
Though the ALS center began transitioning some visits back to in-person visits in mid-June, it is anticipated that ALS care will ultimately involve a mix of telehealth and in-person visits, depending on patients’ needs and their ability to travel. This approach reduces the length of in-person visits, decreasing patient fatigue while enhancing access to care.
Sustaining Momentum Post-Pandemic
How can healthcare leaders continue to eliminate disparities in care using telehealth following the pandemic? Here are three lessons learned from Norman Regional and Penn State Health.
Strengthen the infrastructure for telehealth. A crisis is not the time to disrupt a provider’s workflow, so implementing a telehealth program that provides seamless support for providers is vital to increasing use and improving the care experience. Whether your organization needs to expand an existing telehealth program or launch a new one, consider partnering with a telehealth vendor with strong integration capabilities and deep clinical expertise.
Adopt a train-the-trainer approach. At Norman Regional, where department heads and staff trained physicians and clinicians to use the staff, a train-the-trainer approach ensured physicians and clinicians had multiple layers of support in building out telehealth services in near real time. It also eliminated bottlenecks in service, since Norman Regional’s telehealth support team was small—just two FTEs.
Use telehealth to provide critical education. For example, empowering clinicians to access in-the-moment guidance around proper ventilation procedures ensures that all patients gain expert care when and where it is needed most. And, as Penn State Health’s experience shows, involving caregivers in the telehealth experience is a valuable way to ensure care protocols are maintained in a home environment.
Zachary Simmons, MD, is a neurologist and director of the ALS Clinical and Research Center at Penn State Health, Hershey, Pa. Bryce Ell is the manager of telehealth, Norman (Okla.) Regional Health System, and an ACHE Member. Molly McCool-Hare is telehealth coordinator, Norman (Okla.) Regional Health System, and an ACHE Member.