Tom Sullivan | March 20, 2020
COVID-19 will prove to be an igniting moment for a patient-centric care model and that change is already kindling on a global scale.
Amid the COVID-19 pandemic, in fact, the U.S. government and private sector are quickly and aggressively rewriting the rules of health care in several ways. We’ve seen sweeping changes: The Centers for Medicare and Medicaid Services issued new rules that expand telehealth and waive HIPAA, followed by CMS enabling all medical professionals to practice across state lines whether virtually or physically. The DEA announced that because of COVID-19, physicians can temporarily prescribe controlled substances via telemedicine without a prior in-person exam.
Taken together these offer a picture of the increasingly virtualized world we all know is coming but has thus far felt like a distant point on the horizon.
Indeed, one can now envision the various pieces enabling a world where a patient in Topeka, Kansas, can consult, via consumer apps such as Facetime, Google Hangouts, iMessage or Skype, with a primary-care specialist in Boston, a cardiologist in Los Angeles, or just about any type of doctor elsewhere in the country — who, in turn, can now finally be paid for delivering care virtually. Atrium Health, based in Charlotte, announced that virtual health visits in the last week have gone up 500 percent.
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Former Veterans Affairs Secretary David Shulkin, MD, is among the health care leaders who anticipate these changes lasting beyond the pandemic.
“When we find this is a better care model for patients, it’s more effective for everybody as we move toward value-driven health care, and it enables doctors to deliver care at lower costs, more efficiently and in a safer way. I don’t understand why there would be a reason to go back,” Shulkin says. “I think it won’t be possible to put that genie back in the bottle.”
VA déjà vu?
The Veterans Affairs’ Anywhere to Anywhere Telehealth program, in fact, was something of a pre-cursor to these policy changes.
Started under Shulkin, and announced in May of 2018, the VA program involved lifting restrictions that have long been barriers to telehealth use and reimbursement.
“VA needed the ability for physicians to reach people in locations all across the country so I pushed for federal supremacy to allow VA providers to use telehealth at any location. It didn’t have to be in a specific facility, and it needed to be across state lines, to make care more accessible,” Shulkin says. “That’s a lot like the changes CMS just made.”
The administration also relaxed HIPAA regulations by waiving the Privacy Rule for 72 hours after a hospital puts its disaster protocols into place. This includes requirements to obtain patient consent for speaking with family members or friends, to distribute privacy practice notice, and a patient’s right to request privacy restrictions.
“What we have seen CMS announcing, we have also seen worldwide as well,” says Michael Dahlweid, MD, Chief Medical Officer of DXC Technologies, an IT services company based in Tysons, Virginia. “And many country’s agencies have lifted similar restrictions.”
COVID-19 also calls for modern remote workforces
At the same time as they now can virtualize care delivery, many health systems are scrambling to enable remote workforces to slow COVID-19 spread, try to maintain a semblance of pre-virus productivity levels, protect employees and safeguard revenue streams as much as possible.
“Even hospitals that were against remote work, or thought it was the worst thing ever, are now trying to scale fast,” says David Chou, a veteran digital health care industry leader who has held executive roles with the Cleveland Clinic, Children’s Mercy, University of Mississippi Medical Center. “Rolling out a virtual workforce and building that as quickly as possible, when some don’t have any infrastructure for it, is challenging. But they have to do it.”
There’s no switch to flip that gets anyone there without laying the foundational infrastructure, crafting necessary internal policies, enlisting the right talent, establishing workflows, and leading culture change into an age of value-based and patient-centered care.
But there is a sense of urgency, given that COVID-19 continues spreading out of our control, to embrace new technologies for the greater good.
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“My advice for consumer apps and remote workforces is to pick an open platform with mobility and the capability to be linked into telehealth services – period, end of story,” says Dahlweid. “Get the tools out there now. The rest you can figure out later.”
Chief executives, C-suites, and everyone will need to learn how to function in virtual environments using modern collaboration tools, adjusting workflows, fine-tuning processes, and mastering time management, are just some of the basic changes to expect.
“What we’re going through will change how we work,” says Mohammed Saaed, MD, CMO of Health at Scale, a machine learning startup, and a practicing cardiologist who serves on the Faculty in the Division of Cardiovascular Medicine at the University of Michigan. “Doctors are going to have to figure out new ways of delivering care because patients will have the luxury of finding the best cardiologist in the country, whether that’s in Boston or LA.”
Will the advancements last beyond COVID-19 outbreak?
Whether or not the telehealth, consumerism and workforce strides health care CEOs are leading amid the pandemic actually take root and sprout into the new normal, or fade back into the ether, remains to be seen.
It will depend on a number of factors. Precisely how damaging and lengthy will COVID-19’s impact be? What unforeseen privacy and security incidents occur and, if so, to what degree of severity? What benefits manifest from telehealth and virtualized workforces and how important will they become to everyday Americans? How many lives will be saved because of these changes?
Those questions will be answered in the coming months. Until then, the actions government and health care leaders enact today will lay the groundwork for a future of care delivery we all know is coming and accelerate advancements more rapidly than had the coronavirus not yet presented itself.
“These changes signal the future of how health care operates,” Chou says. “They’ve been discussed for a while but now it’s really happening.”