COVID effect on US practices: in-person visits down 37%, telehealth peaks at 14%; ATA asks Congress to make expansion permanent

A Commonwealth Fund/Harvard University/Phreesia tracking study of outpatient visits in 50,000 US healthcare practices, specialty as well as primary care, has tracked the effect of the COVID pandemic on practice visits during the period 8 March through 20 June. Using as their baseline the week of 1-7 March, which was the last ‘normal’ week in line with February, the results are not unexpected:

  • From 15 March to 20 June (three months), practice visits, including telehealth, plummeted 37 percent
  • Disproportionately affected were pediatricians, pulmonologists, and surgical specialties such as orthopedics
  • Against the baseline, week of 14 June visits are still down 11 percent
  • The nadir was 29 March, off 59 percent
  • The rebound tracks the same by US region, with the least dip in South Central and Mountain regions. (The most affected, of course, are New England-Mid-Atlantic and Pacific, with the highest COVID rates and the least rebound.)
  • Looking at the ‘rebound week’ of 14 June, the effects linger on in pediatrics, pulmonology, and (interestingly) behavioral health. (Anecdotally, behavioral health patients are continuing with telehealth for convenience versus the physical visit.)
  • Telehealth visits took off starting 8 March and at their peak were 13.9 percent of visits (19 April)
  • Since 26 April, telehealth visits have declined as in-person visits resume, and are at 7.4 percent as of 14 June (46.7 percent less). However, compared to the baseline of nearly zero (0.1 percent), it’s nearly a 140 percent increase.

Phreesia is a scheduling and patient check-in platform. The practices surveyed are Phreesia clients, covering 1,600 provider organizations, with 50,000 providers in 50 states.

Physicians were also interviewed as part of the study. The office operation has had to change, and the patient experience in returning to practices is very different. Making up deferred care is complicated, and precautions to mitigate risk of viral transmission inevitably slow care down. 

Much of the press around this study is that telehealth is receding quickly. As a trend in an extraordinary time when there was no alternative, as practices reopen a shift back to the office is to be expected, and often there is no substitute for in-person exams and procedures. Still, there are elements of long-term uncertainty on the future of practice telehealth. Both CMS and payers announced that payments for telehealth (audio/visual and telephone only) would remain in place only for the duration of the pandemic. What are their long term plans? Providers are having difficulty getting paid or paid enough even in parity states. State Medicaid presents even more of an unwanted ‘discount’.  Telehealth also demands a commitment to (ultimately) a HIPAA-compliant platform, workflow/staff support, and input in the practice’s EMR/population health platform. STAT, HealthcareITNews

The American Telehealth Association (ATA), coming off their virtual annual meeting last week, sent a letter to Congress with 340 signatories supporting a permanent expansion of telehealth after the public health emergency (PHE) ends in four priority areas:

  • Remove location restrictions 
  • Maintain HHS authority to determine eligible practitioners who may furnish clinically appropriate telehealth services
  • Authorize Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) to furnish telehealth services 
  • Make permanent the HHS Temporary Waiver Authority to respond to emergencies

Release and letter

Call9: we’ll be back — with a different model!

“It wasn’t viable in the way that we did it,” Peck said. “We were very far ahead of the curve.”

Call9‘s founder, Tim Peck, MD, interviewed by local business publication Crain’s New York Business, shed a bit more light on the company’s planned reorganization as Call9 Medical. According to Dr. Peck, Call9 Medical will be in a much larger network of nursing homes and add primary care physicians to its services. The reopened company will be backed by its Silicon Valley lender, Western Technology Investment, which apparently forced the closing issue when the company’s cash on hand fell below the amount lent by WTI. No timing for resumption was given.

In the interview, Dr. Peck returned to reasons why the Call9 original model did not work. Insurers would pay for fee-for-service based telemedicine visits in nursing homes but not pay on their operating concept of fewer hospitalizations and better health outcomes that saved money, which had a longer-term payoff. 

Apparently this led to a standoff with controlling (over 50 percent) funder Redmile, which encouraged the FFS revenue stream. “We had to do services in a particular way that in no way brought value to our model,” Peck said. The ‘change in funders’ as noted in TTA’s article on the shutdown now is in a fuller context; Redmile will not be participating in the repositioned company. Confirmed in the article is that a few former investors, WTI, and some former employees will be part of it.

In this Editor’s view, Call9 had trouble accommodating both payment tracks, perhaps because they were overly invested in their concept. In the real world, it seems odd in a company of this size and investment level, which at one point employed close to 200 people and was about 100 at shutdown. Young companies, if anything, learn to be flexible when it comes to getting profitable cash flow into the exchequer, including standing their ground against ‘pilot-itis’–especially when their major investors encourage it.

One of their earliest customers also warned them of another flaw in their model. The author interviewed the CEO of one of Call9’s earliest clients, ArchCare, a Catholic nonprofit LTC organization in New York. ArchCare was able to “get its patients’ hospitalization rates low enough on its own that paying the startup no longer made sense.” “Their model wasn’t able to move the needle sufficiently to justify the ongoing expense,” CEO Scott LaRue explained. 

One hopes that Call9 Medical will avoid those pitfalls in being too far ahead of the curve and recast their telemedicine model to improve health outcomes for our most frail, vulnerable, and poorly served. Hat tip to HIStalk.

Primary care ‘virtual health’ could save $10 billion annually: Accenture study

A newly-released Accenture study on US primary care estimates that savings of about $10 billion per year in US primary care could be achieved through use of ‘virtual health’, defined as “digital tools such as biometric devices, analytic diagnostic engine and a virtual medical assistant” that would allow much of the work of a typical office visit to be done prior to or separately from the visit, and follow up/check in tools such as video visits/telemedicine which would further offset costs. The cost savings were calculated by Accenture Insight Driven Health as a total of time-per-visit savings of five minutes–when aggregated, $7 billion, $300 million in telemedicine visits, telehealth self-management in diabetes alone $2 billion, health system savings $63 million. This could potentially solve the shortage of US PCPs now projected at 31,000 in the next ten years. Nary a mention of patient care savings, chronic care management or telecare for proactive behavioral home monitoring, however. Accenture release (BusinessWire), Accenture page and paper.

Soapbox: Further thoughts on CarelineUK, O2 & WSD

The many, excellent, comments on O2’s withdrawal of their current telecare & telehealth offerings in the UK market, most notably from my fellow editor Alasdair Morrison, have prompted further thoughts on the post about CarelineUK’s 25th anniversary earlier today: what will CarelineUK,  and other organisations like it, look like in 25 years’ time?

Perhaps the most significant change that appears to be coming in the area of telemonitoring is  (more…)