At first, some Providence physicians were reluctant to use virtual consultations in place of in-person visits, said Jennifer Schaab, chief operating officer of physician enterprises at the Renton, Wash.-based system.
Primary-care physicians were more easily convinced. Watching cardiologists embrace the technology and remotely monitor patients’ pulse via a Fitbit has been more of a surprise.
“We ramped up so quickly on the telehealth front—within seven business days we went from 50 providers to 7,000 providers,” Schaab said. Providence went from around 700 video visits a month to 70,000 a week, with significant increases among neurologists.
In one case, a mother followed up to tell a Providence doctor that her young daughter had stomach pain but was afraid to leave the house. The physician guided the mom through the exam, which brought them to the emergency department. The young girl had her appendix taken out and was home the next day.
Stay-at-home orders made the transition necessary. But the speed with which the industry adapted has been eye-opening. Changes to federal payment and regulation helped, medical professionals said, urging a permanent adjustment.
“Initially, a lot of providers were against telemedicine because they weren’t getting enough work (relative value units) or didn’t think it was good for patients,” Schaab said. “But telehealth is tailoring care to both patients and individual physicians. The crisis brought them together.”
One patient of a Sanford Health endocrinologist told him he hopes to never see him again—at least in person. His visits would typically take two hours with the drive. Now, he’s done in 30 minutes.
Telemedicine mitigates patient transportation issues and requires less time away from work. It can also free up physicians who want to spend more time at home with their families.
“We won’t be able to take those things away from physicians now that they have seen how well this works,” said Dr. Allison Suttle, chief medical officer at Sioux Falls, S.D.-based Sanford. “Patients also expect it to continue.”
Under fully capitated payment models, higher telehealth utilization will likely last, said Kevin Manemann, chief executive of physician enterprises at Providence. “The reason stuff doesn’t progress in healthcare is because reimbursement doesn’t drive the incentive,” he said.
It will be unwise to unwind payment for phone calls and video visits, more robust remote monitoring, interstate licensing, local supply chains and more adaptive clinical trials when the pandemic subsides, Suttle said.
“Our dependency on other countries for our supply chain has made us consider what this looks like when this happens again and if we pivot,” said Suttle, adding that the generic drug manufacturing coalition CivicaRx has helped Sanford stem drug shortages. “It has definitely been eye-opening when you think about the base components of medications that are only made in a couple of countries.”
“Now that we kicked this into gear, we are thinking differently and doing things en masse now,” Schaab said. “It’s like a rolling snowball that I hope will lead to other developments.”
