Telehealth expansion has been transformational; payment changes should be made permanent
Telehealth became an instant necessity amid the COVID-19 pandemic. With its newfound prominence, it is catapulting American healthcare forward in ways that make care more accessible, adaptable and affordable— all to the benefit of patients.
Yet the federal government’s approval of telehealth use and payment was only made on an emergency basis. It should become permanent, as the benefits of telehealth are profound, far-reaching and transformational. And health systems must make it as easy as possible for patients to utilize.
While its existence isn’t new, telehealth use had been minimized over privacy concerns and compensation issues. With the onset of COVID-19, it became an essential means of reducing infection risks for patients and care providers as well.
On an emergency basis, the federal government wisely authorized the same payment as in-person visits. That opened the door to a new day in healthcare and quickly proved that both patients and providers would adjust to it.
We’ve seen those benefits firsthand at Intermountain Healthcare, where our use of telehealth visits has increased dramatically during the pandemic. From Montana to Utah to Arizona, telehealth visits skyrocketed from 7,000 in March to 63,000 in just one month and continue to average 40,000 a month. Fortunately, nearly a decade ago we launched multiple telehealth initiatives that now connect about 700 caregivers in 40 programs to providers across our 24 hospitals, 215 clinics, and multiple partner hospitals.
The benefits for patients extend far beyond the convenience of routine virtual checkups. Telehealth-based oncology, for example, can provide pre-surgical and post-surgical assessments. At Intermountain, we’ve used the technology to evaluate a patient for a bone marrow transplant and conducted some post-transplant visits.
The technology also enhances care for widespread chronic conditions such as diabetes and hypertension, enabling a broad range of remote monitoring as well as “nudging” to increase patient adherence to treatment plans and medications.
Intermountain’s Connect Care, a consumer-focused service that accommodates telehealth visits seven days a week, has contributed to a significant decrease in unnecessary emergency department and urgent-care visits. About 60% of patients who used Connect Care said that they would have otherwise accessed care in a more expensive setting, like a hospital ED or urgent-care clinic.
Unsurprisingly, telehealth is popular with younger patients who have grown up in the digital age. About 65% of all patients using Connect Care so far are 35 or younger. Our goal is to encourage older patients to adopt telehealth too.
Telehealth especially benefits rural areas. One cancer patient in rural Utah faced multiple four-hour car trips each week to receive chemotherapy. He was so discouraged by the travel on top of his illness that he decided to abandon chemotherapy. His doctors then switched to telehealth, enabling his small local hospital to administer the treatment just minutes from his home and helping him make a full recovery.
With COVID-19 surging in many states and likely to persist into 2021, telehealth usage will remain high into the winter. Health systems can further expand their reach by making it as easy as possible for patients to use. For example, Intermountain is assisting patients through pre-visit verifications and assuring they are ready in terms of basics such as accessing the website or downloading the app, registering, and filling in their personal information. We’re also working to help assure there is adequate connectivity and bandwidth for our patients’ visits.
The pandemic has made it clear that telehealth is here to stay and that adoption can be sustained for the future— many patients like it, public health circumstances dictate it and the government is reimbursing for it—with a strong case to make reimbursement permanent. Looking forward, health systems must broaden its access, make it simple to use, and encourage patients of all ages to embrace it when appropriate for
● their individual care plans.
PODIATRIST DR. MARK LEWIS greets his first patient of the morning in his suburban Seattle exam room and points to a tiny video camera mounted on the right rim of his glasses. “This is my scribe, Jacqueline,” he says. “She can see us and hear us.”
Jacqueline is watching the appointment on her computer screen after the sun has set, 8,000 miles away in Mysore, India. She copiously documents the details of each visit and enters them into the patient’s electronic health record.
Jacqueline (her real first name, according to her employer), works for San Francisco-based Augmedix, a startup with 1,000 medical scribes in South Asia and the U.S. The company is part of a growing industry that profits from a confluence of healthcare trends—including, now, the pandemic—that are dispersing patient care around the globe. The scribe workforce is expected to reach 100,000 this year, up from 15,000 in 2015, according to the American College of Medical Scribe Specialists.
Before COVID-19, most scribes—typically young, aspiring health professionals—worked in the exam room a few paces away from the doctor and patient. This year, as the pandemic led patients to shun clinics and hospitals, many scribes were laid off or furloughed. Many have returned, but scribes are increasingly working online—even from the other side of the world.
Remote scribes are patched into an exam room’s sound via a tablet or speaker, or through a video connection. Some create doctors’ notes in real time; others annotate after visits. And some have help from speech-recognition software programs that grow more accurate with use.
While many remote scribes are based in the U.S., others are abroad, primarily in India. Augmedix in San Francisco recruits people who have a bachelor’s degree or the equivalent, and screens for proficiency in reading, listening comprehension and writing in English, the company said. Once on board, scribes are trained for about three months. The curriculum includes medical terminology, anatomy, physiology and mock visits.
Revenue has grown this year, and the sales team went from four to 14 members, Augmedix CEO Manny Krakaris said. Sachin Gupta, CEO of IKS Health, which employs Indian doctors as remote scribes for their U.S. counterparts, projects 50% revenue growth this year for its scribing business. He said the company employs 4,000 but declined to share how many are scribes.
Remote scribe “Edwin” gives internist Dr. Susan Fesmire more time, freeing her from having to finish 20 charts at the end of every day. “It was like constantly having homework that you don’t finish,” she said. With the help of “Edwin”—Fesmire said he declines to use his real name—she had the time and energy to become chief operating officer of her small Dallas practice. Edwin works for Physicians Angels, which employs 500 remote scribes in India. Fesmire pays $14 an hour for his services.
Doctors with foreign scribes say notes may need minor editing for dialectal differences, and scribes may be unfamiliar with local vocabulary.
Remote scribing is still a small part of the market. ScribeAmerica’s remote business has increased threefold since the pandemic’s outset, said Craig Newman, chief strategy officer of parent company HealthChannels, but “a large majority” of the company’s 26,000 U.S. scribes still work in person.
It’s a highly unregulated industry for which training and certification aren’t required. The service typically costs physicians $12 to $25 an hour, and studies show scribe use is linked to less time spent on patient documentation, higher job satisfaction and more time to see patients—which can mean more revenue.
Remote scribing also raises cybersecurity concerns. Reported data breaches are rare, but some scribe companies have lax security, said Cliff Baker, CEO of the healthcare cybersecurity firm Corl Technologies.
The next step in the trend could be no human scribes at all. Tech giants like Google, EHR companies and venture-backed startups are developing or already marketing artificial intelligence tools aimed at reducing or eliminating the need for humans to document visits.
AI and scribes won’t eliminate physician burnout that stems from the nature of the healthcare system, said Dr. Rebekah Gardner, an associate professor of medicine at Brown University who researches the issue. Neither can take on burnout-driving EHR tasks like submitting requests for insurance approval of procedures, drugs and tests, she said.