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New Trend or Passing Fad?
Telehealth Services

This blog is the SECOND in a new series regarding the ‘unintentional consequences’ of the COVID-19 pandemic. As our lives have been abruptly altered due to social distancing requirements – both at home and in the workplace – unplanned ‘disruption’ of previous normal activities could permanently replace sacred elements once believed to be unyielding to any change. But COVID-19 just may have dictated new approaches to how we live and work.

Thanks to the COVID-19 pandemic, social distancing and stay-at-home orders during the past two months have made it difficult to have a face-to-face meeting with our doctor(s).

But necessity is indeed the mother of invention, and thankfully, telehealth – using email, video conferencing, online patient portals and other technologies – was already being used by some providers to aid in the delivery of patient care, typically to the benefit of rural patients.

Telehealth has been around for quite some time – at least a few decades. But its relatively steady growth trajectory has been refueled by the COVID-19 virus, prompting enhanced usage that we have not seen before. Patients, both young and old, have found a new method to safely seek care. Cleveland Clinic, as one example, has reported that demand for virtual visits is up more than 1,000 percent since the start of the pandemic.

For the sake of simplicity, I will be using the term telehealth interchangeably with telemedicine. According to HealthIT.gov, telehealth is different from the term, telemedicine, “because it refers to a broader scope of remote healthcare services than telemedicine.” Telemedicine refers to remote clinical services, while telehealth goes beyond clinical services to also include non-clinical services, such as provider training, administrative meetings and continuing medical education. Any reference to telehealth, therefore, also includes telemedicine.

Prior to the pandemic, telehealth usage wasn’t widely adopted in healthcare for many reasons. To understand the push-pull of telehealth, we must first understand the perspectives from patients and their healthcare providers.

Patient Perspective

For patients, telehealth can provide value and benefits for many key reasons, including:

  1. Less time in the doctor’s waiting room.
  2. No need to take time off of work.
  3. No transportation time or parking hassles.
  4. Reduced risk of obtaining infection while at doctor’s office.
  5. Eliminate child or elder care issues.
  6. More affordable.
  7. Access to specialists.

Telehealth, it must be noted, is not the panacea for every health-related scenario. A medical emergency or a difficult case to diagnose will still require a visit to the doctor or hospital. Telehealth can include physical exams, but depending on procedures performed (e.g. blood drawing, biopsy, X-ray, strep test) the process is more limited. But for wellness-related interactions, such as common office visits and mental health consultations, telehealth can be an efficient interaction process. A sample telehealth consent form offered up by the Agency for Healthcare Research and Quality provides easy-to-understand insight for patients who pursue telehealth services.

Physician Perspective

Physicians and hospitals, on the other hand, are a different story – at least prior to the pandemic. Generally, in the pre-COVID past, providers did not receive higher pay when using telehealth care, and most of the time, they received less pay for telehealth care when compared to in-office care.

With telehealth services, doctors would have to do essentially the same amount of work regarding time spent with the patient and documentation requirements, all while learning a new workflow to interact and treat patients. For this, the doctor is paid less for their time – something that few of us would want to experience in our own jobs.

Telehealth usage prior to the pandemic, therefore, struggled to quickly trend upward largely due to lack of payment parity with face-to-face office meetings. Without payment parity, telehealth did not see the growth gains that it currently has found under the current pandemic environment.

The value equation must also work for the health provider as it does for the patient.

Telehealth and the COVID-19 ‘Experiment’

With the advent of the virus epidemic, telehealth became an overnight ‘sensation’ for a few key reasons. To help providers experience telehealth as a value equation, Medicare is now paying for most visits and many private payers* waive virtual visit copayments, including Wellmark in Iowa. As of March 6, Medicare and some commercial insurers have said they will pay the same rate for video calls as for office visits.

*Some insurers have subsequently found, due to software problems, they are unable to immediately eliminate telehealth copays and cost sharing for millions of members. Additionally, carriers need consent from their self-insured clients to implement these policies.

Many states have relaxed, or deregulated, more stringent requirements for telehealth usage, including Iowa.  The Federation of State Medical Boards provides an updated listing of all states and their telehealth practices regarding COVID-19.

Stay-at-home orders offered legal risks if doctor offices and clinics stayed open and did not adopt telehealth services. Avoidance of legal risks and in-office infection, coupled with payment parity has made telehealth a tool for many health providers to finally embrace.

Going Forward

The value equation for both patients and doctors will be interesting to watch. When the virus finally simmers down and social distancing requirements are greatly relaxed, how will doctors react when their patients can safely return to visiting the doctor? Will the value equation for the doctor shrink from the heightened COVID period or will doctors look more long term on valuing physical distance for their own health, including staff members, and accept telehealth in the future?

Now that the genie is out of the bottle, will patients demand more telehealth services? Perhaps the patient experience during the COVID period will push patients to seek telehealth services elsewhere should their doctor reduce or eliminate the telehealth options in place during the pandemic.

How telehealth services are reimbursed from payers will certainly predict the future for telehealth. Will telehealth reimbursement to providers become more marginalized whereby payment parity is no longer being practiced by key payers? Perhaps payment parity becomes more prominent and, as a result, unleashes additional sophisticated telehealth services than what is provided today? Clearly, the opportunities are just as great as the barriers. The barriers can be difficult to accessing telehealth, such as absence of technology, digital literacy and reliable internet coverage.

The future of telehealth services looks extremely bright, but it will largely be dependent on how physicians view the value proposition of delivering this service to their patients. The COVID-19 pandemic may have provided the fortuitous nudge for telehealth to become a mainstream model of delivering healthcare to Americans. This will be a trend worth following!

Next Week’s Discussion:  Reliance on Drugs from Foreign Countries

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New Trend or Passing Fad?
Remote Work Environments

This blog is the first in a new series regarding the ‘unintentional consequences’ of the COVID-19 pandemic. As our lives have been abruptly altered due to social distancing requirements – both at home and in the workplace – unplanned ‘disruption’ of previous normal activities could permanently replace sacred elements once believed to be unyielding to any change. But COVID-19 just may have dictated new approaches to how we live and work.

Prior to March and the COVID-19 pandemic, shuttered workplace offices and businesses in Iowa and around the country was unthinkable, it just could not happen – or so we believed. The only way it could happen, we reasoned, was through a sci-fi movie that made this horrifically possible.

But it DID happen, and this B-level movie with an apocalyptic plot has now become reality. Jeffrey Cole, a research professor at the University of Southern California, calls this period in our lives the “greatest social science experiment of all time.” Lockdowns, layoffs and massive public measures to contain COVID-19 “will last long after any threat from the virus is gone,” Cole shared. “In the future, we’ll talk about ‘BC,’ before corona, and after.”

As organizations prepare to reopen businesses and offices throughout our country, thermal scanners and hand sanitizers will be the bare minimum required to keep employees and customers safe. The foreseeable future remains extremely murky as to when (or whether) life will return to pre-virus living. Although working remotely has been around for many years, telecommuting has become an uninvited experimentation for many Iowa and U.S. employers and their employees.

Many health experts believe it will be months, if not years, before a ‘new normal’ develops in our country. Scientists struggle to understand the intricacies of COVID-19. The Wild West mentality of searching for a vaccine to protect people has become a major national priority. America, after all, must cobble together innovative approaches to get people back to work while keeping the public safe.

Working Remotely – an ‘Audition’ for the Future

To ensure safe, social distancing to minimize risk of a second (or third) wave of infections, some organizations are planning to eliminate long rows of desks without partitions, replacing them with work-stations sheathed with glass sneeze guards. Having more space between desks and wearing masks will supplement periodic temperature tests. Designating staircases for entry and exit, strategically staggering lunches and work times will also be very much part of new work environments.

The pandemic has offered proof – supportive or not – that in given industries and organizations, some people can work efficiently from a remote location without having to be physically stationed in an office with other co-workers. It must be noted, however, the mental wellbeing of more isolated workers must seriously be considered and addressed before making a leap into expanding remote workplaces. Will future work mean abandoning in-person connections and replacing with internet connections?

A friend recently mentioned that working remotely for a large insurance company revealed enhanced positive customer service metrics that surpassed pre-COVID-19 results.  This revelation provides a new frame of reference to this organization that working remotely can offer surprising benefits to the company…and to its customers. Having these new performance metrics to complement decision making will be critical in the future.

Nationwide Mutual Insurance Company recently announced a permanent transition to a hybrid operating model that consists primarily of four main corporate campuses (Central Ohio, Des Moines, Scottsdale and San Antonio) for in-office personnel and working-from-home in most other locations. Although Nationwide had been investing in technological capabilities to do this for years, the pandemic has urgently nudged Nationwide to make these changes now.

Recent Studies about Telecommuting Experiences

According to data from the Coronavirus Disruption Project, 42 percent of American workers said their telecommuting experience has made them want to work from home more. Not too surprisingly, 61 percent of those teleworking said they are enjoying the relaxed attire and grooming standards, greater flexibility and lack of a commute. Over three-quarters (78 percent) said they are as effective or more so working from home.

From the employer viewpoint, nearly three-quarters of corporate finance officials surveyed in late March by Gartner, a business research and consulting firm, revealed that at least five percent of surveyed organizations will convert on-site workers to permanent remote status as part of their post-COVID cost-cutting efforts.

A survey by USA Today and LinkedIn reveals that, according to 54 percent of respondents ages 18-74, working at home positively impacts work productivity. Reasons cited for higher productivity include time saved from commuting (71 percent), fewer distractions from co-workers (61 percent) and fewer meetings (39 percent).

It is fair to say the virus has served as an audition for organizations to determine whether working remotely can become the norm based on the type of work being performed. The implications of evolving from office locations to remote or home locations can have immense consequences to the economy.

The supply and demand of office space could change significantly if organizations eschew owning larger buildings or rent smaller office space than in the past. Even ‘The Oracle of Omaha’ himself, Warren Buffett, has commented that working from home may very well become the norm because productivity has not suffered in certain scenarios. Buffett commented, “…When change happens in the world, you adjust to it.”

Conclusion

Suffice it to say that most organizations are not yet making radical permanent changes when responding to a seemingly ‘transient’ pandemic. However, developing worksites that can appropriately adapt to COVID-19 – and any future health threats – warrants implementing strategies that go beyond short-term fixes.

While embracing telecommuting, organizations may find low-hanging fruit by purchasing or renting smaller buildings and office spaces and convert these overhead ‘savings’ into other operational investments, which could positively impact employee pay and benefits. Would an upward trend of telecommuting adversely impact sectors that currently cater to office-based employees? Absolutely. Lower fuel consumption for commuting, altered business attire and relaxed cosmetic usage are just a few examples of potential long-term disruption that may occur.

We are only two months into this pandemic, yet much is to be learned by employers about long-term trends versus short-term fads in the workplace setting. My best guess is that the COVID-19 will make telecommuting a more permanent fixture in the business world where it makes most sense to the organization and its customers. As the telecommuting ‘experimentation’ phase continues, each organization must weigh the pros and cons when strategizing for the future.

Next Week’s Discussion:  COVID-19 and Telemedicine

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Straddling the Pandemic ‘Tightrope’ into the Future

All of us, I am confident, would like to know when we will eventually return to some type of ‘normalcy’ in our personal and professional lives – and inject more stability and certainty into our local and national economies. Whatever this new ‘normalcy’ will eventually look like, and when it will happen, remains to play out for various reasons.

Growing evidence suggests that our eventual ‘new normal’ will be different from the environment we had prior to the onslaught of COVID-19, just over a month ago. As the weeks accumulate, over 90 percent of Americans are staying home to work and practice social-distance living. Trying to jump-start ailing local and national economies while keeping the population safe from this contagious virus is akin to walking a tightrope over the Grand Canyon. As a country, this is the ‘balance’ we hope to obtain.

Some good news for Americans – the Grand Canyon tightrope was indeed completed in 2013 by Nik Wallenda.

Through the dedication of those researching a vaccine to treat COVID-19 and the brave medical workers serving our communities, our country will inch our way through this pandemic tightrope – but it will take precious time and patience.

One mathematical modeling study recently released by Harvard University’s T.H. Chan School of Public Health, predicting various scenarios for the pandemic, suggests that intermittent periods of social distancing in the U.S. may be required into 2022. Yes, 2022!  A number of factors will determine the path the virus will take in the coming years – such as, if transmission subsides this summer and resurges in the winter, and if some immunity is induced by infection and how long it will last. Taking delicate steps to avert a surge of severely-sickened people from overwhelming the U.S. healthcare system is paramount.

When implementing national policy and procedures, researchers from this particular study are not advocating any single course of action over another, but their modeling suggests it will require a number of actions to fight this virus into the future. As mentioned by the researchers, “Intermittent distancing may be required into 2022 unless critical care capacity is increased substantially or a treatment or vaccine becomes available.” The researchers acknowledge that ongoing intermittent social distancing will have profound consequences on economic, social and educational outcomes.

The overall conclusion of this research? It is unlikely that life (as we once knew it) will return any time soon. An article that explains this study in greater detail can be found in Stat Reports. This modeling research is expected to be useful to public officials and disease experts when planning for the continued response to the COVID-19 virus.

Please understand, there will be competing projection models that will suggest more rosy prognostications while others will suggest more dire projections toward reaching a new level of ‘normalcy.’ Although performed by a prestigious institution, the Harvard modeling effort will likely be updated as more is learned about the impact of the virus in the weeks and months to follow.

Iowans and Americans will need to confront the brutal facts of what the long-term COVID-19 implications are in the next chapter of this worldwide pandemic. We must learn to adapt by having realistic expectations of living a ‘new normal’ life.

Despite having no practice, this tightrope performance will require stamina, courage, and a great deal of patience.

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