As people stay home to avoid exposure to COVID-19, healthcare leaders across the country worry about the potential long-term health implications of patients putting off their general medical appointments and procedures. Could there be a future health crisis as a result of, for example, missed routine cancer screenings or delayed testing for chronic conditions such as diabetes and high blood pressure?

THE PROBLEM

Dr. Scott Hayworth, president and CEO of CareMount Medical, the largest independent multi-specialty medical group in New York State with more than 650 physicians, worries that over the next couple of years the country could see a spike in preventable disease and death because of missed or delayed screening for skin cancer, gynecological issues and other health conditions.

“The COVID-19 pandemic has had a major impact on our practice, as it has on all medical practices across the country,” Hayworth said. “During the pandemic, we have experienced a significant decrease in patient volume; we could not perform elective procedures; and we substantially increased our telehealth utilization. One of the serious concerns we’ve had during the pandemic revolves around patients with chronic conditions such as hypertension or diabetes obtaining needed care.”

It’s a balancing act for provider organizations to deliver care to chronic patients while also ensuring patients and providers aren’t exposed to unnecessary COVID risk – telehealth has greatly helped us achieve this balance, he said.

PROPOSAL

The primary objectives of boosting telehealth use during the pandemic were to increase access to care, preserve continuity of care by enabling patients to visit with their existing providers and maintain a safe environment for patients and staff. Because CareMount had experience prior to the pandemic using a telehealth platform, the transition for providers has gone relatively smoothly after leadership communicated the importance of embracing telehealth.

"It is critical that management teams maintain frequent communication with both providers and patients about what the practice is doing to deliver quality care and promote safety."

Dr. Scott Hayworth, CareMount Medical

“For patients, the transition has been a little more challenging,” Hayworth noted. “While most patients have heard of telehealth, far fewer had experience using it, particularly the elderly. To educate patients, we adopted a three-pronged approach: First, we created a massive patient telehealth campaign using emails and social media to detail the benefits and availability of telehealth. Then we ramped up staffing of our ‘virtual center,’ which is a call center with an 800-number that patients can use for telehealth questions and appointment scheduling.”

CareMount also created online self-scheduling for telehealth appointments. It asked all providers to adapt to telehealth and provide access to care for all of their patients.

MARKETPLACE

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MEETING THE CHALLENGE

CareMount has been very pleased with the response to virtual visits by both providers and patients. Patients love the convenience of obtaining care from their own homes and appreciate the ability to continue visiting with the providers they have built trusted relationships with over the years. Providers have been happy that telehealth enables them to maintain communication with their patients, while reducing their risk of exposure to the virus.

“The greatest challenge associated with telehealth for providers is simply that we can’t physically examine our patients, which in some cases limits the information we can gather about patients’ conditions,” Hayworth reported. “In these instances, patients have to come in for office visits.

Another challenge is the variability in the quality of patients’ internet connections, which can make video visits difficult.”

At times, providers have had to conduct audio-only virtual visits when patients’ connectivity is insufficient to support video.

“In real estate, the mantra is: ‘Location. Location. Location.’ In telehealth, it’s: ‘Reception. Reception. Reception,’” Hayworth quipped.

RESULTS

CareMount’s providers and patients have had such positive experiences with telehealth that the organization believes use will remain strong even after the pandemic subsides. Today, CareMount is conducting about 1,500 telehealth visits per day, compared with times prior to the pandemic, when it was conducting six telehealth visits per day.

“At the beginning of the pandemic, our daily patient volume dropped to as low as about 35% of our pre-COVID level,” Hayworth said. “Now, it has returned to 80% of what it was earlier in the year.”

ADVICE FOR OTHERS

Everything starts with communication, Hayworth advised.

“It is critical that management teams maintain frequent communication with both providers and patients about what the practice is doing to deliver quality care and promote safety,” he said. “This enables patients and providers to feel informed and confident about any changes the practice plans to make to improve care delivery.”

Separately, it is a huge advantage to have a robust infrastructure in place prior to any public health crisis, he added. This includes information technology systems, training teams and a secure, HIPAA-compliant telehealth platform. Providers should avoid using platforms that were not originally intended for secure healthcare communications such as Zoom and FaceTime, he warned.

“Additionally, providers should ensure that their telehealth platforms are fully integrated with their electronic health records systems,” Hayworth concluded.

“This integration greatly eases and speeds up patient communication when providers need to schedule follow-up appointments, send referrals or obtain patient-consent forms, for example,” he said. “This functionality is of critical importance at a time when many providers are working from home without the direct support of the in-office staff they have grown accustomed to over the years.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himss.org
Healthcare IT News is a HIMSS Media publication.