Telemedicine has had an interesting history. During what may be seen as the utopian period for telemedicine – the COVID-19 pandemic – telemedicine lived its gilded age.

The pandemic was tragic from a health perspective, with so much loss of life. But it has offered technological advancements that are taking better care of people today and will set up healthcare workers for crises in the future.

Sage Growth Partners, a healthcare consulting firm, has set out to determine whether telemedicine, a high-growth technology, is here to stay. In the firm's latest report, based on a survey of 155 physician group leaders and hospital executives, is a check on the industry’s sentiments around this now-mainstream technology. The survey was created in partnership with the Nashville Entrepreneur Center and The Disruption Lab.

Dan D'Orazio is CEO of Sage Growth Partners. Healthcare IT News sat down with him to discuss telemedicine and the results of his firm's study.

Q. What did your survey find about which services were used via telemedicine and what the virtual care picture looks like?

A. The pandemic created one of the largest systematic revisions of our care delivery model. Each week of the early days accounted for perhaps years of workflow and care model advancement. Barriers of every type fell and, for once, providers and patients were equalized in their need and desire for virtual care.

Routine visits, orthopedics, follow-up visits, mental health and other health services partook in the proverbial virtual care banquet. Three-plus years later, we are starting to see a different picture emerge. Today, the utilization has consistently baselined between 10-20%, writ large.

With the Pareto Principle (about 80% of consequences come from 20% of causes) settling in, one must ask, Is this mission accomplished? That thinking is dangerous, almost lazy. We need to re-evaluate our mindset and thinking about telehealth.

As an example, in our recent survey, respondents reported use of telehealth for initial visits fell for both providers (mostly specialists) and hospitals – ironically both at 11%. With the burning access crisis, is 11% for initial visits sufficient?

As an industry, we talk almost glibly about buzzwords like the "digital front door." However, with telehealth utilization for initial visits close to almost single digits, is the front door really where the value is being created?

In the data, we see some positive signs of how the market is still adapting to telehealth. In our study, most specialists, representing just a little north of 50% of active physicians, we see virtual care going beyond the front door. Thirty-seven percent of providers report using telehealth for follow-up care, with hospitals reporting the use of telehealth for follow-up care at 27%.

One of the greatest areas of utilization growth for hospitals is chronic care management – increasing from 8% in our 2022 survey to 19% in our 2023 survey.

Q. What are some of the opportunities hospitals, health systems and group practices are missing with telemedicine? How can providers fix this?

A. While 10-20% of telehealth visits occurring today may be seen as the new norm, I encourage key system players to continue to think expansion. Let’s examine the access crisis occurring in our emergency departments and our growing ED boarding challenge.

A 2017-2021 study found the left without being seen (LWBS) data doubled from almost 1.1% to 2.1%, and among the worst performing hospitals, LWBS was a staggering 10%. Data shows these challenges are even worse in minority and low-income communities, a stark reminder of health equity issues.

As a first step, I suggest we examine our language, as words have true power. For example, what if we changed the nomenclature of left without being seen to left without being served? While we talk often about the rise of consumerism (I think we are a long way from consumerism but remain hopeful we edge at least to being more "consumerish"), changing our language may help to change our actions.

Why? The consequences for not serving patients who show up and leave the hospital before been "seen" are real. Research has demonstrated that quality and safety concerns can be real for those who leave without being served.

Other studies have posited that beyond safety and quality, folks who are coming to the ED for non-emergent issues remain as a thorny reminder of inappropriate site-of-care for primary and chronic care.

Furthermore, we know our mental health crisis significantly contributes to ED challenges. Happily, our data shows behavioral health is a bright spot in hospital telehealth utilization at 23%.

Contributing to ED challenges like LWBS is ED boarding. The Joint Commission demarcates boarding over four hours as a patient safety risk. When hospital capacity reaches 85%, boarding time nearly doubles to eight hours, further complicating safety and quality concerns.

For LWBS, telehealth triage is emerging as a viable use case, perhaps one that needs some more attention. Our data revealed while 32% of respondents have triage capabilities, only 5% use it. Emerging data may cause some to reconsider.

For example, a 2019 study aiming to assess the value of deploying telemedicine to screen ED patients demonstrated a significant reduction in LWBS rates during the early morning hours of 1 a.m. to 3 a.m., from 25.1% to 4.1%.

Q. You suggest via your survey results that telehealth needs to be made a habit to ultimately succeed. Please elaborate on this and use some of your survey results to bolster your point.

A. The fundamentals of healthcare are often driven by key workflows based on setting type, practice and even some types of encounters. So, what does the data reflect about how our respondents deploy these solutions? Seventy-five percent of hospital respondents report creating new workflows, compared to roughly 50% of providers.

In what we still view as the early days of telehealth, the question remains whether virtual care will be integrated into the historic practice workflows, in essence digitizing existing models, or whether virtual care will change or enhance traditional workflow and care models. The market appears to still be operationalizing fundamentals like scheduling, with a plethora of approaches.

For instance, 40% of practice respondents report a set time for telehealth visits, 27% conduct visits during specified blocks, 22% don’t have any specific model, and 17% conduct telehealth visits on certain days and times. As expected, instantiating telehealth appears to still be on the journey to find its footing.

Outside the fundamentals like office visits and scheduling, providers and hospitals report they consider telemedicine less from a macro view like overall business strategy, market capture or referrals.

With just 13% of providers and 12% of hospitals perceiving value from telehealth for referral capture, one must question if telehealth is being given sufficient mindshare. We raise this question as providers and hospitals report the highest value of telehealth being patient satisfaction and patient access, yet concomitantly, they report using telemedicine for referrals at the bottom of the value chain.

There appears to be some cognitive dissonance in this example, especially as access for specialists and primary care is hard to come by.

Can providers optimize patient satisfaction if they essentially ignore using it for referrals and to further extend patient access? Consider that in 2023, MGMA found 37% of practices reported an increase in patient no-show rates. What can be done with this dynamic capacity?

We have witnessed how our industry can deploy telehealth to cut through time, space and barriers like social determinants of health. If we view telehealth as technology first, rather than a workflow solution or, better yet, as a driver of unused capacity, aren’t we selling telehealth short on some of its greatest potential benefits?

Q. Why, according to your survey, do providers see little threat from Big Tech telemedicine entrants like Amazon Clinic?

A. Healthcare is hard. And that’s an understatement. Healthcare has seen its fair share of outside entrants fail spectacularly, and each day those data points continue to trickle in. Will CVS continue to pick off patients in stores, more and more of whom may be chronic care patients, while then also eventually figuring out how to maximize their Signify acquisition?

Furthermore, will they get better with deploying delivery and health plan assets if they own more and more of the patient relationship? Will Best Buy Health, whose assets include access to a Geek Squad, who have an otherworldly 89 NPS, help people remain at home with greater comfort and safety?

Providers don't worry about "outsiders." Fifty-four percent of specialists and 50% of hospitals considered the aforementioned outsiders to be a minor threat because of their leg up with "patient loyalty."

There is danger in resting on such laurels. Currently, more than 70% of Americans feel the U.S. healthcare system has failed them. Part of the reason the Harris Poll study revealed such profound disappointment: long wait times and poor patient satisfaction.

Providers have a remarkably difficult job, especially as they inherit so much of what has failed patients along their mostly sick care journey. However, solutions like telehealth can make the lives of both providers and patients better.

Maybe, just maybe, unused capacity, missed appointments and time travel (aka telehealth) can be part of the solution rather than simply an evolutionary response brought on by a generational crisis.

Q. What do you think the telemedicine landscape will look like five years from today?

A. My hope is that we think about virtual care as a broader solution, one that drives efficiency, bolsters capacity and delights patients.

What’s more, and perhaps among the most important benefits, is that it creates better, if not equal, experience for the providers as it does the patients. We need to stem the tide of broken workflows and outdated delivery models.

Among the lowest ranked reasons for continued use of telemedicine in our study was the improvement of professional satisfactions – 24% of provider respondents and 40% of hospital respondents. Also, our data shows less than 30% of respondents believe telehealth has reduced staff and nurse workloads.

The other 70% are either neutral or somewhat/strongly disagree that telemedicine has decreased workload. It’s well established physicians' and nurses' workloads and burnout are at crisis levels.

Often, innovation comes not during a time of abundance but rather from times of distress and great challenge. COVID and telemedicine clearly fit that description. But as we fade away from those hardest days, the danger and laziness in our thinking may transform this great advancement of our time to a mere side show, not a true habit. I'm betting we will make this get better because, don't we have to?

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