April 8, 2020: Healthcare's Transformation Continues

Apr 08, 2020

Healthcare’s Transformation Continues

On March 19, I wrote:

From what I’m hearing from my doctor friends, clinical care in the US has been completely transformed over the past week. Video visits are now the norm, patients who can self-treat at home are told to do so, and non-urgent care is canceled. Moreover, physicians who couldn’t dream of being able to work from home are now able to do so, at least in theory.

There’s now more evidence of this happening, and more detail on the implications. From NEJM Catalyst:

The speed of the transition has been dizzying. Changes that would typically encompass months of planning, pilot testing, and education have been compressed into days. At one extreme, one of our clinics made the decision to go fully virtual on a Friday afternoon with a scheduled start date the following Monday. [see figure below]

What has gotten lost in this dizzying transition? To start, data protections for patients have gone out the window, the article continues:

Some attempted video visits unfortunately have had to be switched to the telephone or less HIPAA-compliant platforms such as FaceTime and Skype. While neither of those platforms is compliant with privacy regulations, the U.S. Department of Health & Human Services has recently declared it will not enforce compliance rules in this time of crisis.

Granted, I feel pretty safe about using Skype and FaceTime for medical purposes (from a data privacy standpoint), but there may be other more problematic practices that emerge given these relations. Red tape, it turns out, is a double-edged sword.

Also comforting to note that the problems doctors are finding when WFH are basically the same as the rest of us encounter:

Given varying levels of Internet capacity, some video visits have been plagued by dropped calls, poor image quality, and lags. Clinicians are quickly disseminating best practices for “Web-side” manner, including having the camera at eye level, which clothes work best on a video screen, ensuring our badges are visible to the patient, and removing visual distractions from behind the clinician.

Those sound exactly like my WFH problems, except I don’t need to display a badge.

Another thing to note is hospitals are businesses with revenue and expenses, and while they may be seeing record amounts of COVID-19 patients, they may not actually be getting paid all that much. First, note how in the chart above the visits per day declined by about half. I’m also hearing that hospitals aren’t sure if they can bill for telemedicine visits. The article continues:

Last week Medicare implemented temporary rules allowing clinicians to bill videoconference visits into any patient’s home (or any other site) anywhere in the country. Medicare is also paying for telephone care and e-visits and waiving out-of-pocket costs.

Medicare is only one part of our healthcare system, and other parts may still not be able to bill for visits. And to make matters worse, the major moneymakers for hospitals, typically procedures like elective surgeries, are all but gone. It seems crazy to say, but we might need a hospital bailout to keep our hospitals around, let alone allowing them to grow their practices to have a higher capacity for future waves of COVID-19.