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ASCM Insights

A Healthy Dose of Technology: Investigating Telehealth

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The COVID-19 pandemic has changed how people work, shop, and connect with others. It’s also changed how people see doctors and get other medical services. The recent rise of telehealth and telemedicine enables patients to handle minor issues at a safe distance and from the comfort of their homes. In addition, it reduces the flow of patients into doctors’ offices — a key benefit during times when social distancing and intense sanitation procedures are the norm.

Although the terms are often used interchangeably, telemedicine and telehealth are different. Telemedicine refers to remote clinical services; telehealth can include these and remote, nonclinical services, such as provider training, administrative meetings and continuing medical education (HealthIT 2019). For the purposes of this article, the terms will be used interchangeably.

Early signs

Interestingly, this isn’t a new concept. In 1984, Higgins, Dunn and Conrath noted that telemedicine was useful for delivering health care to remote areas. However, the authors pointed out that there were a few problems preventing widespread adoption, including 

• resistance from doctors who felt threatened by alternative approaches to       medicine
• the justification of high costs
• physician reimbursement
• legal implications (Higgins, Dunn and Conrath 1984).

Although these authors were generally optimistic about telehealth, the service only received modest growth throughout the next few decades. More recently, widespread use has been limited by low reimbursement rates and interstate licensing and practice issues (Mahar, Rosencrance and Rasmussen 2019).

A decade ago, the health care community celebrated virtual health as a gamechanger. However, providers, payers and patients were slower to adopt than anticipated (Fowkes et al. 2020).

As technology improved and pilot programs demonstrated the method’s usefulness, telemedicine gradually extended its footprint in a number of areas. From 2012 to 2013, the market grew by 60% (Mahar, Rosencrance and Rasmussen 2019). In 2016, an estimated 61% of U.S. health care institutions and 40-50% of U.S. hospitals used telemedicine.

However, the practice did not truly achieve widespread adoption until COVID-19 transformed the delivery of health care seemingly overnight. Consumer adoption increased from 11% in 2019 to 46% by mid-2020. It also helped that in 2020 the U.S. Centers for Disease Control and Prevention expanded the scope of telehealth classifications. Telehealth allowed providers to keep more appointments, rather than canceling them to space out patients for social distancing and sanitizing or because patients did not feel comfortable visiting in person (Bestsennyy et al. 2020).

Telehealth and telemedicine offer a variety of benefits, whether or not a pandemic is happening (Lowenhaupt 2020). Again, they can be ideal services for rural and aging patients. They can also be quick and highly effective ways to treat minor illnesses and ongoing medical conditions, as patients can save time and travel expenses by seeing a doctor from home. Although some medical needs require in-person care, many do not. Furthermore, home blood pressure monitors, pulse monitors and smartphone apps can track and transmit vitals to medical providers.

Trials and treatments

In spite of all of the benefits and arguments in favor of telehealth, there are factors hindering its growth. One of the more obvious ones is that patients have been reluctant to give up direct contact with their care providers. This is especially common among older populations. However, attitudes are changing, as telehealth has been proven to be an effective way to provide higher-risk populations with non-emergency medical care without potentially exposing them to the coronavirus. Telehealth also removes barriers to physical access to a doctor’s office by bringing care to the patient’s home, encouraging more frequent visits and earlier intervention.

“About 75% of the older adults I’ve seen over the past few months have been via telemedicine,” said Dr. Tom McCarrick, chief medical officer of Vanguard Medical Group, a family medicine practice with a large base of patients who are 60 and older, in an NJBIZ article. “It’s amazing how easily they have adapted to the technology,” (Peifer 2020).

Another obstacle has been that smaller medical practices have been slower to adapt to the new technology. However, this also is changing. As a result of the pandemic, physician practices are experiencing decreases in patients coming to the office. The situation would be even more dire if not for telehealth and the new willingness of the Centers for Medicare & Medicaid Services (CMS) to cover virtual visits. Since CMS changed its regulation of reimbursement, some medical practices report that telehealth is enthusiastically embraced across the country — to the point where it has become an integral part of care delivery (Terry 2020).

This leads to a third obstacle: Restrictive government regulations for Medicare and Medicaid previously declined to cover payments for this type of service. However, the scope of telehealth services reimbursed by these programs has increased. This includes CMS expanding Medicare reimbursement, Congress giving the U.S. Department of Health and Human Services authority to waive originating site requirements for Medicare beneficiaries, and states waiving licensing restrictions (Cohen 2020). Prior to March 6, 2020, when the policy expansion started, Medicare could only pay patients for telehealth for routine visits in certain circumstances, such as if the patient lived in a remote area and traveled to a local medical facility to get telehealth services from a doctor in another remote location. Even then, telehealth services generally could not be received at home.

Now, under the Coronavirus Preparedness and Response Supplemental Appropriations Act and Section 1135 waiver authority, doctors, nurse practitioners, clinical psychologists and licensed clinical social workers can offer a specific set of telehealth services, including evaluations and management visits or common office visits, mental health counseling, and preventive health screenings (Centers for Medicare & Medicaid Services 2020). Patients can receive care from a physician’s office, nursing home, rural health clinic or at home. According to the waiver, the goal is to enable social distancing and reduce the transmission of the new coronavirus, especially among high-risk populations (Centers for Medicare & Medicaid Services 2020).

COVID-19 truly has made telehealth indispensable and showed that doctors, patients, governments and insurance institutions that it can deliver quality medical care while reducing risks, costs, inconvenience and exposure to germs (Lipoff 2020).

The telehealth supply chain

Like many other industries and services, the growth of telehealth is dependent upon a supply chain. In this case, the supply chain delivers the service from the provider to the patient and includes the following links:

• Communication: The patient and care provider must be able to communicate. This requires reliable audio-visual technology.

• Diagnosis: Once the communication has been established, the provider needs to diagnose the problem. This may be accomplished quickly if the doctor is aware of the patient’s health history but otherwise may take longer as the provider tries to match the diagnosis with the best possible treatment. In this case, a diagnosis and treatment plan may require consultation with colleagues or additional research.

• Prescription: The doctor prescribes medication or therapy to treat the ailment. Prescriptions may be sent electronically to a pharmacy for in-store or curbside pickup or delivery via the pharmacy’s own service or a third-party delivery service. Some therapy treatments can be conducted through video conferencing or pre-recorded videos that the patient can follow.

• Follow-up: Virtual or in-person follow-up visits can be scheduled at the convenience of the doctor and the patient. Furthermore, remote monitoring devices that transmit blood pressure, blood sugar or other vital levels can make it easier for a doctor to offer ongoing care or do quick virtual check-ups (Sharma 2020).

• Billing and payment: Consumers already can offer remote payment for a variety of products in a plethora of ways. The major requirement for this supply chain is to coordinate payment from individuals with approvals from insurance providers or government agencies. However, changes have been made during the COVID-19 pandemic to make this process smoother.

This particular service happens in real time and also can lessen challenges such as traffic for other supply chains.

A positive prognosis

Telehealth has proven to be both reliable and cost effective, and there is widespread optimism that it will continue to be a dominant practice, even after the pandemic is under control. Krajecki (2020) suggests that emerging technologies will significantly improve the quality of virtual care beyond typical voice and video consultations. One example is the direct integration between telehealth services and consumer wearables that will enable clinicians to monitor and track such patient variables as heart rate, activity levels, sleep patterns and electrocardiogram results. In addition, augmented reality can enhance telehealth by providing a mechanism to better gauge a patient’s physical condition. Expected enhancements to digital devices include LIDAR cameras that will enable accurate measurement of physical changes, such as swollen glands, and detection of changes to physical appearance, such as paler skin. Finally, chatbots can handle simple tasks like pre-screening patients prior to a telemedicine appointment and more complex ones like providing potentially life-saving information.

Before the COVID-19 pandemic, the total annual revenue of U.S. telehealth players was an estimated $3 billion, with the largest vendors focused in the virtual urgent care segment, or helping consumers get on-demand instant telehealth visits with physicians. With the acceleration of consumer and provider adoption of telehealth and the extension of telehealth beyond virtual urgent care, up to $250 billion of current U.S. health care expenditures could come from telehealth applications (Bestsennyy et al. 2020).

Despite the enthusiasm for telehealth, it may be more beneficial in some situations than others. Both patients and doctors need to become accustomed to the practice and evaluate its benefits and drawbacks in relation to their specific needs.

For now, one thing is clear: Technology made telehealth possible, but the new coronavirus made it necessary.

References

1. Bestsennyy, Oleg, Greg Gilbert, Alex Harris and Jennifer Rost. 2020. “Telehealth: A quarter-trillion-dollar post-COVID-19 reality?” McKinsey & Co., May 29. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality.

2. Centers for Medicare & Medicaid Services. 2020. “Telehealth Services.” CMS.gov.

3. Cohen, Jessica Kim. 2020. “HHS studies how to keep telehealth waivers, but can't do it alone.” Modern Healthcare 50 no. 23: 6.

4. Fowkes, Jennifer, Caitlin Fross, Greg Gilbert and Alex Harris. 2020. “Virtual health: A look at the next frontier of care delivery.” McKinsey & Co., June 11. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/virtual-health-a-look-at-the-next-frontier-of-care-delivery.

5. HealthIT 2019. “What is telehealth? How is telehealth different from telemedicine?” HealthIT.gov, October 17. https://www.healthit.gov/faq/what-telehealth-how-telehealth-different-telemedicine.

6. Higgins, C., E. Dunn and D. Conrath. 1984. “Telemedicine: An historical perspective.” Telecommunications Policy 8, no. 4: 307.

7. Krajecki, Michael. 2020. “Technology for healthcare's new reality.” KPMG, May 11. https://home.kpmg/xx/en/blogs/home/posts/2020/05/technology-for-healthcare-new-reality.

8. Lipoff, Jules. 2020. “It's Telemedicine or No Medicine, Whether Doctors Like It or Not.” Barron's. https://www.barrons.com/articles/telemedicine-on-the-rise-in-era-of-social-distancing-coronavirus-51589906377.

9. Lowenhaupt, Charles. 2020. “Wealth, Aging and Technology in a Pandemic.” Wealth Management, May 11. https://www.wealthmanagement.com/high-net-worth/wealth-aging-and-technology-pandemic.

10. Mahar, Jamal H., MD; James Gregory Rosencrance, MD; and Peter A. Rasmussen, MD. 2019. “The Future of Telemedicine (and What’s in the Way).” Cleveland Clinic’s Consult QD, March 1. https://consultqd.clevelandclinic.org/the-future-of-telemedicine-and-whats-in-the-way/.

11. Peifer, Keith. 2020. “Time for telemedicine: How technology provides easier access to care for older adults during the pandemic, and beyond.” NJBIZ, June 15. https://njbiz.com/time-for-telemedicine-senior-health-care-access/.

12. Sharma, E. Kumar. 2020. “A Virtual Dose: Digital connect with doctors and remote health monitoring are changing the healthcare delivery model.” Business Today, May 31. https://www.businesstoday.in/magazine/cover-story/a-virtual-dose/story/403596.html.

13. Terry, Ken. 2020. “Medical practices reel financially from COVID-19 losses.” Medical Economics, 97, no. 7: 4-6.

For a list of 70 annotated references about this topic, contact the author at crandllre@appstate.edu.

About the Author

Richard E.Crandall, PH.D., CPIM-F, CIRM, CSCP Professor Emeritus, Appalachian State University

Richard E. Crandall, Ph.D., CPIM-F, CIRM, CSCP, is a professor emeritus at Appalachian State University in Boone, North Carolina. He is the lead author of “Principles of Supply Chain Management.” Crandall may be contacted at crandllre@appstate.edu.

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