2021 Innovation Issue: Telemedicine is subverting the traditional care model of doctors and hospitals

You can use your mobile phone to trade stocks, order a luxury car, track deliveries, interview jobs, order takeaway food, and read almost any published book.
But for decades, one industry—healthcare—has largely adhered to its traditional physical building face-to-face consultation model, even for the most routine care.
A public health emergency declaration that has been implemented in Indiana and many other states for more than a year has forced millions of people to reconsider how they do everything, including talking to doctors.
In just a few months, the number of phone and computer consultations that accounted for less than 2% of total medical insurance claims in 2019 has soared by more than 25 times, reaching a peak in April 2020, accounting for 51% of all claims.
Since then, the explosive growth of telemedicine in many healthcare systems has gradually decreased to a range of 15% to 25%, but it is still a huge single-digit increase from the previous year.
“It will stay here,” said Dr. Roberto Daroca, an obstetrician and gynecologist in Muncie and president of the Indiana Medical Association. “And I think it’s really good for patients, good for doctors, and good for getting care. This is one of the best things that can happen.”
Many consultants and health officials predict that the rise of virtual medicine—not only telemedicine, but also remote health monitoring and other Internet aspects of the healthcare industry—may lead to more disruptions, such as decreased demand for medical office space and The increase of mobile health devices and remote monitors.
The American Medical Association stated that it is estimated that the US$250 billion in US healthcare may be permanently transferred to telemedicine, accounting for about 20% of the expenditures of commercial and government insurance companies on outpatient, office and family health visits.
The research company Statistica predicts that, in particular, the global market for telemedicine will grow from 50 billion U.S. dollars in 2019 to nearly 460 billion U.S. dollars in 2030.
At the same time, according to data from research firm Rock Health, investors provided a record US$6.7 billion in funding for digital health startups in the United States in the first three months of 2021.
McKinsey and Co., a large consulting firm based in New York, published this stifling headline in a report last year: “The reality of $2.5 billion after COVID-19?”
Frost & Sullivan, another consulting company based in San Antonio, Texas, predicts that by 2025, there will be a “tsunami” in telemedicine, with a growth rate of up to 7 times. Its predictions include: more user-friendly sensors and remote diagnostic equipment to achieve better patient treatment results.
This is an earth-shaking change for the American healthcare system. Although advances in software and gadgets have shaken many other industries, including video rental stores, the system has always relied on its office consultation model, film photography, rental Cars, newspapers, music and books.
According to a recent Harris poll, nearly 65% ​​of people plan to continue using telemedicine after the pandemic. Most people surveyed stated that they would like to use telemedicine to ask medical questions, view laboratory results, and obtain prescription drugs.
Just 18 months ago, doctors at the Indiana University Health Center, the state’s largest hospital system, used only smartphones, tablets, or desktop computers to see dozens of patients remotely every month.
“In the past, if we had 100 visits a month, we would be very excited,” said Dr. Michele Saysana, vice president of quality and safety at IU Health.
However, after Governor Eric Holcomb declared a public health emergency in March 2020, all but essential staff must stay at home and millions of people poured in.
At IU Health, from primary care and obstetrics to cardiology and psychiatry, the number of telemedicine visits soars every month—thousands first, then tens of thousands.
Today, even if millions of people are vaccinated and society is reopening, IU Health’s telemedicine is still very strong. So far in 2021, the number of virtual visits has exceeded 180,000, of which there were more than 30,000 in May alone.
Why it takes so long for doctors and patients to talk comfortably through the display, while many other industries are scrambling to switch to online business models, is unclear.
Some people in the medical industry have tried—or at least dreamed of—becoming more virtual. For more than a century, industry leaders have been pushing and pushing to achieve this goal.
An article in the British medical journal The Lancet in 1879 talked about using the telephone to reduce unnecessary office visits.
In 1906, the inventor of the electrocardiogram published a paper on “electrocardiogram,” which uses telephone lines to transmit pulses from a patient’s heart activity to a doctor several miles away.
According to the National Center for Biotechnology and Medicine, in 1925, the cover of the magazine “Science and Invention” showed a doctor who diagnosed a patient via radio and envisioned a device that could perform video examinations on patients several miles away from the clinic. .
But for many years, virtual visits have remained strange, with almost no registration on the country’s healthcare system. The forces of the pandemic are pushing systems to adopt the technology in a wide range of ways. In Community Health Network, during the worst of the pandemic, approximately 75% of outpatient visits by doctors were conducted online.
“If there is no pandemic, I think many providers will never change,” said Hoy Gavin, executive director of Community Health Telemedicine. “Others certainly won’t change so soon.”
In Ascension St. Vincent, the state’s second largest healthcare system, since the beginning of the pandemic, the number of telemedicine visits has soared from less than 1,000 throughout 2019 to 225,000, and then dropped to 10% of all visits today about.
Dr. Aaron Shoemaker, chief medical officer of Ascension Medical Group in Indiana, said that now, for many doctors, nurses and patients, this is just another way to contact.
“It becomes a real workflow, just another way of looking at patients,” he said. “You can go to meet someone in person from one room, and then the next room might be a virtual visit. This is what we are all used to.”
At Franciscan Health, virtual care accounted for 80% of all visits in the spring of 2020, and then fell back to today’s 15% to 20% range.
Dr. Paul Driscoll, executive medical director of the Franciscan Physician Network, said that the proportion of primary care is slightly higher (25% to 30%), while the proportion of psychiatry and other behavioral health care is even higher (over 50%).
“Some people worry that people will be afraid of this technology and don’t want to do it,” he said. “But this is not the case. It is much more convenient for the patient to not have to drive to the office. From the doctor’s point of view, it is easy to arrange someone very quickly.”
He added: “Frankly, we also found that it saves us money. If we can continue with 25% virtual care, we may need to reduce physical space by 20% to 25% in the future.”
But some developers said that they don’t think their business has been greatly threatened. Tag Birge, president of Cornerstone Cos. Inc., an Indianapolis-based real estate company, said he does not expect medical practices to start giving up thousands of square feet of office and clinic space.
“If you have 12 test rooms, maybe you can reduce one, if you think you can do 5% or 10% telemedicine,” he said.
Dr. William Bennett met with a 4-year-old patient and his mother through IU Health’s telemedicine system. (IBJ file photo)
Some experts say that the little-known story about virtual medicine is its promise to provide comprehensive care, or the ability of a group of providers to gather to discuss a patient’s condition and provide care with experts in a particular field (sometimes with hundreds of doctors). Miles away.
“This is where I see telemedicine really have a huge impact,” said Brian Tabor, president of the Indiana Hospital Association.
In fact, some of Franciscan Health’s hospital doctors have already used video conferencing in patient rounds. In order to minimize exposure to the COVID-19 virus, they have established a procedure where only one doctor can enter the patient’s room, but with the help of a tablet or laptop, six other doctors can have a meeting to talk to the patient and consult about care.
In this way, the doctors who usually see the doctor in groups, and see the doctor sporadically throughout the day, all of a sudden, see the patient’s condition and talk in real time.
Dr. Atul Chugh, a cardiologist from the Franciscans, said: “Therefore, we all have the opportunity to examine patients and make key decisions for them with the required specialists on hand.”
Due to various reasons, virtual medicine is booming. Many states have relaxed restrictions on online prescriptions. Indiana passed a law in 2016 that allows doctors, physician assistants, and nurses to use computers or smartphones to prescribe medication.
As part of the “Coronavirus Prevention and Response Supplementary Appropriations Act,” the federal government suspended a number of telemedicine regulations. Most medical insurance payment requirements are waived, and recipients can get remote care no matter where they live. The move also allows doctors to charge medical insurance at the same rate as face-to-face services.
In addition, the Indiana State Assembly passed a bill this year that significantly increased the number of licensed practitioners who can use telemedicine reimbursement services. In addition to doctors, the new list also includes psychologists, licensed clinical social workers, occupational therapists, etc.
Another major move by the Holcomb government removed other obstacles. In the past under the Indiana Medicaid program, to reimburse telemedicine, it must be done between approved locations, such as a hospital and a doctor’s office.
“Under Indiana’s Medicaid program, you cannot provide telemedicine services to patients’ homes,” Tabor said. “The situation has changed and I am very grateful to the governor’s team. They suspended this request and it worked.”
In addition, many commercial insurance companies have reduced or eliminated out-of-pocket expenses for telemedicine and expanded telemedicine providers within the network.
Some doctors say that telemedicine visits can actually speed up diagnosis and treatment, because patients who live far away from the doctor can usually get faster remote access instead of waiting for half a day off when their calendar is free.
In addition, some elderly and disabled patients must arrange for a van to leave the home, which is sometimes an additional cost for expensive medical treatment.
Obviously, for patients, a big advantage is the convenience, without having to drive through town to the doctor’s office, and without having to hang out in the waiting room endlessly. They can log in to the health app and wait for the doctor in their living room or kitchen while doing other things.


Post time: Jun-18-2021