Telemedicine is Here to Stay

Mitchell Fong is the Director of Telehealth at Renown Health, a multi-hospital system that is locally governed and locally owned. Renown is a not-for-profit integrated healthcare network serving northern Nevada, Lake Tahoe and northeast California and was an early adopter of telehealth in 2012.

Mitchell Fong and Ray Barrett of Telehealth Certification Institute discuss what goes into a telehealth program, the impact COVID-19 has had on the necessity and delivery of remote services, the increase in utilization of telemedicine for both provider and patient, the challenges of pushing through change to improve access to healthcare for all, and the fact that telemedicine is here to stay.

Fong has been in the field of healthcare for over a decade. He holds a degree in molecular biology, a masters of Public Health with a focus in epidemiology, and an MBA. He helps create the strategic plans for population health vision and is dedicated to improving healthcare in a community and getting services to those who really need it. Fong says that telehealth is essentially a startup of healthcare, looking to validate what you can do and how you can drive change. Being persistent is a key element for those innovators and ultimately for those in the industry. 

Nevada is the 7th largest state, yet is ranked 47th with regard to access to care. This is primarily due to Nevada having counties designated as frontier, which is more remote than rural and they have no access to specialists. Fong knows of patients who have driven over 2 hours during a snowstorm to attend a 20 minute follow up cardiac consult. There is a broad area in need in healthcare where telemedicine could be impactful and prove to be more efficient, easier and safer for the patient.

With COVID-19, we are facing a move to value and drive preventive medicine visits. For example even in urban settings, parents can’t take their kids as easily to the doctors office. The challenges we face when increasing the perceived value and the utilization of telemedicine include:

• stigma
• adoption
• access to technology
• learning curves
• reimbursement and licensure parity
• short-term solutions converting to long-term goals
• modelling use of technology

The greatest challenge to overcome is the stigma that healthcare through a camera won’t provide the same quality of care as an in-person visit. We have to address this stigma from both aspects: the clinicians’ end and the patients’ end. More often than not, the care needed can be addressed through a virtual visit, and the necessity of this modality due to COVID-19 has proven to be quite successful.

Having the peripheral tools on the patients’ end (such as bluetooth stethoscopes, otoscopes, etc) makes a virtual visit just as impactful and as comparable as an in-person visit. We can also enhance the ability for asynchronous telemedicine. For example, patients can send pictures to a dermatologist, who can then use their “down time” (perhaps from no-shows or cancellations) to review the material and provide asynchronous care.

Barriers include reimbursement, state licensure and all of the policies that are restrictive of telemedicine and prevent parity. There are a lot of positive moves to address these as a result of COVID-19. Ultimately what we need to have is parity between telemedicine and in-office visits from both the service coverage and reimbursement standpoint. Once that is established, the access to care will be a challenge for health care providers, but it can be worked out if reimbursement is in place.

COVID-19 necessitated a lot of quick program launches for many organizations. You need to reevaluate what was done for the short term to make sure it meets your program’s long term sustainability goals. Making sure you have the right quality, the right vision and the right backbone to set yourself up for sustainability and expansion.

The process of being a telehealth coordinator requires persistence, transparency, to be a good collaborator, and a good model for what you want your product to be. If that means meeting via video, then encourage everybody to jump on video meetings. This has been new and a challenge for some, but we need to start encouraging the fact that video is now a part of healthcare - it’s no different than face-to-face.

A telehealth program requires teamwork and collaboration. Ask yourselves, “What is the value you want to deliver to the patient?” Change is not easy, so the program has to push through and make these changes and deliver value to the patient. Be responsive and adaptive when tracking metrics - start with a clear baseline and make sure what you are doing impacts the key metrics. There will be a learning curve but the provider “buy-in” is extremely important. A program needs physician champions – this is ultimately what is going to be the drive to success.

Renown Health is currently working on “webside manner”: providers become more comfortable if they get the right training and understand why telehealth is so impactful on the other end. Delivering that training, making your care team feel supported to use technology while making sure you all have shared goals and vision, that’s the key to delivering the outcome you want.

The conversion rate of in-office visits to telehealth visits is a metric being followed closely. Defining the percentage of success for providers who are willing to see new patients via telehealth and then refining the algorithm to improve efficiency (improving no-shows and cancellation rates) and for identifying patients who are appropriate for telemedicine, and those who are not a good fit for remote services.

 Adoption, access, parity, screening for fit, and modelling technology - all prove to be both the challenges and the key to drive successful telehealth care programs.

Mitchell Fong advises us all to keep pushing forward: Telemedicine is here to stay.

You can find more information about the Virtual Visits program at Renown Health here and detail on a telehealth grant they recently received.