Doctors comment on telehealth one year later: Lots of progress, lots of plans
Beginning in 2020, athenahealth has been conducting research into the use and impact of telehealth. The research includes analysis of de-identified data from across athenahealth’s network of customers as well as conversations with providers. This article is based on that research.
Dr. Kemi Alli is the Chief Executive Officer of Henry J. Austin Health Center, a New Jersey-based federally qualified healthcare center (FQHC). Three quarters of the center’s visits have been conducted via telehealth since the onset of the pandemic, and Alli envisions a future hybrid model of 50 percent virtual visits, and 50 percent in-person. The center has expanded its behavioral health offerings, a move which also included hiring new professionals.
Dr. Scott Maurer owns his own primary care practice in Maryland. Eighty percent of his visits are now conducted via telehealth; he hopes that future model ratio is 50-50, for which he plans to hire a nurse practitioner or doctor.
Christian Zarnke is the practice administrator at Family Medical Home in Texas. Unlike Drs. Alli or Maurer, Family Medical Home had no infrastructure in place in March entering the pandemic. But by transitioning quickly, the six-doctor practice has been able to serve a geographically broad patient population, some of whom would have to drive hours to be seen in-person. “Post-pandemic we're absolutely going to keep using telehealth forever,” he says.
Alli said that a lack of technology savvy presented initial hiccups that have since been smoothed over thanks to having some staff assigned as “telemed navigators.” “It was an interesting lesson learned, just how many people are not technologically literate, like health literacy. But even to the degree of, ‘OK, how do I turn my camera on?’” For the FQHC, that meant plans to install a telehealth solution they’d been researching changed quickly. “The choice we probably would have made pre-COVID, we didn’t end up with. We needed something quick, simple, easy to navigate, low-cost, and a solution that didn’t require an app,” she said.
“With the COVID crisis evolving, everybody accepts it, even the oldest of the old, 95-year-old people are doing telehealth visits — even without help,” said Maurer. He opted for athenaTelehealth after dipping his toes in the virtual-visit waters with another solution before the pandemic. Ultimately, an embedded solution that meant he didn’t have to toggle between windows made for a better experience for both provider and patients. But for them, he admits having the tools to access services can vary. “I live in a well-resourced ZIP code. So, I don’t really have people who are challenged with being resourced,” he said. “But right now, technical barriers keep telehealth from being easily deployed to at-risk, socially challenged populations.” (Alli was able to combat that — and keep staff safe from exposure — by setting up a station at one health center location so patients without internet or a laptop could still have virtual visits.)
For Zarnke, he notes that digital visits can be finished up faster, with no changing of clothes, for instance. Dr. Alli adds that the throughput of patient to provider is much more efficient online, when there’s no nurse screening prior to the doctor logging in, for example.
athenaNet data show that across five major specialties including primary care, pediatrics, mental health, cardiology and OB/GYN, virtual visits are more likely to be scheduled for shorter durations compared to in-person appointments.
Telehealth has forced the hand of Family Medical Home to offer more virtual appointments post-pandemic. “We've grown, both revenue-wise and size-wise, over the course of the pandemic in that we have far too many providers at this point to see 100 percent of our patients in-clinic — they wouldn't fit,” said Zarnke.
He credits that to the willingness of his patient population to use telehealth, and word-of-mouth about the practice’s Spanish-speaking providers. But part of the transition to virtual care is out of necessity, Zarnke said. “Rural health is just getting massacred in Texas right now,” he said. “When you get out to these smaller towns, clinics are closing down, hospitals are shutting down, just because there's a trend of urbanization going across the nation. And especially we have a lot of places where people need to drive an hour or two to get seen physically in person.”
HJAHC has seen an increase in demand for behavioral health services — currently at 20 percent higher than pre-pandemic level — that required them to hire more providers for one of the easiest appointment types to translate virtually.
Maurer also notes opportunities to enhance care and profitability using telehealth. “Telehealth allows me to care better for people because I can easily do a follow-up in a short interval. I can have more encounters with somebody who has difficult-to-solve problems. I can have deeper encounters because of what the world of value-based payment is doing. I’m able to do that with not as much effort as would ordinarily be required if my setting was purely in the office. It’s easier for the patient, easier for the doctor.”
Zarnke says that since physicians are “generally social” — including the team at Family Medical Home — many of them tell him that they “miss seeing patients in-clinic” and are looking forward to a hybrid model post-pandemic.
At HJAHC, physicians on call after-hours can now convert calls into telehealth visits, which enhances that provider-to-patient connection 24/7. But the convenience of being able to work from their couches can be a Catch-22, shares Alli. “Something like 80 percent of our employees are women, and 50 percent of them are moms. So it really is an issue for us to think about how are we creating balance and how do we create it going forward? … (But) maybe I have a parent who wants to work from noon to nine p.m. We really need to think about how we create flexible systems.”
Maurer jokes that he’s “fortunate to have a wife who doesn’t resent me too much for working all the time,” but admits that the lines are blurred because he works at home daily. “People are going to expect availability that replicates what happened during the COVID crisis in years to come,” he said, but added that “you relinquish control of your life a little bit when you’re a doctor.” (Find additional research and insights on provider work-life balance here.)
The geriatrician admitted that increased use of telehealth could impact work/life balance, unless the physician has a bit of control over their situation. “I’m a solo practitioner, my own boss. And I do what I want to do. Every time I see a patient, it’s a relationship, and it’s revenue.”