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Telemedicine is Reshaping the Local Healthcare Industry

In a matter of months, San Diego’s healthcare leaders have seen technology transform the way healthcare organizations do business everyday and how they will care for patients in the future.

Brett McClain hit the ground running when he started his new position as chief operating officer at Sharp HealthCare on March 16. Just days later, the stay at home order went into effect and his introduction to the organization came mostly through video calls.

For the first three months of the pandemic, McClain said he had meetings seven days a week with the Sharp Highly Infectious Disease Committee which he said gave him a “real rapid fire introduction to the organization.”

Like other healthcare leaders across the region, McClain embraced telemedicine and video calls as a key element of Sharp’s response to the COVID-19 pandemic. Although Sharp HealthCare has been offering telehealth services — video and phone visits — since 2015, McClain said he is excited about healthcare embracing this platform and how it will impact the industry at large.

“It’s one of the biggest innovations to ever affect healthcare,” McClain said. “It sounds dramatic, but I can’t imagine anything more dramatic from a tactical and operational innovation.”

According to a report by Fortune Business Insights, the global telehealth market size is projected to reach $266.8 billion by 2026. The report notes that the adoption of telehealth services in response to the pandemic is a driving force behind a growing market that was valued at $49.8 billion in 2018.

Rise in Virtual Care Visits

Local healthcare leaders have seen a trend of more patients opting for virtual care than ever before.

Prior to the COVID-19 pandemic, McClain said Sharp Health delivered a total 50-60 telehealth visits per day.

Less than a month into the pandemic, he said Sharp did more than 2,500 video visits a day.

Kaiser Permanente’s virtual care capacity increased by more than 700 percent said the organization’s Chief Administrative Officer, Marie Zappia-Kuzmack. At the end of 2019, just 11 percent of all Kaiser Permanente ambulatory visits took place in the virtual platform.

“A year ago, we would have thought that being at 11 percent was high,” said Zappia-Kuzmack who leads Southern California Permanente Medical Group, San Diego County’s largest medical group. “Now this pandemic has just changed our mindset and that of any healthcare organization.”

Kaiser Permanente has offered secure video and telephone visits since 2012, and serves a variety of care options from physical therapy to behavioral health. Zappia-Kuzmack said that she is optimistic about the growth in telemedicine as patients are able to save time and access care from anywhere.

“We have learned an incredible amount and we really kept our eye on what we needed to do by listening to our members,” Zappia-Kuzmack said. “We thought was moving quickly in 2019, but 2020 pushed us to do things we thought we could never do. And so, we will see many silver linings from this pandemic and this will be one of them.”

For some San Diego healthcare groups, the pandemic was a catalyst for quickly establishing a telehealth platform and a new way to expand care to their patients.

Prior to the pandemic, San Ysidro Health Center’s President and Chief Executive Officer, Kevin Mattson, said that telehealth wasn’t on their radar due to policies that required patients and physicians to meet in-person in order to get reimbursed for visits.

Now, Mattson said 85% of the Federally Qualified Health Center’s visits are done via telehealth.

Through the telemedicine platform, Doxy.me, LLC, Mattson said people can schedule secure video appointments with their physician. Without telehealth, Mattson said that San Ysidro Health Center would only operate at approximately 15% of its budgeted volume for patient care.

“Most doctors will tell you that complete telemedicine is not ideal — they want a mix,” Mattson said. “What will decide that is the regulation.”

In response to the public health emergency, Congress and the Centers for Medicare & Medicaid Services made several changes to the requirements related to telemedicine and payment options.

For instance, the adoption of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) on March 27 allowed Rural Health Clinics and Federally Qualified Health Centers to be paid for telehealth services to patients covered by Medicare during the pandemic.

According to the California Telehealth Resource Center, “Medicare telehealth services generally require an interactive audio and video telecommunications system that permits real-time communication between the practitioner and the patient.”

Scripps Health President and Chief Executive Officer, Chris Van Gorder said that the change in regulations of telemedicine reimbursements also allowed his organization to adapt to virtual care ahead of schedule.

He said Scripps Health launched telehealth services at the end of 2019. However, when the pandemic began, only a small number of caregivers had joined the program and only about 20 video consultations had been done.

Over the past few months, Van Gorder said Scripps has done well over 150,000 virtual visits.

Scripps was able to build off its existing infrastructure of its Epic electronic health record system, which allows its physicians to see the medical records of the patient while also caring for them via video calls.

Van Gorder said that by using “technology to identify those who don’t need to come in and those who need to” health professionals are also able to make strategic decisions that keep people safe and preserves valuable Personal Protective Equipment (PPE) supplies that are used during in-person visits.

“I have no doubt that technology will save lives,” Van Gorder said.

Changing Workplace

Moving forward, healthcare leaders are also seeing how telemedicine could change their day to day operations on a clinical and administrative side.

At Kaiser Permanente, some of the physicians have been able to start at home with virtual appointments and finish their day with in-person appointments.

“Currently there is no co-pay so it is just convenient for our members,” said Zappia-Kuzmack, who is also a registered nurse. “It’s also time-saving; many of our members are sending compliments for how grateful they are that they didn’t even have to exit their car or even sit in a waiting room.”

McClain said working from home was not common in the healthcare industry. In terms of the healthcare workforce, he sees how the flexibility to work remotely could expand opportunities for job seekers. For instance, he said that by extending the option of working from home, it could take out the factor of a long commute for someone who wants to work at Sharp in the future.

In a recent Healthcare Roundtable , McClain told the San Diego Business Journal that the financial challenges of the COVID-19 pandemic offer large organizations the opportunity to evaluate their “office space footprint.”

“With more employees working from home, the need for extra office space to accommodate growth diminishes,” he said. “Add to that the growth in telehealth, which could have an impact on how much space is needed for future medical offices if more people are comfortable ‘visiting’ their physicians from home for certain conditions.”

Just a few months ago, Mattson said San Ysidro Health Center was looking at how to expand parking options at its administrative building — now he’s surrounded by a surplus of parking and empty cubicles.

“I think all of us healthcare providers are scrambling for solutions,” Mattson said. “They are all very similar

solutions, but it’s a question of how much resources do you have and how much financial resources do you have.”

While the healthcare environment is changing with the integration of virtual care, Mattson acknowledged that the need for supplies and staffing remains a challenge across the industry.

“Just because we have PPE and the equipment to protect us — it improves our odds against infection — but we are seeing significant issues of staffing,” Mattson said. “That’s a big piece of having enough workforce and enough staff whether that is through telehealth or in-person care.”

Innovation and Access to Care

In many ways, telemedicine has also shown healthcare organizations how leaning into technology can push them to find creative solutions to meet patients where they are at.

In addition to launching telehealth services through Doxy.me, San Ysidro Health Center created the San Ysidro HealthLine, where anyone in the community can call to get connected to a provider.

At Sharp, they have distributed iPads to COVID-19 patients and set up video tripods so they can communicate with doctors and family members outside of their hospital room. One nurse had the idea of using baby monitors to help doctors check on COVID-19 patients, so Van Gorder said they invested in more monitors and distributed them to patients.

While there are still many unknowns posed by the pandemic, San Diego’s healthcare industry has risen to the challenge by embracing technology as the way forward.

“We learned a long time ago that we needed to build a lot of different models of care because people have very individualized needs,” said Zappia-Kuzmack. “Virtual care is here to stay.” 

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