Look for 2023 to be a momentous year for virtual care as it continues to be shaped by healthcare economics, provider shortages, consumer demand, and government funding and regulation.
Despite recent declines in volume, virtual care is simply too valuable - and necessary - not to become an increasingly important part of healthcare going forward. While 2023 will not repeat the explosive growth of 2020 and 2021, progress will likely remain steady, if slower.
Telehealth received several significant boosts in the Omnibus spending bill passed at the end of last year. The funding package extended for the next two years several key provisions that expand the ability to provide and pay for virtual care services, provisions that otherwise would have lapsed at the end of the Covid-19 public health emergency.
Firstly, it extends critical Medicare telehealth flexibilities. This includes waiving originating site requirements, delaying the in-person visit requirement before receiving mental health services, allowing reimbursement for audio-only telehealth and allowing telehealth for acute hospital-level care at home.
Secondly, it allows employers to continue to offer telehealth on a pre-deductible basis for their employees in High Deductible Health Plans with Health Savings Accounts.
Congress is also requiring the Medicare Payment Advisory Commission and HHS to study and report on telehealth use during and after the public health emergency, as well as to recommend reforms.
Two years is far from permanent, but the additional time will allow for virtual care to further prove its value and make the case for Congress to provide more permanent solutions.
Patients like virtual care
While crucial, federal support is not the only factor driving virtual care. Consider patient demand, for example.
Telehealth visits exploded during the Covid-19 pandemic, particularly among Medicare patients, growing from 840,000 in 2019 to 52.7 million the following year. However, as the pandemic waned, more providers and patients resumed their normal routines in 2022 with in-person appointments ticking up and telehealth use declining.
But that doesn’t mean patients are turning their backs on this new kind of care. In fact, having sampled the benefits and convenience of virtual care, they are not inclined to give it up.
Survey after survey shows patients, particularly younger ones, like virtual care and expect their providers to offer it. While consumers don’t yet hold the same sway in healthcare as they do in many other industries, their power shouldn’t be underestimated. The growing consumerization of healthcare means more patients are comfortable making demands of their providers and, if those demands are not met, going elsewhere for care. For example, switching is common among Medicare Advantage beneficiaries who, on average, have access to 39 different plans. Providers who want to attract new patients need to offer virtual care.
One reason why healthcare systems are slowing the expansion of virtual care is because they know they know they need to get better at it. According to a September 2022 survey of healthcare executives by consultant Sage Growth Partners, only 11% of hospitals and 8% of independent practices were looking to expand their telehealth offerings this year. Most respondents (70% of practice physicians and 56% of hospital executives) said they are focused on sustaining or optimizing their telehealth programs, many of which were hastily set up or expanded during the pandemic.
Health systems face financial and staffing challenges
Another impetus for virtual care is the dire economic condition of healthcare systems. Plagued by declining revenues and faced with crippling clinician and staff shortages, hospitals are desperately searching for ways to continue to deliver quality care more efficiently. While offering in-house virtual care is an option for some, many health systems cannot muster enough resources to start and operate such services on their own. The Sage Growth Partners survey found that 52% of practices and 35% of hospitals feel telehealth has increased the workload of support staff and 57% of organizations report not yet creating new workflows to optimize virtual visits.
So more healthcare systems are looking for outside help and support with virtual care. Some use third-party telehealth platforms and providers to expand coverage, but this can pose problems with sharing clinical data among incompatible EHRs.
As a result, this year will see more healthcare systems partner with Virtualist provider partners who can augment their own team and collaborate through the systems’ Epic EHR. These virtual care partners can help manage the routine care of patients via a combination of video, phone and asynchronous visits, which is ideal for the treatment of minor urgent care issues, the monitoring of chronic disease, or for checking up on post-op patients.
Such partnerships will allow health systems to expand the total number of patients they manage as routine care is shifted online, the overuse of certain services declines, and physicians have more time for office-based visits for the patients who need it most. By embracing the right virtual care strategy and partners, health systems can increase access, improve efficiency and ensure patients get the care they need, when and where they need it.
In summary, expect growth in virtual care this year, largely in the form of refining and improving existing offerings, creating more efficient systems, and forming new partnerships between health systems and Virtualist providers.
Author: Lyle Berkowitz, MD, FACP, FHIMSS is the founder and CEO of KeyCare, the nation's first virtual care company built on Epic.
Physicians Practice | January 31, 2023