There is an element of my job that directly coincides with the financial end of
healthcare as my position follows select surgical cases collecting numerous data points
pre-op, intra-op, and post-op. The post-op data points or surgical outcomes including the
length of stay, returns-to-OR, readmissions, as well as other post-operative complications
that might occur, are reported to hospital management as they directly translate to
increased costs per patient than had that patient not had a post-op occurrence. I would
imagine that this course will give me a keen insight into what upper management is faced
with when it comes to the information, I provide surrounding such things as hospital
readmissions and protracted length of stay for patients.
One healthcare trend that has emerged since 2020 and COVID-19, is the more
widespread use of telehealth. Koonin et al (2020) define telehealth as two-way
telecommunications technologies that provide remote clinical health care through a variety
of methods. During the first three months of 2020, the number of telehealth visits
increased by 50% over the same period in 2019 (Koonin et al, 2020).
One implication of this trend was to be able to ensure that the institution and/or the
provider were being appropriately reimbursed for the visit. Shachar et al (2020) write that
one of the significant changes in telehealth related to the pandemic was the fairness and
equality of payment between in-person and telehealth visits. Before the surge of
telemedicine during COVID, many states required insurers to cover these visits but did not
stipulate equal reimbursement between the two types. Low reimbursement translates to a
huge disincentive for the care provider to offer this type of visit (Shachar et al, 2020).
Another implication was that the clinician could not use a valuable assessment tool
during these visits – the hands-on assessment of the patient. The clinician was forced to
rely on the quality of the internet connection or photos that were uploaded from the patient
to assess and provide an accurate medical assessment. If something was missed by the care
provider not being able to do a physical assessment, then this could impact the provider or
institution financially through hospital admissions, undiagnosed infections, etc.
Conversely, a telehealth visit may do the patient an injustice if there is not the
ability to have a hands-on visit. I ran across this early in the pandemic when I ‘tweaked’
my back. My primary care physician, a DO, who routinely does osteopathic manipulations
and has helped me numerous times over the last 30 years, called me instead of allowing an
in-person visit due to COVID restrictions. Needless to say, the outcome of a phone call to
remedy my back dysfunction did not quite have the same effect as a somatic manipulation
would have. Yet he billed my insurance company for the visit as if I had trekked to his
office.
A third implication was the increased resources had to be shifted to ensure that
these telehealth visits and subsequent patient communications were Health Insurance
Portability and Accountability Act (HIPAA) compliant. Previously, the regulations
surrounding HIPAA had been perceived as a potential barrier to the wider adoption of
telehealth visits (Shachar et al, 2020). Not all healthcare providers have the means to
ensure that remote visits could be conducted with the same privacy and security as
office/hospital/clinic visits (Shachar et al, 2020). My institution does not allow the use of
personal email as a means to contact a patient for surgical case follow-up. We have
recently gained access to MyChart messages to facilitate another means of contacting the
patient.
I feel that telehealth visits will remain an important tool for non-critical healthcare
needs as it renders traveling unnecessary for certain patient populations while still having
that provider connection and/or follow-up.
References
Koonin, L. M., Hoots, B., Tsang, C. A., Leroy, Z., Farris, K., Jolly, T., Antall, P.,
McCabe, B., Zelis, C., Tong, I., & Harris, A. M. (2020). Trends in the use of
telehealth during the emergence of the COVID-19 pandemic. Morbidity and
Mortality Weekly Report, 69(43), 1595–1599.
https://doi.org/10.15585/mmwr.mm6943a3
Shachar, C., Engel, J., & Elwyn, G. (2020). Implications for telehealth in a
post-pandemic future: Regulatory and privacy issues. JAMA.323(23),
2375–2376. https://doi:10.1001/jama.2020.7943
