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.
Healthcare reimbursement models are payments that are made to healthcare organizations for
medical services provided (Torrey, 2020). There are many healthcare payments models that are being
used today, such as hospital value-based purchasing, Medicare, fee-for-service, bundled payment, etc.
Ever since COVID, telemedicine has become one of the largest ways that health care providers
provide services to patient. FFS is a very traditional model that tracks, quantifies and pays for a
service (University of Alabama at Birmingham [UAB], 2018). If you receive care, you pay the
provider for that specific service. With the use of telemedicine, providers are able to see more
patients virtually and are providing lower quality care. FFS is not a great trend or model for patients
because even if the provider does or does not have a solution to your problem, the provider gets paid
anyway. Eventually causing providers to offer care based on quantity, instead of quality care.
Trisha Torrey. (2020). How Healthcare Providers Are Paid by Reimbursement. Verywell Health.
https://www.verywellhealth.com/reimbursement-2615205
University of Alabama at Birmingham (UAB). (2018). Fee-for-service vs. value-based healthcare.
University of Alabama at Birmingham. https://businessdegrees.uab.edu/blog/fee-for-service-vs-value-
based-healthcare/
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
