The leaders of patient care organizations nationwide have had to shift very quickly to telehealth-based platforms, as the COVID-19 pandemic has compelled clinician and administrative leaders to do whatever they could to make patient care delivery safer both for patients and for the clinicians and other frontline workers in hospitals and clinics.
One of many such organizations is the Hendrick Health System, based in Abilene, Texas. Hendrick Health serves a 24-county region of west Texas, a region with a population of 400,000 people. Hendrick Health centers around a community hospital with 500-plus inpatient beds, plus more than a dozen medical clinic locations, and employs about 100 of the 250 physicians on its medical staff.
Hendrick continues to expand; on April 27, in a press release posted on its website, the organization announced that “Hendrick Health System has signed agreements to purchase Abilene Regional Medical Center (Abilene Regional) and Brownwood Regional Medical Center (Brownwood Regional) from affiliates of Community Health Systems, Inc. (CHS). The organizations anticipate finalizing the transactions by the fall of 2020, subject to state regulatory approval.”
“Throughout our more than 95-year history, we have met the healthcare needs of Abilene and surrounding areas,” Brad Holland, president and CEO of Hendrick Health System, said, in a statement in that press release. “We are proud to be a trusted healthcare partner to so many in our community, evidenced by the fact that we are often at capacity for many of our services. By Abilene Regional and Brownwood Regional joining Hendrick, we will be able to ensure patients have access to care when they need it.”
As the announcement noted, “This decision reflects the determination of the Hendrick Health System Board of Trustees to ensure Hendrick is well positioned to navigate the healthcare industry’s changing landscape. Through the proposed transactions, Hendrick is committed to maintaining healthcare services and promoting local jobs, while expanding access to care.”
As have senior leaders at other patient care organizations have been doing, Hendrick Health’s executives have been moving forward to shift care delivery to remote care, to the extent possible. In that regard, they have been partnering with the Chicago-based Allscripts.
On March 30, Allscripts executives noted in a press release that, “In the last month, more than 100 clients have selected, and more than 50 clients have already implemented, FollowMyHealth Telehealth. The solution allows for the engagement of patients in their homes and enables communication between quarantined people and sponsoring healthcare organizations. By converting appointments to telehealth,” the press release noted, “the solution limits interactions that could further spread the COVID-19 virus to patients and healthcare workers, as well as provides peace of mind to patients who are able to use telehealth visits and limit their exposure in times of this outbreak. In addition, the solution can help limit no-shows and cancellations while delivering care to those in need. During the COVID-19 crisis, Allscripts clients have increased the number of video visits by 9,000 percent.”
And, the press release noted, “This expedited implementation includes a step-by-step client decision workbook, 10 remote project hours for training, a specialized COVID-19 form and alert verbiage for patient outreach, enabling clients to be up and running in a matter of days. The average installation is less than 5 days from contract to go-live. The FollowMyHealth solution follows recommendations made by the CDC to proactively reach out to triage patients prior to appointments and explore alternatives to face-to-face visits.”
And it quoted Hendrick Health’s Holland as stating that, ““Because this unprecedented health crisis has deterred patients from seeing their providers, it’s never been more critical for healthcare organizations to utilize available telehealth capabilities. With FollowMyHealth, we have been able to reach our patients while they remain safe in their homes. It’s a tool that has proven vital in our efforts to flatten the curve of COVID-19.”
Recently, Holland spoke with Healthcare Innovation Editor-in-Chief Mark Hagland regarding Hendrick Health’s transition. Below are excerpts from that interview.
Where were you in terms of the development of telehealth in your organization right now?
The fact that we serve a region of west Texas that encompasses 24 counties tells you how geographically dispersed we are. Yet until recently, we hadn’t been focused on telehealth. From a prioritization perspective, telehealth was not on the radar; we had put other priorities first. But when COVID-19 hit, our priorities shifted dramatically. With Allscripts, we were working on traditional EHR [electronic health record] implementation. Allscripts is a good partner to us. And we’re in the process of converting a lot of our systems. One of our systems is called FollowMyHealth. Our adoption of mobile and remote technology has been relatively slow. And this all changed. I would say that COVID-19 and the need to social-distance, in addition to the need to also maintain contact with the consumer, and seek additional revenue opportunities when healthcare revenue dried up overnight, to the tune of 50 percent, based on the postponement or cancellation of elective surgeries and asking people to stay remote—that need and the federal government’s cutting of red tape, changed everything.
Given that your service area has a sparse, diffuse population, that offers a real opportunity for the development of telehealth, correct?
We’ve always identified telehealth as a need, but because of the large amount of red tape and the uncertainty of reimbursement, and the low margins in healthcare, it just hasn’t been a priority. We always knew it should be, but there were just too many barriers. And not because it’s not successful in its utilization; it just hasn’t been well-adopted by consumers or physicians.
But COVID-19 really created a rapid adoption both by the consumer and the physician. And now that it’s been rapidly adopted and is being paid for by the payers and government, with red tape eliminated, it’s been rapidly adopted. And we’ll never go back to the way we were before. It will be a new tool in the physician’s toolbox. They can have their office staff reach out and give the patient the option of being seen in person or remotely. So a doctor doesn’t have to choose one all-in strategy or the other. So I do believe it’s here to stay.
What has been the timeline of your activity been?
We had been working with Allscripts through a number of platforms, including FollowMyHealth, our patient engagement platform, a secure portal for communications between the patient and doctor or hospital. When COVID-19 hit, I suspected it would not be a realistic pivot; we had looked at telemedicine, but it seemed like too far a bridge to cross with the barriers we had at the time. But we literally picked up the phone and called Allscripts, and within ten days, they had their pilot programs up and running, and we were doing some telemedicine visits. It was clunky at first, and we’re still learning. But Allscripts really worked through the FollowMyHealth platform.
What volume of visits has been involved?
It involves hundreds of televisits a day. We lost about 50 percent of our patient volume overnight; and have replaced about 50 percent of that lost volume through televisits. So about 25 percent of our visits today are televisits.
At this point in time, as far as Hendrick Health System goes, we’re using a couple of different platforms for telemedicine. Because all the red tape has been completely removed, telemedicine is anything within a visit within the portal to an Apple FaceTime visit. Telemedicine is here to stay, but I do believe that HIPAA and new restrictions will come back; so I do believe that the Allscripts portal has created a platform that will survive any red tape that comes back. Apple FaceTime is OK for now, but there’s no way to track or measure performance. So we’ll learn a lot.
Have there been any particular challenges?
The rapid adoption is the challenge. Cutting the red tape—how do you bill and collect? How do you determine that the physician really did that televisits, how do you prove and document it, does it need to be in the medical record? That’s just a compliance issue, to validate and track all the compliance.
What have the biggest lessons learned been in the past month?
Well, I think the biggest lesson learned is that you’re not in control of the future. Just because you have your priorities doesn’t mean you won’t have to pivot quickly. And you need to have partners that you can work with. And it won’t go back to the way it was. There are just going to be new tools in the toolbox.
Have there been any technological issues?
There have been a number of them—everything from FaceTime to having to download a portal, sign up for it, and everything else. So how do you make it easy for a consumer to want to adopt, versus ease of tracking the visits and integrating them into the electronic medical record, to document them, for payers? So how do you balance that between apps that are too clunky and complicated, and something like an Apple FaceTime, but yet so that you can document them in the record? I think it’s not known yet, only time will tell, and the government will have to decide what they want to do.
How do you see the prospects, relative to the recent relaxation of telehealth regulations on the part of CMS [the Centers for Medicare & Medicaid Services]?
I look at what the healthcare industry has been able to accomplish around COVID-19. And there have been hundreds and hundreds of federal and state waivers. And healthcare has risen up and met the needs, because red tape has been cut, and innovation has been spurred. I believe that hospitals are very innovative, but you have to give them the opportunity to do so. I’m not naïve enough to think that we won’t put barriers back on. I don’t think an Apple FaceTime is going to carry the day; but it also won’t go back to the way it was. I think you’re going to have some modest regulations. That’s why developers like Allscripts who have developed telehealth through a portal, so that interactions can be documented in the record, will do well. But I’ve done this long enough to know that regulation happens in healthcare. Right now, payment is at parity for telehealth. It remains at parity, that’s great. But if it they pay it less, then you’re going to see people not use it as much, because they can maximize reimbursement by having people come in.
