On one hand, Medhavi Jogi, M.D., an adult endocrinologist in Houston, was not unlike many of his physician colleagues across the country whose practices were upended as a result of the COVID-19 pandemic. Having to significantly limit in-person visits, practices of all types had to quickly pivot to telehealth to provide patient care while also recouping at least some of the revenue that would be lost due to shutting down face-to-face appointments.
But on the other hand, Jogi—whose practice has five adult endocrinologists who mostly see diabetics, along with patients with thyroid cancer, and thyroid and hormone issues—may have been more prepared to deal with the dramatically different care delivery landscape since the organization has been growing comfortable with digital health, in a few different forms. In a recent interview, Jogi explains that since his practice is a cognitive specialty—meaning there aren’t a lot of procedures that need to be done—they have been pushing the envelope on telehealth for several years now, and have seen significant upticks in its use. Jogi, while admitting that the practice hit somewhat of a telehealth “brick wall” in 2018 due to insurance providers that wouldn’t cover these services, reports that leading up to the pandemic in March, his practice was doing about 30 percent of its visits via telehealth.
“So for us, the transition wasn’t really a ‘transition.’ We only needed to work on how to get the phones to our staff’s homes, but the transition for patients was less painful for us than for some of my colleagues,” Jogi contends. “We kind of just flipped the switch to only doing telehealth visits, and since we have already played around [with this], it wasn’t a big leap, there were no huge technology barriers, and the processes around collections and routing patients to the right places was already set up.”
Indeed, in March, when COVID-19 turned into a real crisis for U.S. healthcare, Jogi’s practice turned to 100 percent telehealth, though visit volumes were still down from pre-pandemic levels, just as they were across the healthcare system nationwide. Jogi reports that the practice reopened in June, and while some of his co-workers started to get back in the office regularly, he personally has stuck with high volumes of telehealth. “I have remained at about 85 percent telehealth visits; the rest of our doctors are now realizing this hybrid practice has to exist, and it’s not that easy to go back-and-forth [from telehealth to in-person],” he says. “It’s similar to having two different physical offices, as I view telehealth as a separate facility from the main office. When you’re going from a telehealth visit to an in-person one, the mood and efficiencies are different. So some of our doctors have been trying to go back-and-forth, but I had already realized that doesn’t work.”
Of course, the environment has changed in the past few weeks in Houston, as the broader state of Texas continues to break records for new COVID-19 cases and deaths. As a result of this surge in the region, Jogi says that patients are now expressing concern about coming in physically and want to convert to getting care from home. On the week ending July 4, Jogi offers, half of patients converted back from planned office visits to telehealth visits. “I personally only see patients a few days a month in the office to reduce exposures, and I have pushed for only the patients who need to come into office to do so—meaning they are either incapable of getting digital health [services] or need a procedure,” he says.
Going forward, Jogi believes that telehealth should be a big part of providers’ care delivery future, noting that it hasn’t taken off yet mostly due to “bureaucratic reasons.” He says that he’ll get calls from patients all over the country who self-schedule appointments online, but once Jogi finds out what state they live in, if it’s not Texas he has to end the call since he’s not legally allowed to give medical advice across state lines. “There’s currently no way to easily get a license, let alone malpractice coverage, [beyond] my current state. These barriers are artificial and need to go away,” he asserts.
The importance of targeted messaging
Although most prominent, telehealth has not been the only digital health vehicle used by Jogi’s endocrinologist practice. The organization is also leveraging a patient engagement platform from the San Francisco-based Luma Health to blast key messaging out to its patient population. Via the Luma tool, the practice has been blasting out targeted messaging on a week-by-week basis, giving patients a variety of important messaging, such as: what has changed in the practice this week compared to last; updates about social distancing in the waiting room; referring patients to an informative web page that continuously gets updated; and reminding them to wear a mask if they come in.
Jogi also uses the messaging technology to sub-divide patients based on visit type or how at-risk they are, resulting in only those groups of patients getting the messaging as opposed to everyone. What’s more, the messaging capability enables the practice to provide what Jogi calls “an infinite waiting room,” encompassing the entire building, parking lot and sidewalks. He explains that a patient can now come into his or her appointment, get screened, and then wait outside the building—assuming there are more than four or five people in the waiting room inside. Patients will then get a text message to their phone via the Luma tool when they’re ready to be seen—exactly like a restaurant’s waiting list service, Jogi says.
Jogi notes that using the Luma platform is much more appealing than using the organization’s electronic health record (EHR) for these functions since the latter tool “nickels and dimes for everything and isn’t intuitive.” For example, in the context of patient communication, he believes the biggest problem is that many EHRs charge 10 to 15 cents per text, “which is crazy.” With Luma, however, “there is a fixed cost, meaning I can [forecast] my expenses better. “I didn’t know that I’d be sending 10 times as many texts to patients in March compared to February, for instance. So from a business perspective it’s nice to know your costs are fixed in,” he says, adding that in the EHR system, it’s not always clear where the responses from patients get filtered to.
What’s more, with the Luma platform, the practice’s manager receives the messaging instructions from Jogi, and blasts them out right from his phone or computer. And in terms of post-visit care, once the patient is seen as either a telehealth or in-person visit, there are automated follow-up actions enabled by Luma, as opposed to having the staff call each person individually pre- and post-visit, which often results in back-and-forth phone tag. “The stress that we would have passed onto the office staff has been reduced quite a bit in terms of getting hold of patients and telling them something related to the visit,” says Jogi.