The past few months have undoubtedly put the spotlight on virtual care in the face of the COVID-19 pandemic, As internal health system data continues to come out, it’s become evident that for some patient care organizations, the surge in telehealth visits has been beyond anyone’s expectations.
At MedStar Health, for example, based in the Baltimore–Washington metropolitan area, health system leaders have dabbled in telehealth visits for years before launching its Telehealth Innovation Center in 2017. It was certainly a struggle in the beginning, notes Ethan Booker, M.D., medical director of the MedStar Telehealth Innovation Center and MedStar eVisit, though in the three years since the center was built, he says the organization learned valuable lessons around education, expertise, and distributed knowledge “that allowed us to respond quickly to the pressures that came on [via COVID-19].”
But make no mistake, before the pandemic began to hit the U.S., the volume of video visits at MedStar was still quite low. Booker recalls that in the month of February, the organization conducted just 240 telehealth visits, an average of eight visits per day. These virtual sessions were mostly for urgent care rather than scheduled visits, of which there were usually only two or three per week. Booker and his team were realizing what many others around the country were experiencing—while patients liked having telehealth as an option, they still greatly preferred face-to-face visits. He notes that the fact telehealth was previously rarely used speaks to core reimbursement and regulatory barriers, but also a significant cultural challenge in how patients wish to receive care, and how healthcare delivery has historically been set up around the in-person model.
Of course, the epidemic then turned everything from a care delivery perspective upside down. “We’re a large health system; we had 4.9 million [overall] ambulatory visits last year. The scale of our outpatient footprint is very large, so there [was an opportunity] to transition a significant percentage of those visits to some other modality,” says Booker.
The health system has been using telehealth services vendor Bluestream Health to perform its virtual visits, and began to pivot from a business-to-business deployment use-case to a direct-to-consumer strategy that was jumpstarted by the pandemic, Booker says. Previously, as he explains it, MedStar used the Bluestream platform that enabled attending physicians in a command center to provide remote triage to eligible patients in the emergency department via video.
As a health system, MedStar had done about 80,000 virtual visits using this B2B approach, so even though they were transitioning to a direct-to-consumer model to meet the demands created by COVID-19, Booker says having the infrastructure already in place from an onboarding, provisioning, and security standpoint was a big help. In late February, when conversations among MedStar leaders on how COVID-19 would impact care delivery began to ramp up, Booker’s team was able to fall back on the several telehealth use cases already established via the Bluestream platform as opposed to needing to reinvent the wheel. “Rather than trying to rebuild infrastructure from the ground up to respond to the new digital reality, we used the infrastructure that existed already and pieced it together in ways that made a lot of sense,” he says.
A virtual explosion
From March 23 to April 22, MedStar performed 50,000 telehealth sessions, compared to just 240 in the month of February. Booker calls it a “rapid explosion that was the result of several years’ worth of careful collaboration between MedStar and Bluestream,” as well as developing a lot of internal knowledge related to how the health system would deploy this on such a large scale if barriers ended up presenting themselves. Other key telehealth surge metrics, as called out by MedStar officials, include:- Volume increased from two sessions per week to a peak volume of nearly 4,000 in a single day, totaling more than 51,700 visits in the service’s first month
- 425 providers delivered 1,236 scheduled video visits in a single day just one week after launch and more than 2,070 providers were conducting them by the service’s first month
- The average weekday outpatient telehealth visits reached 3,626 visits in the week of April 12, more than 500x growth when combined with MedStar eVisit urgent care telehealth volumes
- As of May 10, more than 98,480 MedStar Health video visits alone had been delivered, with more than 100,000 telehealth sessions administered during the COVID-19 outbreak overall
From a training perspective, Booker contends that providers were brought up-to-speed with just a short tutorial, a one-page sheet along with an education module they can go through online in just a few minutes. “Our providers have been able to take that and run with it. And on the patient side, our experience has been traditionally that we need to reach out to them beforehand to ensure they will be able to connect [remotely], and do a little education and training with them so they’re prepped. But at the scale we were going to deploy this, we knew we wouldn’t be able to do that,” Booker acknowledges. Nonetheless, he adds, it’s been a positive experience for patients as the technology is very easy to use. “They get a link [on their device] and when they consent, they get connected right to the live video.”
What happens post-COVID?
Although industry stakeholders are mostly happy that CMS moved quickly in March and April to remove payment- and licensing-related barriers to the expansion of telehealth, the question as to whether enhanced payment for telehealth services, and whether the licensing restriction relaxations would continue into the future beyond the immediate phase of the epidemic, continue to linger.
To this end, Booker hopes that providers and vendors both will take the opportunity to collect “really good data about the quality, safety, cost and benefits” of telehealth, which would then bring solidified information to the table for when stakeholders meet with CMS, payers and regulators about what should happen after the crisis winds down.
Booker acknowledges there’s a real possibility that some guardrails will go back up, “and it’s incumbent on us who have been doing this work to collect the data and be thoughtful about which [elements] do go back in place.” He adds it will be incredibly important to carefully consider “what we do next and how we deliver this type of care, once physical distancing and other issues related to a communicable disease are eased. It’s a complex world we’ll be evolving into, and I hope we do the right thing in data collection. I know we have done the right thing in care delivery.”
