“If we were having this conversation six months ago, and you said physician groups would be switching to 100% telehealth, I would have said you were smoking something very powerful.”
Honestly, I could end this article right there, because Dr. Betty Rabinowitz, Chief Medical Officer at NextGen Healthcare pretty much said it all in that one statement. Telehealth has emerged as one of the most important technologies in this pandemic – not because it helps fight the COVID-19 virus, but rather it helps keep patients in contact with their care team when physical distancing is keeping us all at home. Dr. Rabinowitz foresees profound changes to ambulatory care due to the adoption and acceptance of telehealth.
A confluence of four factors laid the groundwork for this telehealth renaissance:
- Canceling of all non-essential healthcare
- Physical distancing and stay-at-home orders
- Reimbursement parity between telehealth and in-person visits
- Suspension of HIPAA Penalties for telehealth during COVID-19
In just a few weeks, the barriers (perceived and real) that had stymied the adoption of telehealth were removed. Dr. Rabinowitz singles out reimbursement parity as the key to telehealth’s rise in ambulatory practices: “In the past, the compensation structure for telehealth visits was very restrictive in the ambulatory space. There was a very narrow definition of the kinds of telehealth visits that were covered. With the relaxation of the rules by CMS and other commercial payers, that barrier was removed, and offices were able to adopt telehealth.”
Dr. Rabinowitz points out that many physician practices and healthcare organizations already had telehealth capabilities prior to the pandemic. However, many were not fully utilizing that capability. She likened it to having a slick Italian sports car and only using it to drive around the neighborhood at 25 miles an hour.
Because NextGen’s focus is on ambulatory practices, Dr. Rabinowitz has interesting insights on the future of waiting rooms as we know it. Really, it’s a no brainer. When patients – many of whom are working and/or taking care of their families – have to drive, find parking, take time off work, and then sit in a waiting room with other people who are coughing, sneezing, or otherwise sick, telehealth is a welcome relief. And waiting rooms will likely either see massive overhauls or be removed altogether.
Waiting rooms were originally designed for space efficiency – packing as many people together as possible into a small space. But now, people are being asked to wait in their cars and check in on their mobile devices rather than congregate in the waiting room.
“During this pandemic, waiting rooms have been under duress” says Dr. Rabinowitz. In the immediate aftermath of COVID, she sees the need for new waiting room layouts – ones that respect physical distancing. This would likely mean fewer chairs spaced further apart and instead of fabric seats, hard surfaces that can be disinfected easily. Dr. Rabinowitz also sees a day when offices will be redesigned with smaller waiting rooms.
Dr. Rabinowitz also believes telehealth will have a profound effect on practice staffing: “If there are less patients that need to be ‘roomed’ then fewer patients need to be weighed, have the blood pressures taken, etc.” This means fewer staff will be needed to handle the in-person volume. On the other hand, staff will need to be trained to give them the skills necessary to see patients via telehealth.
According to Dr. Rabinowitz, clinicians as well as admin staff need to learn an important new skill – triage. “I think the challenge for practices is going to be to learn what visits in the future are suited for telehealth and what issues require the patient to come into the office. That nuance between the patient’s preference, the physician’s preference as well as the clinician content of that visit all need to be balanced. There’s no point in starting a telehealth visit only to tell the patient they have to come into the office.”
Having serendipitously acquired a telehealth platform (OTTO Health) in late 2019, NextGen is well positioned to help physician offices incorporate virtual visits into their standard workflows. “At NextGen we really believe that in order to be effective, population health, telehealth, mobile, etc. all have to integrate into the EHR,” states Dr Rabinowitz. “Physicians are very fatigued and don’t want to log into multiple applications to do their job. Integration is key.”
Finally, as she was able to do multiple times throughout our interview, Dr. Rabinowitz put into words what a lot of us are thinking right now: “Any of the challenges we face, pale in comparison to the sacrifice, the devotion, the risk, and the courage that our clients are demonstrating at this time, and we salute them.”
Watch the full interview to learn:
- How physician practices are (or aren’t) adopting telehealth differently than hospitals
- Why staffing ratios and skill sets will be changing in the near future
- How the demand for convenience will manifest post-COVID-19
- Why the adoption of telehealth will go much smoother than EHRs originally did
- Why telehealth can’t solve everything
For more information Visit https://www.nextgen.com/
This article is part of the #HealthIT100in100
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