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The #COVID pandemic made telemedicine emerge, will it last?

#TelemedNow Twitter Chat Wednesday, May 27 – 8 PM ET Introduction & Welcome: Ceci Connolly (@CeciConnolly) -- Moderator

Q1 Due to #COVID-19, 72 percent of US consumers have dramatically changed their use of traditional care services, with many delaying in-person care & embracing virtual options. How do you see this changing in the next months or years?

A1 Notable Responses: Jamey Edwards (@jameyedwards) The #CatisOutoftheBag & the #GenieIsOutoftheBottle. Whatever your analogy, #Telemedicine is here to stay & will be a part of the daily practice of #healthcare. While volumes may peak during #COVID19, #patients & #doctors are building musclememory w/ #telehealth Jamey Edwards (@jameyedwards) It's time to redefine "health system" away from its geographical boundaries. 4 walls of #hospital are breaking down & need to meet #patients where they are. Future hospitals will be smaller as #healthcare migrates to other venues (home, work, etc...) Susan Cantrell (@amcpceo) #ACHPAMCPpoll results show that U.S. consumers will continue the same behaviors they adopted during the #COVID19 pandemic. From adopting telehealth to filling their RXs — 90% of consumers have filled their RXs @ a local retail pharmacy & 91% plan to continue to. #TeleMedNow Andrew Watson (@arwmd) We will definitely fall back but not all the way back, I hope realistically we can end up somewhere between 30 to 50% of #Telemedicine moving forward, and expand it. This will take strategic work. A resurgence of #Covid19 could drive it. Andrew Watson (@arwmd) Likely #TelemedNow growth over months due to pent-up need and patient fears. Beyond current crisis (is there a beyond?), will likely see > shift back to in-person care, especially for care that can’t be provided virtually. Payment parity across payers will be a big factor. Ginny Whitman (@GinWhitman) Here’s hoping we can create a smooth transition for those who are delaying care. People will want to rely on comfort and convenience post-pandemic-trauma #TelemedNow Kevin Fowler (@gratefull080504) In my opinion the policies need to support the adoption #Nephrology is uniquely positioned because of the Executive Order, Advancing American Kidney Health #TelemedNow Jim St.Clair (@jstclair1) Also concerned about uneven distro of #virtualcare resources, and lack of plan/policies Jagdish Patel (@jpkca) Patients will become comfortable with #Telemedicine They would prefer to have online meeting for simple problem like HTN Mx and needing Rx Ritu Thamman (@iamritu) as contact tracing improves/vaccine arrives telehealth will remain an important & necessary way to deliver primary care, mental health care - esp. for those in rural areas esp if senator @lisamurkowski proposed 2 billion for broadband is approved

Ami Bhatt (@AmiBhattMD) #healthcare is a #consumer industry. #patients want high #quality care 24/7 ... they will demand #access that we can only provide with #TelemedNow with in-person care. Ryan Louie (@ryanlouie) I wonder if patients will think about their #privacy in new ways (either need for more, or ok with less). Balancing that with their personal realization of technology and health. #TelemedNow Ritu Thamman (@iamritu) Privacy & with the nuance of preventing virus Microbe exposure & spread will remain a key motivator for #TelemedNow demand by both patients & doctors Sam Lippolis (@samiamlip) I still think provider adoption is a barrier. Patients don't know #telehealth exists if providers don't offer. We need to help #telemednow be easy and integrated for providers so they want to keep using it. Stacy Hurt (@stacy_hurt) While most of these changes may have been fear driven initially, they will be #accessibility driven sustainably- As a chronically ill #patient and permanent #caregiver, I have NO PLANS to give up these options which have improved my life #TelemedNow Salim Saiyed (@SalimCMIO) Once you go #TelemedNow route, you don’t go back! #patients will demand convenience, #docs have responded, & #insurance industry will shift. We have finally made routing part of delivery model. We are aggressively thinking newer models to shift to even more #telehealth Chang Na (@cna006) rural doc in an integrated system here. Agree! Improved access to internet is key, if we are to realize the true potential of telemedicine. #TelemedNow Jagdish Patel (@jpkca) #TelemedNow Scope for future growth in each area of following Ted Chan (@upwardmobility) I believe the future practice is something like 30% virtual and 70% in person. #Covid_19 accelerated the trend towards what the consumer ultimately wants. #TelemedNow Matt Sakumoto (@MattSakumoto) #TelemedNow Both patients and providers have taken the plunge and realized the water is fine! Predicting a baseline 30-40% Virtual Care, even long after COVID is gone.

Q2 How can we encourage people & clinicians to avail selves of the convenience of #virtualcare without threatening the viability of brick and mortar facilities? A2 Notable Responses: Jamey Edwards (@jameyedwards) There is still a place for in-person care. It's not going away or being replaced. #telemedicine will be integrated as part of a broader care continuum. Will save time & money while lowering #carbonfootprint & improving experience for #patient & #doctor. Susan Cantrell (@amcpceo) Current experiences with #virtualcare will instill confidence and demand in both patients & providers. In turn, payers will incentivize providers who give the best & most cost-effective care. Or am I too optimistic?

Kevin Fowler (@gratefull080504) Speaking for people living with #kidneydisease it is the path to bring long overdue change + create a system of care in the best interests of #kidneydisease people Ritu Thamman (@iamritu) parity with face to face visit payments & incentives -ie asynchronous telemonitoring with text messages to keep better continuity b/w visits, w complementary not competing services offered ie drive-thru/walk-up express health care site: for vaccines, x-rays, EKG Salim Saiyed (@SalimCMIO) We started with a 5 step plan to sustain or halt the backsliding 1. Need #physician alignment 2. Create seamless #virtual #patient workflows 3. Engage staff training for new roles 4. Align strategic goals with new #TelemedNow models 5. #payor contracts Focus on sustaining! DLarriviere (@d_larriviere) As great as #telemedicine is, it's not the correct fit for all issues. As a neuromuscular neurologist, I see challenges in strength/sensation assessments via telemedicine; validated pt reported scales may help w/subsequent visits. #TelemedNow Aditi Joshi (@draditijoshi) don't think we have to - some visits need to be back in clinic. also clinicians can then evaluate and see their patients and if they did fine at home. This will increase comfort with #virtualcare visits, rather than decrease it. Andrew Watson (@arwmd) I think it varies by specialty, I was speaking to a vascular surgeon, and they need to have patients come to clinic for tandem testing. But educating the patients, and making sure physicians understand it is critical. You and @JuddHollander are so good at this Thumbs up #TelemedNow Ritu Thamman (@iamritu) Agree & we need to really look at what is “backsliding” for example the relative “decline” in telehealth visits remains largest among surgical & procedural specialties where you need face to face to get the procedure done:we need to frame this “backsliding” narrative #TelemedNow Helen Burstin (@HelenBurstin) Great point, Ritu. A deeper analysis will help us understand what type of telehalth is "backsliding." Expect to see a spike in visits due to pent-up demand for necessary procedures. #TelemedNow will be key to meet demand for other services Andrew Watson (@arwmd) I agree, that’s a great point Ritu. I wonder where it will level out, or if #Covid19 returns, will we not get a good sense of that. It may take months to get caught up with procedures. #TelemedNow Judd Hollander (JuddHollander) Interestingly, as our offices are now carefully seeing more in-person visits once again, our ambulatory telemedicine volumes are holding steady. Patients tried it and they liked it. Just added another tool to care for patients. #TelemedNow Helen Burstin (@HelenBurstin) Yes! Lots more can be done virtually than most docs ever believed, but we need to safely bring back in-person care where it's needed. For #TelemedNow to be sustainable, we also need payment parity across all payers. Kamala Tamirisa (@KTamirisaMD) Procedural subspecialty - so far we are continuing to use #telemedicine for satellite offices/follow ups/distant referrals. And face to face visits have picked up too. Stacy Hurt (@stacy_hurt) We need so much more #patient education- these new technologies were thrust onto some of our most acutely ill populations (ie the elderly) without much guidance-we can start to fill in those gaps to show peaceful coexistence of #TelemedNow with brick and mortar

Q3 How can we create sustainable biz model for #telehealth that incentivizes docs to offer & affordable enuf to incentivize people to continue to use? How about a capitation model just for #telehealth? A3 Notable Responses: Jamey Edwards (@jameyedwards) #Telemedicine needs to be an ROI driven investment that postively impacts #quadruplebottomline. As #healthcare continues its #DigitalTransformation, those not offering #telehealth options will be left behind as patients vote with their fingers instead of feet. bloomrhealth (@bloomrhealth) Efficiency and Cost Savings to the clinic backoffice should translate towards patient costs #TelemedNow Ritu Thamman (@iamritu) There may be a shift towards prevention like #ULIVVOhealth “unlimited Telehealth for unlimited family members $4.95/month “ http://buff.ly/2TsGGhE #TelemedNow Also incentives for behavior like the Stealth.ify app that rewards https://bit.ly/2ZIrReB Andrew Watson (@arwmd) Telemedicine always struggles in an E&M environment. Once there is risk, or a gain, or some capitated type of model it is far more successful. #TelemedNow as payers expand benefits to include #Telemedicine, and incentive change, this will be more evident. #HEDIS Andrew Watson (@arwmd) One of the key issues with #Telemedicine is that it cannot be an additive cost. It has to be a replacement cost. One of our leaders said “there is no more room in the healthcare dollar.” DLarriviere (@d_larriviere) Finding ways to use #TelemedNow as a force multiplier, not just a force extender - a la Project Echo - could add value by decreasing costs and expanding access. Matt Sakumoto (@MattSakumoto) #telemedNow Capitation. Quality over quantity. No need to nickel and dime for each RPM code. Just monitor if needed, not just if reimbursable

Q4 What types of software solutions and devices do payers and providers need to safely shift some services from in-person to virtual?

A4 Notable Responses: bloomrhealth (@bloomrhealth) Easy/Simple, Adaptable and Interoperable #TelemedNow Jamey Edwards (@jameyedwards) In a #BYOD world, #telemedicine platforms need to be available on #PC, #iOS & #Android. #Interoperability is a key component to long term sustainability. Seek platform not point solution. Focus on #workflow. #Unified #Telehealth is the future of #connectedcare. Jagdish Patel (@jpkca) Patients side - Mobile device like Smart Phone or Laptop with good resolution, bandwidth, sound quality and should be simple to open with one click Providers - Screen which can accomodate EMR, A/V and able to share Docu and conference with other docs #TelemedNow Salim Saiyed (@SalimCMIO) need integrated solutions - my article on this https://bit.ly/2Aa55l7. Need #TeleMedNow App Store that has curated plug ins/#apps that work with the platforms. cannot have silos. Need to get patient input to design #UI #safesystem #patientexperience Q5 How do we strike a balance between opening up offices & clinics & #telemedicine given the recent  @commonwealthfnd report showing tele use plateauing?

A5 Notable Responses: Jamey Edwards (@jameyedwards) Comprehensive #healthcare solution demands integrated approach using #technology at specific spots in the care continuum, guiding patients to higher levels of in-person care where appropriate. #Telemedicine, #RPM, #email, #phone, #video, #chat all have a place.

Susan Cantrell (@amcpceo) #ACHPAMCPpoll shows 89% of consumers are satisfied w #telehealth and high numbers will continue to delay visits & procedures during #Covid19. HCPs must get on board and integrate into their practices. Can we learn from early adopters like #Dermatology? #TelemedNow Matt Sakumoto (@MattSakumoto) #telemednow Telehealth use is plateauing, but I strongly believe we will quickly extend the reach of virtual care and see an uptick in 3-6 mos. The Home Hospital and Home Health monitoring peripherals are imminently possible Ceci Connolly (@CeciConnolly) ACHP/@AMCPorg poll found most folks trust their docs but are still wary of returning to doctors’ offices. Proactively reaching out for cases where #virtualcare works could help them get needed care & build comfort w/ platforms. #TelemedNow Ceci Connolly (@CeciConnolly) Still, patients will begin scheduling procedures and office visits soon. The health care community needs to optimize #telemedicine where it makes sense. Would love to see reduced #providerburden, shorter wait times for patients and efficient #virtualcare. #TelemedNow Jagdish Patel (@jpkca) Actually #Telemedicine will save $ from many areas so it possible that vertical growth may be plateauing but it is wide open for horizontal growth #TelemedNow Ritu Thamman (iamritu) relative decline is smaller in adult primary care & behavioral health & overall #TelemedNow visits are still up from pre #Covid19; this week, @FCC @AjitPaiFCC approved 43 additional funding applications for the #COVID19 Telehealth Program Salim Saiyed (@SalimCMIO) give #patients & #physicians the choice. Build protocols for certain conditions & visit types that can be done #telemednow. As a patient do I really need to drive in for that refill. Etc Sam Lippolis (@samiamlip) We help providers with great workflows. Clinical guidelines of patient populations or disease that fit for telehealth. We make sure the billing & coding is correct so they get paid. #TelemedNow If they threw up a program - it's not the best it can be. Andrew Watson (@arwmd) And just imagine what would happen if there was a second surge. This is a great survey, thank you. #TelemedNow

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