The proper application of telehealth could make health care delivery more efficient, explains Dr. Mike Hoaglin.
As a currently practicing physician with extensive experience working in the emergency department, I am no stranger to advocating for patient access to care within complex and inefficient systems. Barriers to that care range from a shortage of in-network providers to the patient’s own social determinants of health to scheduling and attending a follow-up appointment. Outpatients with mental and behavioral health issues are especially vulnerable to slipping through the health care system, but they hold incredible promise for better outcomes through telehealth.
America’s costly mental health crisis is likely to affect every family in some way. Mental illness affects 1 in 5 adults and half of them do not receive treatment. In addition to the potential toxic effects on the central nervous system of the SARS-CoV-2 virus itself, the COVID-19 pandemic affected mental health due to changes in regular lifestyle, unintended consequences of social distancing, quarantine, working from home, not being able to work from home, or not being able to work at all. Confirming what providers already knew anecdotally throughout the care continuum, a meta-analysis revealed at least a 25% increase in cases of depression and anxiety in 2020 compared to 2019.
During the peak period of the pandemic from March to August 2020, 40% of mental health visits and 11% of non-mental health visits were conducted via telehealth. While non-mental health visits are down to 5% telehealth, mental health remains strong at 36%, according to a March 2022 report. to study.
Telehealth allows us to do more for patients with less
More interaction with the doctor, less waiting. The patient and provider have important live face-to-face video calls (often called “synchronous” visits), similar to in-person visits, but the patient does not leave home or work, arrange childcare, drive, or find parking. or waiting in a brick and mortar waiting room. Patient time is respected and used more efficiently. The provider and health care system also enjoy more efficiencies; according to a to study, the no-show rate for telehealth visits during the pandemic was 7.5%. This is lower than the office visit no-show rate of 36.1% and a pre-pandemic office no-show rate of 29.8%.
Patient-provider interactions can continue between live synchronous visits. While elaborate digital therapy programs exist, the fundamentals include secure text messages and symptom surveys. These typically non-urgent interactions may be referred to as “asynchronous” or “store and forward” visits, since the communications are not live. Symptom surveys (sometimes referred to as a form of “remote patient monitoring”) can include widely accepted instruments, such as the PHQ9 or the GAD7, used to periodically monitor levels of symptoms of depression and anxiety, respectively, between visits live. Armed with these asynchronous logs, clinicians can adjust medications, track safety issues, or otherwise initiate timely intervention instead of waiting for the next scheduled live visit. These online tools keep patients engaged, reducing risk and improving outcomes. In addition, they allow practices to use the doctor’s time in a more efficient way.
More options, less stigma. Telehealth allows providers to meet patients where they are in life. Patients may be at home, traveling on business, or unable to leave due to anxiety. During the pandemic, most US healthcare has enjoyed a relaxation of medical licensing laws, revealing the promise of telehealth nationwide. In many cases, doctors can care for patients in any condition. Patients living in areas with a doctor shortage could finally get an appointment, and cancer patients could get second opinions at multiple renowned cancer centers on the same day from the comfort of their home. Many mental health patients were getting the help they needed after years of feeling stigmatized and out of treatment, as accessing care privately from a smartphone seemed more familiar and accessible.
Telehealth still has its limitations
Not all patients are appropriate for telehealth. Ongoing triage remains an important part of getting patients the care they need, and some patients just don’t prefer telehealth. Patients with serious problems may be out of reach for telehealth and require a higher level of care.
In addition, medical licenses have once again become a barrier as all but 10 states have reverted to pre-pandemic licensing requirements in all states.
Telehealth needs more financial support from payers and legislation
We have been practicing some crude form of telehealth for decades if it includes phone and email communications between doctor and patient. Only now are we accepting the coding of it as a legitimate medical encounter. While synchronous coverage has been widely accepted as reimbursable, payers would do well to expand coverage to better include reimbursement for asynchronous care. They will benefit from providers intervening in a timely manner and patients likely to achieve remission sooner. We also need state support to again lower the barriers to receiving care across state lines.
Regardless of specialty, evidence shows that the proper application of telehealth to the appropriate patient makes health care delivery more efficient.
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