By Mark S. Kestner, MD, MBA, Chief Medical Officer,
Before the COVID-19 pandemic hit the U.S.,
there were already major trends changing the healthcare industry. I believe
we’re going to see these trends not only continue but also accelerate as a
result of our response to COVID-19.
Definitive Healthcare’s 2019 survey of 1,000
healthcare leaders identified top trends, and I’d like to comment on how
Covid-19 is impacting the top three trends.
Trend #1: Industry Consolidation
The Number One trend in the survey was industry
consolidation. This includes consolidation of hospitals, insurance
companies, and physician practices. When you start to consolidate, you’re typically
doing it for efficiency reasons and because margins are getting smaller.
Since the U.S. healthcare industry has been dealing with the COVID-19 pandemic, most providers have put a hold on elective procedures. These procedures serve as the primary revenue generator for many hospitals. I have several friends across the nation who live in small towns. Their small community hospitals survived on elective procedures, yet now they’re laying off people. Their financial infrastructure was based on elective surgery volume which is no longer there. Currently, most cases are related to COVID-19, and are coming through the Emergency department. When the pandemic is finally stopped, these hospitals will not be able to stand alone.
Trend #2: Consumerism
The Number Two trend was consumerism. Consumers have an expectation that telemedicine is available. Historically this was generational; people in their 30s have an expectation that they can access healthcare 24/7, and that waiting in an emergency room is unacceptable in most cases. They also have an expectation that they can see a physician online and access healthcare online. These expectations are starting to be met. With some changes accelerating due to the COVID outbreak, people are increasingly having an expectation that healthcare is available via telemedicine, and I think it’s moving beyond just the younger generations. This leads me to the third major trend in healthcare: telemedicine.
Trend #3: Telemedicine
The telemedicine trend was already strong
prior to COVID, and it’s accelerating. It’s in this context that I want to note
that artificial intelligence (AI) was the fourth top trend and staff shortages was
the fifth, close behind AI. I mention this because staff shortages also
underscore the need for telemedicine. It’s no longer acceptable that people
don’t have access to physicians or mid-level providers. And those healthcare
clinicians who provide services must be able to use tools similar to what they
have in their everyday lives, including their phone and direct access to
With COVID-19, the Genie Is Out of the Bottle
With the COVID outbreak, the federal
government is loosening requirements and recognizing that to access the
healthcare system, you have to facilitate the use of telemedicine and reimburse
people effectively for it. The genie’s out of the bottle.
The federal government has already enabled providers to use non-HIPAA-compliant software products to visit their patients during the crisis. I believe that will change so that the software must be HIPAA-compliant. Furthermore, the government will likely ensure that you have the appropriate documentation that we had before COVID, with federal guidelines that enable you to make any visit a telemedicine visit. Providers will have to put the correct modifier code on their ICD code to indicate the care was delivered via telemedicine.
If I were in private practice today, I would
be doing everything via telemedicine, unless it was absolutely necessary to
have somebody come in for a procedure. If I were doing my rounds in the
hospital, I would have the nurses conduct rounds with my patients via iPads. As
physicians, we have the tools today, and the ability to trust other people to
be at the bedside for us to visit our patients remotely without actually having
to set hands on them every day. Besides being a much more efficient way of
doing work, this approach offers opportunities
to reallocate staff or reduce the expense burden of staff as individual
physicians will require less support.
Today, physicians manage chronic diseases like
hypertension and diabetes by routine check-ups to see “how the patient is
doing.” These time-consuming visits will be managed more easily and more
effectively with telemedicine in the future. For example, blood-glucose
monitoring, vision and feet checks, medication management, and review of blood
pressure measurements, can all be done remotely.
One Final Prediction: A Trip to a Clinic or
Hospital May No Longer Be the Norm
Finally, I believe the trend to telemedicine
will also be part of a trend of providing care outside the walls of hospitals.
They won’t be the primary point of care delivery in the future. Instead, our
local pharmacy or Walmart will be where we go first for care. In fact, Walmart
has already opened Walmart
Health in several Southern states. These clinics offer primary care, x-rays,
counseling, dental services, labs, and more. And Amazon
Care offers its Seattle-based employees telemedicine services as well as
in-person care and prescription delivery.
These distributed locations will become the
points of entry into health systems, and a nurse practitioner or pharmacist will
probably be the person we’ll see first. Many physician “visits” are likely to
happen virtually as telemedicine becomes the new standard.
Mark Kestner, MD, is Chief Medical Officer at TractManager, Inc. Dr.
Kestner is a seasoned executive with leadership experience in the military,
university systems, integrated delivery systems, and, particularly, in
community based healthcare systems. TractManager’s healthcare-specific
application suite serves three out of five U.S. hospitals.