Board support crucial to telehealth success
Challenges include new technology, regulation and patient needs
By Brian Doerr
There is no question that the COVID-19 crisis has rapidly created an unprecedented demand for virtual health care in this country. A McKinsey & Company study showed physicians now see between 50 times and 175 times more patients via telehealth than they did prior to the viral outbreak. Moreover, one industry report said the number of telemedicine consultations would reach 160 million by the end of 2020, a 700% increase from five years earlier.
Widespread use of telehealth, however, was not the case before the pandemic struck the U.S., especially in rural and remote areas. That was largely due to patients’ lack of interest or ability to substitute face-to-face visits with online chats or phone calls with physicians, nurses and other credentialed health care providers. Other reasons included health care providers who were reluctant to use this technology for exams, as well as concerns that costs involved in equipping smaller facilities with telehealth would strain already-tight operating budgets, among other factors.
Nevertheless, at the onset of the pandemic, telehealth strategies shifted into high gear, thanks to fewer government regulations placed on this technology, along with federal- and state-subsidized payments, and private health insurers providing increased reimbursements and expanded coverage for health care via virtual care.
With greater acceptance of virtual care, it is imperative that boards of trustees serving community hospitals gain a deeper understanding of the benefits of telehealth and stay current on its best practices. Then board members can more successfully navigate the confusing maze of ever-changing federal regulations, constant advances in this technology, and the evolving health care needs of their communities.
Reviving Telehealth at a Small, Rural Hospital
The telehealth program at a small Texas hospital serves as one example of how trustees who closely interacted with administrators helped to lead the hospital’s timely use of telehealth during one of the greatest public health threats to ever face this county.
Telehealth Questions for Hospital Trustees
Community hospital trustees should consider the following questions when a hospital is implementing or expanding telehealth services:
- What are the opportunities and challenges of integrating telehealth into our hospital’s operations?
- How will our hospital leaders address connectivity and other access challenges for potential telehealth patients?
- How will hospital leaders monitor potential changes in private and public telehealth insurance reimbursement?
- How will hospital leaders minimize potential cybersecurity risks of telehealth?
- What is our hospital’s strategic plan in rolling out a telehealth program in our community?
- How will health care professionals be trained in virtual care?
- What are the short-term and longer-term financial costs of telehealth?
- What strategic steps will gauge the performance of our hospital’s virtual care platform over the next 12 to 18 months?
At Yoakum Community Hospital, part of Plano, Texas-based Community Hospital Corporation (CHC), hospital leaders had shared plans with its board for fast-tracking telehealth services that had begun two years prior for psychiatry and primary care. But progress of the telehealth program at the 23-bed, acute care facility had slowed to the point that it was eventually discontinued.
However, because of the administration’s strong relations and close communications with the board, the hospital received full trustee support in reviving its telehealth program. Their input was essential for the hospital as the pandemic rolled in last spring.
The support of the trustees and others affiliated with the hospital provided a head start on the facility’s telemedicine services, so its IT staff, with CHC oversight, had thorough knowledge on how to use telehealth and assist with the patient on-boarding process. This, in turn, enabled the staff to work more efficiently when booking and conducting virtual care appointments.
During a seven-month period beginning in March 2020, the early stages of the U.S. pandemic, Yoakum Community Hospital reported more than 960 telehealth interactions, a contribution to patient health and the hospital’s bottom line.
Restoration of the hospital’s telehealth services was facilitated by trustees asking pertinent questions deemed critical to implementation, such as the quality of care and patient and staff safety associated with the hospital’s telehealth strategies. Their participation in renewing the hospital’s telehealth services can be directly linked to years of administrative efforts to build an engaged and high-performing board through various strategies that clearly defined the board’s role and responsibilities. This relationship between the board and the administration has contributed greatly to the hospital’s financial health.
Because of the work of the hospital’s trustees, administration and caregivers on the telehealth platform, there has been significant improvement in access to health care for residents who live further from the hospital or may not have adequate transportation to get to and from the facility. Other benefits include better monitoring of patients with chronic care conditions, improved access to physicians who specialize in various practice areas such as cardiology and neurology, a decrease in hospital readmissions, and fewer overhead costs for health care providers.
Opportunities and Challenges for Telehealth
While the benefits of telehealth are many, trustees at community hospitals also must request information about plans for integrating this technology into a hospital’s operations.
Access to this technology is one of the biggest challenges that health care providers face in offering telehealth services in rural or small towns. Many of these areas lack access to the internet, have low-bandwidth internet or have limited landline and cell phone access. According to one report, more than 40 million Americans are unable to digitally connect with health care providers because they may not have internet access.
Besides connectivity issues, uncertainty still exists over whether federal and state governments will continue to keep intact a series of directives that expanded telehealth coverage during the pandemic. Earlier last year, a congressional bill was introduced to spend $2 billion to expand online connectivity at public and nonprofit health care facilities, but that proposed legislation has not been acted on.
In addition, persuading older adult patients to use virtual care platforms for routine exams and to manage chronic health issues still remains a challenge to greater adoption of telehealth. Telehealth providers have found that some older adult patients are unable to communicate with doctors and other care providers via telehealth. Some are uncomfortable with the idea of replacing in-person office visits with video chats and phone calls. Hopefully, that will be less of an issue as more health care providers educate their patients on telemedicine’s benefits.
As a result of the pandemic, telehealth is moving closer to a mainstream tool in modern health care delivery. Though telehealth use has recently decreased since restrictions were lifted on physical office visits, the future of health care is expected to become a hybrid of virtual and in-person care. For that to happen, hospital administrators, trustees and care providers must work closely together to ensure that suitable telehealth strategies will benefit their hospitals, patients and the communities they serve.
Brian Doerr (firstname.lastname@example.org) is the senior vice president of information technology and the security and privacy officer at Community Hospital Corporation, based in Plano, Texas.
Please note that the views of authors do not always reflect the views of the AHA.