2020 Telehealth Survey – Summary of Results

In late April 2020, Coker conducted a survey evaluating how healthcare organizations are adopting, implementing, and utilizing telehealth solutions, with particular focus on utilization amidst the COVID-19 pandemic and resulting changes in physician-patient dynamics. Participants of the survey included clinical and business management personnel from hospitals, health systems, and medical practices.

The goal of the survey revolved around a simple premise: using telehealth. Despite the widespread discussion around adopting telehealth since the emergence of COVID-19, there has been very little substantive discussion around the specific ways organizations were using telehealth. Also, we found the term “telehealth” could ultimately mean different things to different audiences, making it a broad and wide-stretched category, rather than a specific modality or method of delivering care. Thus, we wanted to understand where the various pain-points were for healthcare providers concerning using telemedicine in their interactions with patients.

Last week, we released an episode of Podcast, our popular healthcare business podcast, featuring a discussion amongst our telehealth team involved in the survey. We highlighted the key takeaways and observations from the survey results. Below is a summary of some of the key points and interesting findings that emerged from the survey, and in the coming weeks, we will feature more content digging into key points that arose from our review.

Observation #1: Telehealth is here to stay

The first conclusion that we came to – and quite frankly we did not need hard survey data to support this – is that telehealth is here to stay.In the recent history of the healthcare industry, rarely has anything been adopted as quickly and as widespread as telehealth (beginning in early March 2020). It is particularly rare for healthcare providers to embrace a relatively new modality of patient interaction, especially if it involves using a technology interface. However, healthcare providers have widely embraced telehealth in recent months.

We think it is safe to say that without the presence of a global pandemic, very little, if anything, could have thrust the industry into adopting new methods as rapidly as we have seen telehealth evolve since the spread of COVID-19.

Over two-thirds of the survey respondents indicated the impact of COVID-19 served as the tipping point for the adoption of telehealth.

Another research study confirmed our survey results. Statistics showed in 2018, the adoption of telehealth was less than 20%; however, as of April 2020, the adoption rate for telehealth exceeded 50%, and the broader consensus is the actual utilization of telehealth is significantly higher today.

94% of respondents agreed that telehealth will be essential to the delivery of healthcare moving forward.

But regardless of what drove the rapid adoption of telehealth, it is clear (at this point) this modality of patient interaction is still evolving and is not going to fade away, even as the pandemic subsides and quarantine requirements lessen. Our survey results reinforced this very clearly.

Observation #2: COVID-19 created an urgent need for telehealth

Another interesting, albeit not a very surprising, observation from the survey responses indicated that in the scramble to respond to the crisis of COVID-19 and resulting challenges, there was an urgent need to adopt telehealth. This ultimately resulted in many organizations adopting what were, in essence, interim or short-term solutions for virtual encounters and other telehealth services.

Approximately 60% of respondents indicated that their organizations’ telehealth services were formed around using tools, such as Zoom, Skype, FaceTime, Microsoft Teams, etc.

The survey results indicate that interim solutions were in place solely to respond to immediate patient needs. And while these tools, and others like them, have proven to be very simple and helpful alternatives in the absence of in-person encounters, one has to consider the fact that these are only short-term solutions. They will ultimately require more expansion if organizations truly want to explore how to permanently integrate and optimize telehealth within their standard services. Perhaps these are not very surprising statistics; however, this certainly supports what we are observing in the market today.

Observation #3: Telehealth technology needs to be integrated

If the majority of organizations are adopting telehealth in response to a crisis, then we can presume that this modality will eventually and ultimately have to be streamlined in the future. So let’s consider how to integrate telehealth within broader technology strategies and infrastructure.

Nearly 70% of respondents recognized that telehealth should be integrated with existing technology platforms.

This includes integration with the EHR as well as streamlined interoperability with revenue cycle management systems that allow for optimized coding, billing, and collections. And with the discussion of integration and interoperability, the data indicated that there are two key functional elements:

1. Incorporating telehealth within a broader compliance umbrella
2. Operational integration

Telehealth Compliance

First, we should break down the feedback around compliance because this topic entails some interesting points. As we know, the priority for healthcare organizations during the COVID-19 crisis was launching modalities that served patients’ immediate needs while allowing for a continuation of (reduced) services and thus, revenue. As a result, incorporating telehealth services within compliance programs, or at par with conventional compliance standards, was (rightfully) placed on the back burner.

Less than 9% of respondents acknowledged compliance as their greatest challenge right now when it comes to telehealth.

This statistic may not appear overly surprising based on our previous points regarding the priority of responding to immediate patient needs. However, as we attempted to break down this point further, we realized there is more to consider with compliance in the long-term adoption and optimization of telehealth, especially when one considers the fundamental assumption that this modality is here to stay. A significant amount of respondents acknowledged that their organizations have concerns when it comes to integrating telehealth within their overall compliance programs.

• 21% indicated that their organizations have not integrated telehealth into their compliance program
• 38% indicated that they have coding or documentation concerns with their telehealth services
• 30% have concerns about cybersecurity
• 30% indicated that they have concerns around privacy or HIPAA

At a high level, we can surmise that compliance is indeed a major consideration of the overall telehealth equation, even if it has been placed on the backburner for now. So, what does that mean? Simply put, there will come a time – and we do not know if that will be next week, next month, or next year – where healthcare organizations will have to synchronize their telehealth strategy with their compliance program. Moreover, this will not be optional. While the federal government may be in a lenient mode right now, these two elements – telehealth and compliance – will ultimately have to be reconciled.

Operational Integration

So with the understanding that the discussion of telehealth and compliance integration will be ongoing, let us now progress on to the other over-arching takeaway: integrating telehealth with healthcare organizations’ operations. There are many elements to this, which we will breakdown in further detail in the future because when one considers the operational integration of a relatively new modality of care and patient interaction, there are many different factors involved in such an endeavor.  For instance, one must integrate telehealth services with an organization’s existing IT solutions and infrastructure.

70% of respondents said that telehealth was either “poorly integrated,” “somewhat integrated,” or “currently stand alone but plan to integrate with existing technology platforms.”

This indicates that integration and interoperability will be a key priority in the future, especially because telehealth is here to stay. As mentioned previously, the concept of integrating telehealth with existing technology infrastructure could – among other things – relate to integrating with an EHR, which may sound relatively simple on the surface. However, if one considered a widescale EHR implementation (such as Cerner or Epic, et al) for a health system, costing hundreds of millions of dollars over multiple years, the idea of integrating telehealth, especially during a global pandemic that alters the fundamental provider-patient dynamic, quickly becomes complicated in a myriad of ways. Not only does it become more complex, but it can also quickly become more costly, which means there must be a financial strategy that compensates for the “new normal” being thrust upon us. Also, operational integration is not just EHR interoperability.

Organizations must consider integration with the entire revenue cycle process, which could extend from coding to billing to collections and everything in between. For instance, the survey responses indicated that while billing is a major focal point for healthcare organizations when it comes to telehealth services, over half of respondents recognize that their organizations are not optimally billing for telehealth services.

The evolution of evolving guidelines and regulatory parameters will add angst to organizations’ billing capabilities. Thus, this concept and all that it entails should be understood and seen as an opportunity to recoup what may otherwise constitute lost revenue in the new world of care delivery. Continuing the discussion around the operationalization of telehealth, we cannot help but think about the impact on personnel dynamics.

• How do providers engaging in virtual visits integrate the appropriate notes of a visit into the patient record?
• How is the virtual visit coded for billing purposes?
• How is the virtual visit reflected in the revenue cycle management system?
• How do the coders incorporate the virtual visit, in a manner that is appropriate for both billing and compliance purposes, into the actual coding and billing pipelines?
• How can we be certain all of this is reported in a compliant manner, while still allowing for the maximum reimbursement opportunity for all payers?

Since telehealth is here to stay, healthcare provider organizations will wrestle with augmented staffing models and resource utilization levels to support this modality as well as the ability to adjust workflows and business processes to optimize its utility. As such, it was no surprise that the majority of our survey respondents recognize operations as their greatest telehealth challenge. Meaning, provider organizations must start planning today for how they can leverage telehealth for revenue and productivity growth opportunities, rather than using it to merely prop-up revenue that would otherwise be lost in a crisis.

There must be a long-term strategy and implementation/optimization plan for telehealth, rather than simply utilizing telehealth as a short-term resource for reacting to market pressure.

We want to dig deeper into these issues because while the high-level perspective of this discussion is a helpful starting point, there is a significant amount of detailed information and analysis that can be further broken down to ultimately understand exactly how this new and rapidly evolving trend is likely to change the dynamic of healthcare delivery forever.

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