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Modern Healthcare - 2021-05-03

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Providence bets on the promise of telehealth

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While telehealth visits have dropped off from their peak from April of 2020, Providence is still planning to reconfigure its real estate and launch virtual care programs. Telehealth accounts for about 20% of all clinic visits offered by the Renton, Wash.based system, down from around 50% in mid-April mirroring national trends. While some medical groups are hovering around 40% of all clinic visits being delivered via video or phone, Providence expected telehealth utilization to level out around 25% across the system. “We were hopeful we could create standards and practice patterns that get us to 40%,” said Jennifer Schaab, chief operating officer of the physician enterprise, adding that telehealth accounted for only a fraction of a percent of clinic visits pre-pandemic. “It’s not just patients who are asking for it. As a healthcare organization that is capitalintense, we’d love to see much more virtual visits so we don’t have to have as much brick-and-mortar space.” Providence already consolidated some of its physician offices across its Southern and Northern California networks. Providence will continue to adjust its real estate footprint based on how many patients and physicians embrace telehealth, Schaab said, noting that they are considering smaller facilities where physicians rotate throughout the week to take video and phone calls. In addition, Providence recently launched its first virtual medical group, comprising specialists and primary-care physicians in Orange County, Calif. The medical group can connect patients to doctors across the county who can offer a wide range of services rather than just treating an earache or rash, said Dr. David Kim, chief executive of physician enterprises at Providence. “It really is a medical group without walls. That was unthinkable a year ago,” he said. More patients and physicians are getting comfortable with the medium. To ease the transition, Providence established a team prior to the pandemic that helped train and field questions from clinicians. Those same coding, engineering and nursing staff were instrumental in helping clinicians navigate billing, technology and workflow issues during the pandemic, executives said. A lot of the providers’ concerns were assuaged during the pandemic: Will the patients find it valuable? Will they be able to establish a connection? Could they address chronic or acute conditions? Will they get paid similar rates? “Many of the hesitations that doctors had were proven to be false,” said Kim, noting that quality scores were similar between virtual and in-person care. But doctors said patients were eager to get back into the clinic, according to Kim. As for payment parity, the jury is still out, Schaab said. Some states have leveled reimbursement for in-person and telehealth visits, similar to the waivers implemented during the pandemic. If telehealth ends up being reimbursed at 70% to 80% of the in-person rate, Providence has crunched the numbers and secured physician buy-in on a volume boost that would offset the payment disparity, she said. Providence is also lobbying for easing federal site-of-service regulations that limit where clinicians and patients are located during telehealth visits. Telehealth has been a lifeline for behavioral healthcare, Schaab said, noting Providence’s growing behavioral health team that serves Alaskans. “We are building a nationwide behavioral health group with a focus on the pediatric and young adult population,” she said. “We will be able to get to a population that we couldn’t get to before.” It also increases access to providers, Kim said. The flexible hours and locations that telehealth offers attract more clinicians. “It is a difference-maker for physicians and other providers,” he said. “I couldn’t find a psychiatrist that I trusted to send my patient to. Now, so much of the access barrier is eased by taking away the geographic limitations. That has had an  enormous impact.”

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