As the world slowly emerges from the COVID-19 pandemic, there’s an abundance of opinions and surveys related to the rapid growth in popularity and reliance on telehealth care.
Many telehealth proponents stress the benefits of its virtual visit functionality, highlighting increased patient access – especially for those who are limited by geography, are transportation dependent limited by their own physical health, or for families trying to balance work and home life. According to a 2021 Cleveland Clinic study, 82 percent of patients said their virtual visit was as good as an in-person visit, 91 percent said their virtual visit made it easy to get the care they needed. Other benefits include increased at-home monitoring of chronic disease and high-risk patients, and the after clinic hours ability to schedule appointments online as well as communicate with providers.
On the flip side, opponents of telehealth highlight limitations to the kinds of care that doctors can provide, concerns with the quality of this type of care, risks of privacy breaches, and higher utilization or duplication of care due to ease of access. The same convenience could limit access to those with challenges, especially the elderly, those with cognitive or learning difficulties and patients for whom English isn’t their native language.
Among the medical community, 57 percent of providers view telehealth more favorably than before COVID-19 and 64 percent report that they are more comfortable using it, according to McKinsey & Company surveys. However, many providers remain concerned with the unintended consequences and the expectation that the healthcare industry is banking on telehealth care increasing efficiencies for providers and assisting with provider burnout.
Now, a new paper coauthored by researchers at NYU’s Stern School of Business, the Grossman School of Medicine and the Tandon School of Engineering argues that telehealth increases the after-hours work burden on physicians. “The assumption was that telehealth makes things more efficient and good for patients, and so it could be convenient and efficient for providers,” says Batia Wiesenfeld, a management professor at Stern who led the study. “That’s not the case.”
The research points to structural handicaps, noting supports aren’t built in for telehealth, “so the doctors are doing everything,” she notes. Wiesenfield, who has studied virtual work since the late 1990s, says she’s noted a burnout crisis among healthcare providers. “If telemedicine increases the after-hours work burden, it might exacerbate this worrisome trend,”.
The stresses of provider burnout and the logistical complications of providing telehealth care are not going away. Nor is telehealth, because of its important functionality supporting both urban America’s fast-paced lifestyle as well as those who live in slower-paced rural areas. The need to find solutions for telehealth and provider mental health to coexist is equally important.
For now, solutions are highly dependent on both electronic medical record (EMR) capabilities and the funding available to a particular healthcare or private medical group. However, we highlight several fundamental and lower-cost strategies that can be adopted to limit provider burnout, realize staff time efficiencies, and improve overall patient care.
- Increase provider engagement for improved performance. End users are often excluded or not at the center of healthcare technology design and functionality. EMR implementation and workflows have too often dictated how providers manage or to some extent care for patients. Solving for these foundational challenges begins with identifying and including your provider champions and early adopters to co-lead with operational and IT leadership to achieve sustainable success.
- Redesign team-based care. Because of haste and lack of resources for implementation, your telehealth care is probably operating with the same workflow as in-person visits. Effective redesigns should be work-cue based, enabling routing to team members with the right expertise; exceptions or errors should be assigned to the correct role to reduce unnecessary waiting and steps. Throughout the redesigned steps, the documented encounter should be updated continuously to meet all meaningful use, joint commission and regulatory requirements so that when it reaches the provider the encounter is mostly complete. Many of these time-saving workflows can be realized through the use of robotic process automation (RPA) or EMR automation.
- Improve existing technology with automation. With proper development and inclusion of clinical staff, RPA can increase time efficiencies in pre-visit demographics, insurance verification, assessing patient appropriateness, recording a patient’s history via questionnaires, and post visit coding/billing. Because of its flexibility, it can be easier to implement for telehealth workflow versus within the existing EMR due to the vendor’s unwillingness or internal limitations of numerous specialists who are utilizing the same EMR system (i.e., what works for one group may not work for another in a large medical group or network).
- Quality and patient education. Utilizing clinical parameters on the patient’s final disposition, automated post-visit touch points can be developed to ensure the patient understood their post care instructions, filled prescriptions and follow-up appointments are scheduled. Additionally, the post visit contact is a great time to build awareness and education on topics like COVID/flu vaccination clinics, importance of regular screenings for breast or colon cancer, as well as announcements of new providers joining a group’s network.
- Get paid for telehealth visits. One of the most important steps to getting paid is making the ask for payment and offering alternatives early in the process. In fact, according to a PYMNTS study, 89% of patients said they would prefer to know the total bill and make a payment ahead of time. Therefore, insurance coverage validation, copay confirmation needs to be just as quick and automated as the next step with alternatives including setting up payment plans.
Implementing these strategies will help limit provider burnout, increase staff efficiencies and improve overall patient care.
C.J. Ehrentraut, Healthcare Consulting Practice