It's time to do our part to move the country forward

It's time to do our part to move the country forward

by | Sep 25, 2020 | Healthcare

Recent months have cast a glaring spotlight on the most insidious fault line in our culture: racial inequity. country

It pervades every corner of society. But healthcare leaders are uniquely positioned to address this intractable problem in two important ways.

First, with health disparities. We are privileged to work in service to the most basic human desire: wellness over sickness; life over death. Any inequity is horrifying; but inequity in physical and mental health is tragic.

Second, as enterprise leaders, we have the power to drive meaningful and sustainable change. In many communities, we are the largest employers and carry enormous economic weight.

Health disparities are an appalling consequence of racial inequity. Providers must do a better job of reaching at-risk populations, developing effective intervention strategies, and making it easier to engage with our systems. We must collaborate with community partners on elder care, education, housing, food security and economic opportunity.

But we can’t close the disparities gap without fundamental change—not just change on the margins. It requires policy and public investment. We must break free of the trap of fee-for-service that disincentivizes access, early intervention, affordability and patient outcomes. The fact that hospital revenue is plummeting during COVID-19 illuminates the dysfunction of the economic paradigms around healthcare.

Reform is easier said than done. Healthcare is the hottest of hot-button issues and enflamed by special interests vested in the status quo. There is no uniform delivery model or data gathering across the country. COVID-19 revealed the flaws of this fractured health system. Past efforts at reform tried to accommodate everyone’s perspective, watering down the solutions. We need political willpower. We must dismiss the rhetoric and disinformation stifling an honest national discussion about how we spend 18% of our gross domestic product on healthcare, using an unsustainable model.

Political fortitude will only happen at the insistence of an informed and engaged public. We need a nonpartisan national commission to holistically reimagine healthcare. The commission should be made up of leaders from healthcare, business, social services and the federal government with one goal—creating national policies to improve health outcomes.

The commission should develop and coordinate initiatives designed to address the social determinants of health to target infant mortality, mental health, healthy aging, substance abuse and other chronic issues. It should emphasize the importance of public health, articulate a national target for healthcare expenditures, and outline the path to achieve that goal.

Closing the racial divide means we must also look inward. As leaders of large institutions, we have the ability to economically empower millions of people when we fully embrace diversity and inclusion at every level, including the C-suite, medical staffs and boards. We must do better to reflect the communities we serve. It requires creating a culture to drive this change and being fully committed instead of simply compliant.

Real change comes through systems that ensure pathways of upward mobility, including training, education, mentorship, and a road map to better and higher-paying positions.

Real change can only happen when we ensure that minority suppliers are considered—and all suppliers are committed to diversity and equity within their own operations.

Real change can only happen when we expand spending among all minority vendors, not just in construction and janitorial services, but in financial, banking, consulting and legal services.

Real change can only happen when we support community partners who are also working to bridge the equity divide. Our work must be deliberate, always asking how every investment of our time and money is helping to heal the community.

Healthcare can’t solve everything alone. But these inequities demand our attention. And if we can make progress, we will have helped reconcile our nation’s long and painful history of racial injustice. We know what ails us. We must find a way to act.

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Source: It’s time to do our part to move the country forward

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How to achieve universal, resilient, affordable healthcare for all

How to achieve universal, resilient, affordable healthcare for all

by | Sep 24, 2020 | Healthcare

While the bill allows employers to continue offering high-quality, gold-level coverage or higher to their employees, employers could enroll their employees in Medicare for America and just pay the government what they would have remitted to an insurance company. universal

Or, employees could choose Medicare for America over coverage being offered by their employer, no questions asked. Their employer would continue contributing to the worker’s health coverage.

We have put a man on the moon, so surely we can figure out how employers can pay the government or an insurance company. Congressional employees have multiple options for insurance carriers and are proof that employers can do both.

During the pandemic, healthcare providers and workers have been unsung heroes providing care for Americans, and our healthcare system should recognize their worth and value. For many providers and workers, student loan debt imposes financial difficulties and barriers to their career goals, and since many healthcare workers are approaching much-deserved retirement, we need to expand the workforce.

To address these realities, Medicare for America creates a new student loan forgiveness program for healthcare workers like direct-care workers, mental health counselors, licensed marriage and family therapists, physician assistants, pharmacists, dentists, dental hygienists, doctors and nurses. The program will forgive 10% of student loan debt for each year the provider or institution the provider works for accepts the Medicare for America plan.

We must also address reimbursement rates, and Medicare for America’s rates will be based on current Medicare and Medicaid rates, while proactively increasing rates for primary care as well as mental and behavioral health and cognitive services. Furthermore, Medicare for America establishes an all-payer rate-setting system to end the wide variation in prices. Private insurers would be allowed to offer plans in compliance with the Medicare for America Act rules.

Democrats believe every single person in this country should have quality, affordable health coverage. We just have a few different ideas on how to get there. The same cannot be said about the Republicans, who are actively seeking to take away healthcare from millions by uprooting the Affordable Care Act, with nary an idea for a replacement. If we could do it all over again, we would not choose our current system, but we must work with the hand we have been dealt. That is why Medicare for America takes the existing and very imperfect framework and makes the progressive and necessary changes to achieve our desired end goal–universal, high-quality coverage.

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Source: How to achieve universal, resilient, affordable healthcare for all

It's time we stop relying on our adversaries for critical medical supplies

It's time we stop relying on our adversaries for critical medical supplies

by | Sep 23, 2020 | News, Healthcare

We’ve seen a similar trend with the pharmaceutical industry, with drug manufacturing slowly moving out of the U.S. As of August 2019, only 28% of the manufacturing facilities making active pharmaceutical ingredients, or APIs, to supply the U.S. were in America. time

The remaining 72% were overseas, and 13% were in China, which has doubled its number of registered facilities making APIs between 2010 and 2019.

U.S. manufacturers are struggling to compete, and we’ve allowed it to happen. Instead of building our own supply chain of American-made PPE and pharmaceuticals, we turned a blind eye to the problem and accepted China’s dominance.

Not only did our reliance on China fail us during this pandemic, it has broader implications for our safety and economic success.

In July, Federal Emergency Management Agency Administrator Pete Gaynor called our reliance on overseas suppliers “a national security issue,” and testified to Congress that, “PPE and lifesaving equipment is just as important as building an aircraft carrier. We need to have that capacity here in the United States. We cannot rely on peer competitors to manage our destiny.”

He’s right. We can’t forget that relying on China for critical supplies means putting our health and security in the hands of a nation that wants to be the dominant world power. Their success depends on our failure. And since the Communist Party controls every company in China, every time we buy their supplies we are supporting a regime that is stealing our technology and intellectual property, building up their military to compete with us, abusing human rights, stripping Hong Kong residents of their freedoms and threatening Taiwan.

We have to stand up and say that we, as Americans and freedom-loving people, are better than this.

President Donald Trump did the right thing by enacting the Defense Production Act to compel U.S. companies to begin manufacturing PPE. But we have a long way to go.

We need to build up domestic manufacturing. As Florida’s governor, I focused on keeping taxes low for manufacturers and eliminated the sales tax on capital equipment. In the Senate, I’m working to pass a bill that will help build the national stockpile of goods from American-based producers and remove China from the U.S. supply chain.

All of us, whether in the healthcare industry or not, need to recognize the threat of China and start taking real steps to stop relying on our adversaries and focus on supplies and products “Made in America.”

The future of our nation and the health and safety of our people depend on our action.

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Source: It’s time we stop relying on our adversaries for critical medical supplies

The intersection of health and technology: How did we get here and where are we going?

The intersection of health and technology: How did we get here and where are we going?

by | Sep 22, 2020 | Healthcare

Patients should control their records. It’s easy to change a credit card or phone number, but biometric indicators and identifying traits are permanent. intersection

To safeguard against identity theft, discrimination and preserve individual privacy, patient records must be secure. Security measures should not come at the detriment of usability. If a patient and their doctor have difficulty accessing electronic health records, the patient’s care will suffer.

This March, the Office of the National Coordinator for Health Information Technology released the final rule required by the Cures Act. This rule eliminates information-blocking and calls for developing standardized application programming interfaces that allow patients to seamlessly access their electronic health information. These APIs are required to adhere to the same security protocols that banking apps utilize.

In many ways, COVID-19 has exemplified why EHR interoperability and the modernization of our public health data infrastructure are essential. The flow of data between clinical care and public health systems often relies on dated technology, such as paper submissions and faxes, and individuals are stuck in the middle navigating paper, emails, phone calls and patient portals. Our antiquated processes slow the tracking of the invisible enemy we know face, COVID-19.

Digitizing information introduces unique vulnerabilities. Information may be stored in perpetuity and transferred virtually anywhere. As a result, nefarious actors work to uncover this information and use it against patients, doctors or healthcare organizations. In recent years, the market for stolen personal information has grown. This demand is exacerbated by COVID-19 and the lack of preparation for the flood of COVID-19-related cyberattacks.

While we cannot legislate away cybercriminals, we can reduce their ability to steal personal information by passing a federal privacy law and offering incentives for stronger cybersecurity. HIPAA governs healthcare information and must be applied in conjunction with a single national privacy standard.

Technological advances transcend sector-specific prescriptions to provide greater benefits for patients and providers. Now is the time to debate and enact privacy and security standards.

Negotiations for a federal privacy law are ongoing. Just like everything else, COVID-19 has slowed down these discussions. Congress must get back to the negotiating table to do the job for which we were elected. If healthcare professionals can go to work each day under difficult circumstances, Congress can come together to write the laws that protect them and their patients.

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Source: The intersection of health and technology: How did we get here and where are we going?

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To combat America's brutal inequities, tax billionaires to make healthcare a human right

To combat America's brutal inequities, tax billionaires to make healthcare a human right

by | Sep 21, 2020 | Healthcare

Under our legislation, the federal government would pay all costs of treatment for the uninsured, and cover all out-of-pocket charges—such as copayments and deductibles—for those who already have public or private health insurance. combat

By empowering Medicare to use its existing payment infrastructure to make healthcare free at the point of service, this could be done quickly, without saddling states or patients with more paperwork and bureaucracy.

Our bill covers prescription drugs as well. This summer, Gilead Sciences announced it would be charging hospitals around $3,000 for the coronavirus treatment remdesivir, even though it costs $10 to produce and was developed with $70 million in taxpayer-funded research.

Enough is enough. It’s time to make coronavirus-related treatments free of charge for everyone in America.

Under our legislation, the federal government would pay the same price the Veterans Affairs Department charges for prescriptions on behalf of the uninsured. That means no costs for patients, major savings for taxpayers, and an end to pharmaceutical corporations ripping off the American people in the middle of a crisis.

Providing healthcare for free to everyone who needs it during a public health emergency is not a radical idea. If every major country on the planet can guarantee healthcare to all, please do not tell me the U.S. cannot do the same.

If, in the midst of this unprecedented crisis, Congress is willing to pass a $740 billion military budget that is larger than that of the next 11 countries combined, we can surely afford to spend a fraction of that to care for our people.

We can no longer ignore the deep injustice that we faced long before this pandemic: We are the only major country in which healthcare is treated as an employee benefit, one that can disappear at any time if you lose your job.

No one who is diagnosed with cancer should have to beg for money from strangers on GoFundMe. No one with diabetes should die because they cannot afford their insulin. No one with coronavirus symptoms should be afraid to go to a doctor because of the cost, and risk infecting their family, friends and neighbors.

Let us use the immense challenge we face as an opportunity to build a just society, where healthcare is finally guaranteed to all as a human right.

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Source: To combat America’s brutal inequities, tax billionaires to make healthcare a human right

CEO Power Panel: Strategies for consumer-centered care shift amid COVID-19

CEO Power Panel: Strategies for consumer-centered care shift amid COVID-19

by | Sep 18, 2020 | News, Covid-19

Carilion Clinic in Roanoke, Va., had been planning to roll out a multipronged digital front door strategy over the next 24 months. Power

But as COVID-19 cases mounted in the spring, executives realized they needed to move faster.

Executives in healthcare for years have been discussing the so-called “digital front door,” wanting to use new technologies to engage patients outside a facility’s walls. But with many health systems compelled to restrict patients from walking into their actual physical front doors at the height of the COVID-19 pandemic, executives had to revisit those plans, pushing out new chatbot symptom checkers and at-home virtual visits.

COVID-19 “hasn’t changed our thinking” about patient-centered care, said Nancy Agee, Carilion Clinic’s CEO. But it has accelerated “how far and how fast” the system moved toward implementing tasks already on its to-do list.

Agee is in good company. Seventy-three percent of CEOs in Modern Healthcare’s Power Panel survey said their focus on consumerism increased amid COVID-19, with the remaining 27% saying their focus stayed the same.

At Carilion Clinic, that included expanding the roster of tools that patients use to connect with the system online, such as rolling out options to self-schedule appointments and pay bills. And Carilion is developing an app, dubbed MyCarilion, which will centralize where patients access those services as well as educational videos, directions to facilities and on-demand telehealth.

Across the board, telehealth has played a major role in how health systems are keeping patients outside of the hospital, but still connected to their care team.

All CEOs who responded to Modern Healthcare’s Power Panel survey indicated they’d increased their telehealth investments during the pandemic. CEOs are chosen to participate in the survey.

Dartmouth-Hitchcock Health in Lebanon, N.H., was averaging just three telehealth visits per week before COVID-19 hit; at the height of the pandemic, it was conducting up to 2,000 virtual visits a day. To make sure patients were prepared for a telehealth visit, medical assistants called patients the day before their appointment to walk them through the process and how to use the technology.

Even if telehealth use slows as the pandemic subsides, as some experts predict will happen, it’ll still be a powerful option for patients, said Dr. Joanne Conroy, Dartmouth-Hitchcock Health’s CEO. In the health system’s territory in New Hampshire and Vermont, telehealth could prove a useful tool to avoid missed patient appointments during snow storms, she said.

“People appreciated the importance of virtual everything during the pandemic,” she said. “I don’t think all of that is going to go away.”

Moving forward, Dartmouth-Hitchcock sees telehealth as a market opportunity. The health system is working to create a direct-to-consumer urgent-care telehealth program, which could help to attract new patients, according to Conroy. The program, which is still being developed, will initially roll out to the health system’s employees, who will provide feedback.

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Source: CEO Power Panel: Strategies for consumer-centered care shift amid COVID-19

We've learned a lot during this pandemic; let's put the knowledge to good use

We've learned a lot during this pandemic; let's put the knowledge to good use

by | Sep 17, 2020 | News, Covid-19

Our country is now more than six months into the worst public health crisis we have known in over a century. learned

More than 6 million confirmed COVID-19 cases and 190,000-plus documented fatalities later, what have we learned?
Truth is, we have acquired an enormous amount of actionable knowledge about the virus—how to test for and better treat it, how to prevent its spread and how to protect ourselves against it. But gaining knowledge and applying it successfully are not the same thing.

Large health systems are in a unique position to share some broad core lessons that can serve us all well going forward:

Take care of our healthcare heroes. Even our doctors and nurses who served in the military or trained in emergency medicine never imagined having to put their own lives and livelihoods on hold for such extended periods. Even after the pandemic has passed, thousands of them may experience a unique form of professional and personal post-traumatic stress disorder. We must recognize and address this by rotating them off the front lines and expanding the healthcare workforce.

Recognize that disparities are a matter of life and death. Health disparities grounded in race and ethnicity have been subject to policy discussions for decades. The disadvantaged face a perfect storm: more likely to be exposed to the virus, but less likely to have access to testing and treatment; more likely to have underlying conditions, but less likely to cope with the financial impacts of the pandemic. And perhaps soon—less likely to be able to access the vaccines that afford some level of protection.

Here comes the flu … It is always important for everyone, most certainly caregivers, to get a flu vaccination. But this year individuals must be accountable for their symptoms like never before. Stay home if you are sick and call your doctor right away if you have symptoms (telehealth calls are easier and more available than ever). Remember: flu symptoms and COVID-19 symptoms can be very similar.

… and sometime soon, a COVID-19 vaccine. Our nation’s handling of the pandemic to date must not presage our handling of a vaccine; the approval process must be science-driven and inspire public confidence. Distribution must initially prioritize essential workers. As more widespread vaccinations are possible, no one should have to go without due to access or affordability challenges.

End the “mask confusion.” As a nation, it took many years and multimillion-dollar public-awareness campaigns for us to wear seat belts and stop smoking in public places. Those were long-term appeals, but we do not have the luxury of time right now. The science has evolved, and there’s more evidence than ever before that wearing a mask is effective. In fact, wearing a mask must be a universally accepted norm.

Quick, reliable testing. We cannot afford an on-again, off-again commitment to COVID-19 testing; for the foreseeable future, it is an imperative. But real challenges remain: while identifying positive cases has obvious benefits, waiting five to 10 days for results almost nullifies the capacity to contain spread. We need a consistent focus on deploying convenient tests that produce reliable, rapid results and actively driving their use, particularly among high-risk populations, in hot spots and for those exposed to a known positive.

Prepare to be screened. For the foreseeable future, and perhaps indefinitely, screening in healthcare facilities and other public venues will be the new normal. When you come to a hospital or clinic, expect to have your temperature taken and answer screening questions. These are for everyone’s safety—patients and caregivers.
No healthcare professional needs to be reminded of the seriousness of what lies ahead. Let’s take what we’ve learned, be ready and willing to adapt—and build a new resolve to defeat this virus together.

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Source: We’ve learned a lot during this pandemic; let’s put the knowledge to good use

Value-based care now at risk

Value-based care now at risk

by | Sep 16, 2020 | News

Both CMS and healthcare providers are using COVID-19 as an excuse to cut back on their experiments in value-based care, a severe blow to those hoping the pandemic would catalyze badly needed payment reforms.

Provider reluctance to embrace reform was apparent before the pandemic hit. The Medicare Payment Advisory Commission’s latest report on accountable care organizations showed their ranks dwindling from a high of 561 in 2018 to 517 this year. The total number of beneficiaries enrolled in ACOs—about 11 million—has changed little over the past two years after six years of steady growth.

Why was ACO growth slowing before the pandemic? In August 2018, CMS Administrator Seema Verma unveiled new “Pathways to Success” rules, which shortened the time ACOs could be in shared-savings programs without taking on downside risk. They now begin absorbing losses after two years—not five—when their costs rise faster than a comparable panel of fee-for-service Medicare patients.

Health systems and major physician practices clearly weren’t interested in payment schemes where making money depended on reducing their top line revenue. CMS received just 41 new applications for its shared-savings programs for 2019. The number fell to 35 for 2020. By comparison, the agency received more than 100 new applicants per year on average in each of the prior seven years.

The number will drop to zero in 2021 because CMS inexplicably stopped processing applications. What’s the ration-
ale? It’s not as if agency officials working from home are too busy taking care of patients to process the paperwork.

Moreover, Verma in May waived consideration of COVID-19 costs when calculating ACO savings and losses this year. The new emergency regulations also reduced the amount of downside risk. No doubt she was responding to an April survey by the National Association of ACOs that showed more than half the organizations in at-risk models planned to drop out of the program because of pandemic-related losses.

It remains to be seen if the relaxed requirements will maintain the current level of engagement. The pandemic-induced revenue collapse has revealed the dark truth behind the “one foot on the dock, one foot in the canoe” metaphor.

Most providers still have both feet firmly planted on the fee-for-service dock. Their ACOs remain little more than experiments—toy sailboats adrift in what now has become a turbulent sea.

There are notable exceptions, of course. Newly launched primary-care practices focusing on high-cost patients are betting that their comprehensive care coordination models can generate huge savings. Many are finding interested customers among Medicare Advantage insurers that assume full financial risk for their customers.

Most healthcare systems are slowly returning to business as usual as they adjust to the pandemic’s new normal. The companies that sell orthopedic and cardiovascular devices report double-digit sales gains in recent months after surgeries fell anywhere from 40% to 80% early in the pandemic.

A recent Commonwealth Fund report showed in-person outpatient visits have been running only 16% below normal since mid-July after falling 70% in the spring. Telehealth visits, which CMS now reimburses, have gone from barely measurable to over 7% of all visits, making up for nearly half the shortfall. The healthcare industry as a whole has recouped over 60% of the 1.6 million jobs lost early in the pandemic.

It’s not too late to reinvigorate value-based payment programs. CMS could offer full capitation payments to ACOs in exchange for forgiving loans made during the pandemic. It could offer transition grants to primary-care practices willing to take on full financial risk for their patients.

Failing to act will not end existing value-based reimbursement programs. But it will ensure they never become anything more than curiosities in a largely fee-for-service world.

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Source: Value-based care now at risk

Are hospitals making money treating COVID-19 patients?

Are hospitals making money treating COVID-19 patients?

by | Sep 15, 2020 | News, Covid-19, Healthcare

Of the $175 billion originally allocated for Provider Relief Fund grants, a little over half has been distributed according to prior total patient revenue, suggesting HHS tried to replace revenue lost from suspending procedures. hospitals

Another $22 billion went to hospitals that saw large numbers of COVID patients. Smaller amounts were targeted at safety-net hospitals, rural hospitals, skilled-nursing facilities and children’s hospitals.

Karyn Schwartz, a senior fellow with the Kaiser Family Foundation, said she agrees that knowing whether hospitals’ reimbursement for COVID treatment covers their costs could be helpful information for policymakers in determining how the remaining roughly $57 billion in Provider Relief Fund grants would be best allocated. “I think knowing how costly it is to treat these patients is important in terms of understanding how important it is to allocate the money that way versus something else,” she said.

Matt Hutt, an accountant who heads AAFCPAs’ healthcare division, said by his estimation, in order for Medicare’s 20% add-on payment to cover the cost of COVID care, it would have needed to be a 35% add-on. Going forward, he said it’s important to tie Provider Relief Fund grants to the losses providers are seeing on COVID care.

“That’s really what the funds should be used for: the impact that COVID had on your business,” he said.

The problem with that, however, is the numbers used to calculate margin can be “warped,” Johns Hopkins associate professor Bai said. While revenue from COVID treatment is clear-cut, the cost component is open to interpretation. Large, well-connected providers would likely hire savvy consultants to make their margins look worse than they are, she said. Instead, Bai said the decline in charges or outpatient claims would be a more objective way to distribute the money.

Even if, hypothetically, systems were making money on COVID patients but still losing money in every other aspect of their business due to lower demand, that would put the healthcare system in jeopardy, said Rick Kes, healthcare industry senior analyst with RSM. “The sustainability of our healthcare system is maybe the overriding issue.”

Opinions abound on how the remaining federal aid should be allocated. Michael Abrams, managing partner and co-founder of healthcare consultancy Numerof & Associates, said tying the disbursement to fee-for-service revenue, as has been done with much of the money so far, rewards providers who haven’t shifted toward value-based payment models. He thinks HHS should offer incentives for value-based payment with the remaining money.

“I just hate the idea of bailing out an industry that is increasingly on a course that departs from what the country needs,” Abrams said.

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Source: Are hospitals making money treating COVID-19 patients?

Cutting exposure to COVID-19 in EDs using on-site telehealth

Cutting exposure to COVID-19 in EDs using on-site telehealth

by | Sep 14, 2020 | Telehealth, Covid-19

Telehealth has been gaining ground as a breakout star of the COVID-19 pandemic. Cutting

But while much of the recent attention has focused on using it to treat patients at home, the practice has also been vital to keeping clinical staff members safer as providers revamp emergency departments to curb the risk of infection.

Telehealth played a major role when Renown Health set up a medical tent during the early days of the pandemic to expand its ED’s triage capacity for patients with COVID-19 symptoms.

After getting their vital signs taken by a nurse in-person, patients would speak with an emergency medicine physician via video, who would determine whether they needed testing, treatment or another next step.

The Reno, Nev.-based system took down its alternate care site in June, but has kept aspects of that virtual component alive in its ED. “Our first priority is patient safety and patient care,” said Dr. Paul Sierzenski, an emergency medicine physician and chief medical officer for acute-care services at Renown. “Right next to that is our staff safety and staff care.”

When patients present at the ED, they’re immediately screened for COVID-19. Those with symptoms are sent to an individual room, where they’ll typically use a tablet or telehealth cart—which includes internet-connected devices, such as digital stethoscopes—to complete a virtual evaluation and assessment with a physician, depending on their acuity.

Renown uses software and hardware from a few different companies for its telehealth program.

It’s the first time the health system has used telehealth to connect its on-site physicians to ED patients, though it has provided telehealth consultations for specialty services like stroke care and behavioral health to EDs for years.

Some health systems were adding telehealth to their EDs before COVID-19 hit. Those with high ED visit volumes in particular had been rolling out processes for physician assistants or physicians—often based at a central station, but managing patients at multiple facilities—to help triage patients via telehealth, in an effort to reduce long wait times, said Arielle Trzcinski, a senior analyst at market research firm Forrester.

That type of “tele-triage” can help a facility manage capacity, since a remote physician assistant or physician can redirect patients who might be a better fit for urgent or primary care. For patients with more pressing cases, staff can start ordering lab tests and X-rays before a patient even gets to an exam room.

It’s become more common to see telehealth in EDs since March, as health systems have wanted to address patient surges quickly and use portable video equipment in new ways to decrease clinicians’ COVID-19 exposure, Trzcinski said. She believes many health systems will keep the new processes in place, at least for busy times of the year, such as flu season.

Emergency medicine staff at Aurora St. Luke’s Medical Center, a Milwaukee hospital that’s part of Advocate Aurora Health, had been thinking about using remote physician assistants to help triage patients, but the practice didn’t catch on until COVID cases started mounting. Since the spring, patients who present at Aurora St. Luke’s ED with COVID-19 symptoms are directed to a so-called “hot zone”; those without symptoms are sent to the “cold zone.” A telehealth cart with a tablet is rolled over, so a physician assistant—located elsewhere in the hospital—can remotely triage patients in both areas.

The tele-triage system lets remote physician assistants assess any patient without having to change personal protective equipment, said Dr. Bill Lieber, an emergency medicine physician who has practiced at the hospital for more than 15 years.

The tele-triage system is likely to remain at Aurora St. Luke’s after the pandemic subsides, Lieber said. Aurora St. Luke’s uses virtual care technology from EmOpti for tele-triage.

Aside from reducing risk of exposure, Lieber said it has helped with efficiency, since the physician assistant can remotely triage patients at other facilities while at Aurora St. Luke’s.

EmOpti bases its software fees on a facility’s annual ED visit volumes, according to Dr. Edward Barthell, an emergency medicine physician and the company’s founder and CEO.

It’s too early to share outcomes from Aurora St. Luke’s tele-triage use, but a sister hospital saw its typical patient wait time drop from 40 minutes to 10 minutes after implementing tele-triage, according to Barthell. The hospital’s length of stay for patients discharged from the ED decreased by 45 minutes.

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Source: Cutting exposure to COVID-19 in EDs using on-site telehealth