Given the COVID-19 pandemic and President Biden’s role in enacting Obamacare, I am confident healthcare will be a primary focus of the new administration.
As Geneia’s president and CEO, I too have some priorities that I would like the Biden-Harris administration to embrace. They are:
- Payment for telehealth and remote patient monitoring
- Physician burnout
- Strong primary care
As HL7 FHIR founder Grahame Grieve noted, “Interoperability is all about people and connecting their health stories across different specialties, visits and consults across multiple locations. Connecting the health story of an individual holds valuable clues to the diagnosis and treatment.”
We’ve made some progress with interoperability, but we’re not there yet and very much need to be, even more so to better manage the COVID-19 pandemic. Take lab reports, for example. “ In the area of lab reporting, half of lab reports submitted to public health can lack a patient address or zip code, often key demographic data elements used in identifying infection clusters and localizing disease hotspots.”
According to Dr. Jonathan Slotkin, vice chair of neurosurgery and associate chief medical informatics officer of Geisinger,
“There are troves of important data like positive COVID results, signs and symptoms, sitting in siloed EHRs across different hospital systems in care settings across the country.
These troves of patient data, when harnessed in an automated, real-time manner, can be used by health systems, states and the federal government to predict surges in COVID-19 cases, to determine which patients are more likely to get acutely infected, and to provide healthcare systems with risk- and severity-adjusted information to predict other findings.”
Payment for telehealth and remote patient monitoring
Virtual visits, telehealth and remote patient monitoring have increased significantly during the COVID-19 pandemic. RPM is even being used for COVID-19 patients. As a part of its digital COVID-19 strategy, “Providence Saint Joseph Health patients who exhibit virus symptoms but are well enough to stay home are given a thermometer and pulse oximeter that connect with solutions from Twistle, Xealth and digital platforms monitored by Providence clinicians.”
Physicians and their patients favor the choice of virtual care, and most would like to continue to have that choice once the pandemic is over, yet reimbursement may prove to be a significant barrier.
During the pandemic, health plans and self-funded employers have waived copayments for telehealth visits and reimbursed providers at the same level as in-person care. We’re already seeing payers revert to pre-pandemic reimbursement policies, which threaten the adoption of virtual care.
The CARES Act enacted by Congress temporarily “allows for telehealth visits to be covered on a pre-deductible basis.” Making this change permanent would support patient choice of telehealth.
Early in 2020, Medscape found 42 percent of physicians reported that they were burned out. The top five contributors to physician burnout were:
- 55 percent Too many bureaucratic tasks
- 33 percent Spending too many hours at work
- 32 percent Lack of respect from administrators, employers, colleagues or staff
- 30 percent Increasing computerization of practice
- 29 percent Insufficient compensation, reimbursement
Physicians have been hard-hit by the COVID-19 pandemic. In the early days of the pandemic, many closed their practices and others shifted to telehealth. Most suffered financial losses.
The Primary Care Collaborative has surveyed physicians throughout the pandemic, reporting new results most weeks. Its November 13-17 survey found:
- One quarter of surveyed clinicians report their fee-for-service volume is still more than 30 percent lower than pre-pandemic levels.
- Two percent of respondents say their practice is closing or has closed.
- Five percent say their practice is merging/has merged with a larger system.
- 44 percent say clinician salaries have been reduced or skipped.
At the same time, too many doctors and clinicians have put their lives on the line to care for COVID-19 patients. “Through the end of July, nearly 120,000 doctors, nurses and their medical personnel have contracted the virus in the U.S.,” and, at least 641 have died.
Let me say we owe a debt of gratitude to all of the many, many physicians who have given – and will continue to give – tirelessly to their patients during the COVID-19 pandemic. Thank you.
As important as gratitude is, it’s not enough. Once and for all, we must commit to fixing physician burnout. It’s high time we worked just as tirelessly to restore the joy of medicine to the practicing physicians we all rely on to treat us and our loved ones.
Strong primary care
The heart of our healthcare system is primary care, and we must do more to support primary care clinicians. Pre-pandemic, primary care shortages were expected. Undoubtedly, the pandemic has exacerbated this trend as many physicians decided to retire early rather than risk their health. Likewise, a robust public health system depends upon strong primary care.
American adults “who have a primary care provider have 19 percent lower odds of premature death than those who only see specialists for their care.” People with a primary care provider save 33 percent on health costs compared to their peers who only see specialists.
Yet, of the roughly 18,000 U.S. medical school graduates every year, only 25 percent choose primary care, and only four to seven percent of healthcare dollars go to primary care.
As I wrote earlier this year, the COVID-19 pandemic has caused immense pain and suffering – and been responsible for bright spots worthy of celebration in the areas of:
- Unparalleled levels of healthcare collaboration.
- Massive research investments to identify and create COVID-19 vaccines and therapeutics.
- Acceleration of digital health.
- Increased adoption of value-based care.
I am bullish on the potential for the healthcare industry to positively impact lives and the Biden-Harris administration to support healthcare advances.