What COVID-19 regulations have lead to the progression of the telemedicine movement, and how we can ensure that telehealth continues to grow

The COVID-19 pandemic resulted in a complete disruption of our healthcare system. As infection risk grew, news reports of hospitals unable to accommodate the growing number of COVID patients were widespread.

In reality, the very early days of the pandemic looked different. According to a study published by the National Syndromic Surveillance Program, ED visits in March and April of 2020 were down 42 percent, and additional surveys found that in-clinic visits dropped to 20-30 percent of their usual volume.

Why? The emergence of telehealth.

The progression of telemedicine as a result of COVID-19

COVID-19 fueled rapid development and adoption of quality telemedicine solutions to provide a broader range of health services.

In March 2020, telemedicine visits rose by over 1000 percent year over year as both patients and providers moved to quick adoption of telehealth. Since then, use of telemedicine has remained high—even outside peak periods of COVID-19. This achievement, completed in months, would normally take a decade to accomplish and would be impossible without the recent changes in healthcare regulations.

CMS changes impacting telemedicine during the COVID-19 pandemic

CMS restrictions previously barred widespread telehealth use in many Medicare and Medicaid populations. The COVID-19 pandemic led to a shift in these regulations, with CMS allowing telehealth visits to be originated from a patient’s home and be reimbursed at the same rate as an in-person visit.

These shifts allowed patients living in rural and urban communities the same access to telehealth and made telemedicine a financially viable choice for providers through parity of payment.

Additional administrative changes were made outside the CMS scope that furthered the growth of telemedicine. These included the removal of cross-state restrictions on medical licenses for telemedicine visits and a relaxation of HIPAA regulations to facilitate information sharing across providers for improved continuity of care.

The results of change: Improved care at reduced costs

The current pandemic serves as a pilot for telehealth, ultimately proving that remote care brings numerous benefits—including improved cost and quality of care. This is especially true for telehealth platforms like Steth IO that rival in-person visits by offering full remote examination capabilities in addition to traditional telemedicine audiovisual functionality.

In addition, telemedicine surpasses in-person care with its ability to provide timely access to care. Patients who struggle to get in and see a provider due to limited exam rooms and appointments—or personal inability to take time off work, travel, or find childcare—can receive needed care when and where they need it, reducing the risk of condition exacerbation and high-cost utilization.

Reducing costs of care through telemedicine

Insurers and providers are reducing costs with the minimal overhead required for digital and remote health visits. Currently, 88 percent of studies show that telemedicine is an effective tool for achieving meaningful cost savings compared to conventional lines of care.

But even this decrease in overhead is minimal to the long-term cost savings both insurers and patients will see as patients are more effectively triaged—reducing the need for walk-in clinics as well as high-cost ED utilization and readmissions. When the cost of technology implementation is covered through government grants or funding from innovative programs like VBID, those savings are even more significant.

Continuing to improve healthcare post-pandemic through telemedicine

Telehealth is here to stay, but its strength and reach will depend on maintaining a number of the regulations and “wins” that facilitate its current widespread use. With the right policies in place, telehealth can be the default system of care—guaranteeing better access to healthcare across populations and ensuring infrastructures are in place to provide consistent, quality care, even in the event of another public health crisis.

Improving and maintaining beneficial telehealth policies post-covid

The relaxed HIPAA regulations will ultimately need to return to their former stringencies, but other regulations created for telehealth mid-pandemic should be considered for long-term adoption as we move forward.

For example, robust telemedicine platforms with diagnostic capabilities like that provided by Steth IO and its Spot device have proven to be an acceptable match for in-person care and should be billed and reimbursed as such. Code classifications may differ, but ultimately telehealth payments need to remain reimbursable in parity with traditional clinic visits.

In addition, the medical licensure restrictions across state lines may go back into effect, but we now have goals that we can strive for in seeking out a national healthcare telehealth license or increased reciprocity between state licenses for telehealth.

Telehealth as the new normal

The U.S. is well-positioned to make all healthcare visits, by default, a remote healthcare visit. Even now, roughly 70 percent of clinical visits taking place—both in primary care and in many specialties—could already be taking place effectively with telemedicine.

Using the innovation momentum gathered from the current pandemic to create long term change in how insurers and providers think about, utilize, and advocate for telemedicine—both within the healthcare system and through patient outreach—can open doors for a quality and cost-effective solution for addressing, diagnosing, and treating many conditions. This ultimately strengthens our health system, reduces the cost of care, increases the quality of care, and improves the access for care across populations for better overall health outcomes.

3 things that need to happen if telehealth will remain a viable healthcare option post-pandemic—and why they need to

Mahesh Mulumudi, MD

Carmen was a 48-year-old mother of three with diagnosed type 2 diabetes. A single mother, she was working extra shifts to help her youngest attend the nearby state college when she started experiencing shortness of breath and heart palpitations.

Concerned about missing work, Carmen had opted for a virtual doctor’s visit—explaining her symptoms quickly during a ten-minute break in her car. She was diagnosed with anxiety and prescribed a care plan that included a short-term dosage of anxiety medication and follow-up visits with a virtual therapist. Within weeks, Carmen ended up in the emergency department where, upon further examination, it was discovered she had a weak heart pump and was experiencing acute heart failure.

Unfortunately, Carmen’s story is not unique—and it’s instances like this that lead patients and providers alike to remain wary of telehealth.

The loss of trust in healthcare

While a public health crisis has necessitated fast adoption of telehealth, a J.D. Power Telehealth Satisfaction study shares that 43 percent of surveyed patients feel telehealth is cold or “impersonal,” and nearly half believe telehealth offers a lower quality of care than in-person physician visits.

And the lack of confidence goes both ways.

More than ten years after the introduction of Teledoc, arguably the first modern telehealth platform, 75 percent of physicians were still reporting high levels of distrust in telehealth as a viable option for correctly diagnosing a patient. Six years later, the numbers have improved, but only slightly.

Combining better audio-visual capabilities with remote patient monitoring devices can help restore both patient and physician trust in telemedicine’s capacity for long-term, effective value-based care. 

Restoring confidence through like-live examinations

Pitfalls of today’s telemedicine system that drive patient and provider distrust include strictly-asynchronous telemedicine models where patient information is submitted for a physician’s later review, or audio-only phone calls where providers lack the opportunity to observe the patient through the addition of live video.

While implementing these “store and forward” or audio-based telemedicine platforms can seem faster to implement than platforms that facilitate live audio-visual telemedicine calls, these models ultimately set both patient and provider up for quick wins rather than reliable, long term gains.

Conversely, a report published by the American Psychiatric Association reviewed 30 randomized controlled trials involving live video-conferencing examinations and found that “With the exception of one study, the review found no statistical difference in clinical outcomes… delivered by synchronous video-conferencing treatment and in-person treatment.”

While it’s easier to see the feasibility of audio-visual calls in addressing mental and behavioral health conditions, these same principles notably improve the quality of care received by chronic care patients as well. When coupled with additional connected devices that offer insight into physical conditions, the visits provided through telehealth services further improve and can even begin to rival the standards of care patients would receive in a traditional clinical visit.

Improving chronic condition care by introducing connected devices into live examinations

Telemedicine as it exists today relies highly on surface level information—things a physician can observe with the eye or be told by a patient—but lacks the ability to observe what’s happening inside the body. As such, evaluating patients through traditional telemedicine practices continues to pose challenges because it still involves a lot of guesswork on the part of the physician—leading to less-confident diagnoses from providers and less confidence in those diagnoses from the patients.

The addition of connected devices—especially for patients with chronic conditions who are seen regularly—can alleviate this guesswork by offering ways for patients to share, and providers to observe, things like heart and lung sounds.

The Steth IO Spot addresses this gap by providing a digital stethoscope that can plug directly into a patient’s smartphone to capture heart and lung sounds as part of a live audio-visual examination via the Steth IO telemedicine platform. As a result, this remote care experience becomes clinical and life-like as patients and providers are able to talk to and see each other while also listening to heart and lung sounds as though the patient was physically in the exam room. 

Furthermore, the Steth IO platform augments the telemedicine experience by visually representing sounds from the Spot device on the provider screen—allowing physicians to quickly identify potential issues that would have been more difficult to diagnose by ear alone and triage care accordingly.

For a case like Carmen, having these capabilities upfront could have helped the provider recognize early stages of heart failure more quickly—even at her younger age—and prescribe a more appropriate care plan that would have reduced her risk of needing to be admitted to the hospital.

Providing continued support through ongoing education, reminders, and monitoring

Current patient support functionality, for many healthcare organizations, consists solely of a printed visit summary following an appointment—summarizing what was discussed, outlining expectations, and listing what follow-up the patient needs to take. Where these summaries end, however, the capabilities of telemedicine platforms begin—reestablishing patient trust through better virtual support via telehealth.

In addition to visit summaries, telehealth platforms offer ongoing, comprehensive direction tailored to each patient’s condition and situation in real time. For example, patients can get notifications to take medications, follow their diets, complete daily at-home rehab regimens and schedule their five-day follow-up appointments—all within one app.

For telemedicine platforms like Steth IO that are able to combine live audio-visual visits with remote patient monitoring within a single platform that also offers post-exam support, patient experience is both simplified and improved. As a result, the comprehensive support provided—which would not have been possible through a clinical visit alone—leads to better patient trust and better overall outcomes.

The bottom-line benefits of telemedicine

The long-term benefits that telemedicine can offer patients with chronic conditions far outweigh the initial cost of platform integration, but only when we’re willing to commit the time and resources upfront to following best practices and establishing models that help both patients and their providers feel confident in the technology. When this is achieved, patient health outcomes and quality of life improve—as do care costs over time.

It has been proven that audio-visual visits achieve average short-term cost reductions between $19-$121 per visit in cost avoidance—and larger long-term savings as patients avoid unnecessary emergency and inpatient utilization, readmissions, and more. Furthermore, as we improve the quality of our virtual visits through platforms like Steth IO, we can reduce the pressure providers feel to order extra and unnecessary tests—a large source of unnecessary cost to both patient and payers—that overcompensate for lack of confidence in the diagnosis as a result from poor telehealth platforms.

As we continue to fine-tune our telehealth capabilities, telemedicine platforms like Steth IO will become a key player in affordably improving patient care as we move past the pandemic and into a healthcare system that is increasingly more focused on value-based models of care.

How providers are overcoming the downfalls of traditional audio-visual telehealth with a single smartphone plug-in

The COVID-19 pandemic has been the catalyst for rapid acknowledgment and adoption of telehealth services across the country, and the new CMS policies for 2021 suggest this adoption could be long-term—even once the pandemic ends.

For organizations looking to expand their telehealth services, the top-down support being given from government agencies makes this the perfect time to strengthen telehealth and remote patient monitoring options by overcoming traditional digital health downfalls and increasing security to better serve populations with chronic and acute care needs.

Vitals are vital: bridging gaps through real-time data

While telemedicine offers greater freedom to have doctor visits from the comfort and safety of a patient’s home, concerns that virtual visits are unable to complete key components of check-ups—such as listening to heart and lung sounds—have posed barriers into long-term adoption.

Mahesh Mulumudi, MD, practicing interventional cardiologist, and CEO of Steth IO shares:

If you are seeing a patient with COPD by audio visual technology, you can ask questions about whether they are short of breath, but you cannot objectively evaluate how the air flow is in their lungs. You need to listen to the lungs to get a feel for what to do next—whether that’s triaging and helping this patient along at home, sending this patient to the ED, or referring the patient to another type of therapy. And that is just one example of a condition where this type of real time active listening to the lungs might make a difference in both chronic and acute care situations.

Steth IO—a uniquely blended hardware and software technology—is bridging this gap. Its remote cardiopulmonary monitors allow physicians to listen to heart and lung sounds as part of real-time virtual visits.

Relying on a small, device-agnostic stethoscope that plugs into patient smartphones, the technology transmits heart and lung sounds—along with visual representations of those sounds—in real time to doctors on the other end of the audio-visual call. This allows the physician to not only check vitals, but have the information needed to reliably identify potential issues and diagnosis appropriate next steps.

Strengthening patient data safety

Concerns about patient privacy continue to cause ongoing concern with telehealth expansion—with over 41 million patient records breached in 2019 (a 48% increase over 2018)—and the federal government temporarily relaxing HIPAA laws during the pandemic.

While telehealth has not been cited as the cause for these breaches, as its use expands, so do fears about meeting HIPAA guidelines and—more importantly—ensuring patient information remains safe.

HIPAA represents a set of laws that organizations agree to uphold, but accountability to those laws is limited. Working with telehealth solutions like Steth IO that are certified through security regulation entities like HITRUST—and adherent to HIPAA laws—can ensure a higher standard of protection and accountability for data shared. In addition, HITRUST certification must be renewed every two years, ensuring ongoing quality control and checks for better data safety.

Telehealth: seeing the benefits beyond the pandemic

While the need for social distancing and face masks will likely subside with the release and wide administration of a vaccine, the importance of live telehealth will not. Remote care—while important for providing safe care during the pandemic—has benefits that reach beyond what traditional brick-and-mortar doctor’s offices are better able to offer.

Telehealth has the potential to fill gaps in lower-acuity care by making it easier for care teams to see more patients with less overhead and exam rooms. Dr. Mulumudi continues:

U.S. healthcare costs and quality of care is hurting because we’re not able to keep up with the volume of patients that need care. Depending on the condition, though, almost 60% to 70% of these needed clinic visits can be done on telemedicine; they don’t really need to come into an office. Using technologies like Steth IO to truly evaluate patients remotely will allow more patients to be seen, evaluated and delivered therapy.

In addition, by bringing the check-ups to patients where they are, remote monitoring technology helps overcome barriers posed by social determinants of health that traditionally prevent vulnerable patients from getting the care they need—leading to condition exacerbation and increased likelihood of a visit to the ER.

When patients are able to complete live check-ups at home or work with devices like Steth IO and their own smartphone, hassles like lack of transportation, finding suitable childcare, or taking two hours off of work become non-existent, increasing the likelihood of the individual getting the appropriate preventative care.

The expansion of digital health offers an exciting frontier for healthcare, and by leveraging available funding, waivers, and reimbursements, implementing safe, effective solutions like Steth IO has become more affordable and profitable than ever. In addition, care costs are reduced through lower overhead with the increase in virtual visits, and more patients receive appropriate preventative care. Ultimately, unnecessary hospitalization is avoided—and patient outcomes improve.

You obviously want to provide your patients with high-quality care and you want to be the best physician you can be. But, if you’re overworked or stressed, it could result in physician burnout. If this happens, not only will you find it more and more difficult to get through your days at work, but the quality of care for your patients may decline as well.

The Burnout, Stress and Overworked Factors

Did you know that overall,42 percent of physicians are suffering from burnout?  And, burnout doesn’t just negatively affect the experience your patients have at your office, it can also affect patient outcomes adversely. When your extremely tired or distracted during a patient visit, you’re not paying complete attention to what they’re telling you. This could cause you to miss important history information which could indicate a completely different health problem than what your patients initially came into your office for.

Being overworked and experiencing stress are other factors. There are various reasons why physicians become so stressed, it prevents them from performing their jobs effectively. Some common reasons why you could become stressed are:

• A lack of autonomy when working with patients.
• A lack of control over the way you use your time.
• Feeling pressured to provide care to as many patients each day as
• possible to maintain the profitability of your organization.

Because of this, healthcare doctors often report their work-life balance is poorer than individuals working in other fields.  Fortunately, there is a newer approach many physicians are taking these days to avoid burnout, stress and distractions and improve the quality of patient care — telemedicine.

Telemedicine for Physicians

Telemedicine is healthcare facilitated by means of phone, video and other telecommunications technology to provide patient care without the need for a face-to-face visit.

There’s been a transformation in the physician/patient relationship over the past 20 years and the arrival of telemedicine technology has contributed to this greatly, particularly in recent years. Advanced technologies provide telemedicine opportunities for physicians that can alleviate some of the challenges that afflict the healthcare system like access to convenient care. A lot of organizations all over the country have begun taking advantage of telemedicine to improve: 

• Patient experience
• Operational efficiency
• Financial portfolios

Steth IO Health for Telemedicine

But, telemedicine should be more than a phone or video call. Most available telemedicine tools today don’t have exam capabilities, like Steth IO. The device within the Steth IO Health umbrella is ideal for home use, which makes it an efficient telemedicine platform.

Steth IO is an iPhone app that turns your phone into a stethoscope. It’s made of three components:

• A software app you download from the AppStore
• A case that fits right on your iPhone
• Assisted Intelligence (AI) to help you make diagnoses with confidence

The case, which is beautifully designed, has an integrated audio waveguide which works by filtering sounds the diaphragm sends and presents them to the microphone. The iPhone’s software app does the rest. Steth IO stethoscope contains a few pieces of technology, enabling an array of features that are designed for improving the information you  have to diagnose and monitor your patients.

Steth IO Health introduces true telemedicine to your patients at home by allowing remote patient exams and monitoring. Patient exams provide valuable data that can affect your clinical decision making and improve patient satisfaction and experience. Being able to expand your practice beyond the walls of your office will allow you to:

• Create a hybrid practice
• Reduce physician burnout
• Increase the efficiency of patient care

Reasons to Look into Telemedicine Opportunities for Physicians

There are several reasons why you’d want to practice telemedicine, including:

1. Get Paid for Follow-Up Calls

Many physicians spend time each day answering messages from patients and making phone calls to follow-up or inform of new conditions. With telemedicine, you can perform this follow-up service over video, have a more personalized visit and even receive reimbursement for this care you provide.

2. Have More Flexibility

Telemedicine provides a great opportunity for doctors in different stages of their career such as:

• Established physicians who would like to supplement their income
• Newly graduated residents who’re looking to explore career settings
• Clinicians who are planning on retiring and would like to phase out their practice and maybe work from home instead

3. Have Improved Access to Care

Telemedicine enables you to provide enhanced access for acute issues during and after office hours. Those patients who aren’t accustomed to being able to visit a board-certified doctor in the middle of the night when struggling with a sudden problem will be happy to have access to this on-demand care. 

This will also improve continuity since you’re caring for the acute conditions under your brand and practice instead of by the local urgent-care center or emergency room. This will naturally build up loyalty and trust to you and your practice and keep your patients experiencing only mild conditions out of the ER.

4. Realize Lower Costs

Another essential advantage of telemedicine is lower costs for you. You not only have another chargeable service to your bottom line, but this lower overhead could mean greater overall quality of care. 

5. Benefit from Streamlined Care

EMT’s can take video conferencing in their ambulance, allowing them to send information, including important clinical data or images to a trauma team waiting at the ER. And, this results in streamlined care and substantial savings in treatment costs and time.

Telemedicine doesn’t just appeal to physicians because it makes things simpler (though it definitely can). It is a necessary and unique approach to healthcare, allowing you the freedom to provide care that works best for you and your patients. It also provides patients with more flexibility in managing their health.

While it’s not a new technology anymore, telemedicine continues to be a buzz word across the medical industry and for good reason. With telemedicine, you no longer have to rely on time-consuming and costly in-person visits, you can now rely on video visits, like Steth IO Health, and other means of examining, treating and managing your patients with medical problems. Contact us to learn more.