Getting physicians to embrace telehealth

August 02, 2019
By Dr. Lyle Berkowitz

Telehealth’s benefits are numerous and include improved patient access to care, greater patient satisfaction and better connection between patients and their caregivers, according to Deloitte.

So it should come as no surprise that demand for telehealth is expected to surge in the coming years as improving reimbursement and advances in technology make this emerging mode of care delivery more pervasive. In fact, by 2025, the U.S. telemedicine market is expected to exceed $64 billion, while the global market is expected to reach $130 billion by that time, according to a recent report by Global Market Insights.

However, the U.S. health system won’t realize these financial and clinical advantages without first obtaining buy-in from health systems and their physicians. To guide physicians toward embracing this disruptive technology, health system executives must demonstrate strong leadership, provide relevant data and education, align financial incentives and change their organizations’ daily culture.

First, health systems leaders must debunk misperceptions about telehealth and emphasize how virtual visits can improve quality, efficiency and financial performance at an organization. This approach involves creating data driven reports on the “3 M’s” (Metrics, Money and eMotion) that help shape physicians’ attitudes and behavior:

Metrics: Physicians are scientists, and respect insights that are derived from data. Acceptance of telehealth starts with providing physicians with the facts and data that illustrate the problems that telehealth can fix. Leadership can begin the education process by creating the following four key reports that quantify common health-system issues:

• Access: Identify what percentage of patients can obtain same-day appointments with their primary care physicians (PCPs). If it is difficult for new and/or established patients to schedule urgent care or annual exams, they will look elsewhere.
• Leakage: Review the 10-year trend in percentage of minor but urgent cases — such as sinusitis or urinary tract infections — that are being seen by PCPs. It is likely declining. Telehealth will not “steal” these visits from PCPs because patients have already been gradually switching to urgent care, retail clinics and similar settings for these types of cases. Teleheath is actually a way for health systems and provider to reclaim these visits.
• Burnout: Compare a physician’s average relative value units (RVUs) per visit with their average appointment time over the past decade. By looking at appointment time and RVU trends, organizations can identify signs that physicians are at risk of burnout, such as physicians being asked to do more in less time (the ratio is going up too fast) or physicians not working at top-of-license (the ratio is going down too fast).
• Quality reports: Review quality reporting metrics, such as avoidance of antibiotics in adults with bronchitis, preventive care screening (colonoscopy, mammogram) and readmission rates. If certain quality scores are less-than-optimal, a telehealth partner might have a positive impact.

Money: A major myth to dispel is that allowing a virtualist to see their patients will hurt providers financially. In reality, by shifting their routine patients to telehealth, physicians can actually increase their panel size and revenue per visit as office visits can be allocated toward new patients and those with more complex issues that create more value to the health system.

Since health systems might benefit more directly than individual physicians in this situation, they would also be wise to create new financial incentives that contribute to the overall success of their telehealth programs by aligning physician compensation with telehealth-program goals. For example, consider implementing the following policies:

• Paying your own virtualists equal to what they would make in an office visit.
• Awarding bonuses to PCPs based on lower emergency room (ER) admissions, thus incentivizing them to encourage their patients to try telehealth rather than the ER for certain issues.
• Providing small RVU bonuses to PCPs who review charts of their patients seen online by a virtualist partner.
• Paying bonuses for office-based, higher complexity visits and/or decrease RVU credits for lower-complexity visits.

eMotion: What’s most important to your providers? What are their biggest challenges? Though physicians are indeed scientists with a strong appreciation for data and evidence, it’s still important to appeal to their hearts. They want the best for their patients and are willing to support disruptive changes such as telehealth — as long as these changes will result in better care and satisfaction for their patients.

Help your physicians understand how telehealth offers potential to relieve some of the most common problems they confront. Certainly, not every physician has the same challenges and goals, but many will likely be interested in helping mitigate the following problems:

• Access: Leading telehealth providers deliver access to care 24 hours per day, 7 days per week and 365 days per year with nationwide coverage for adults and children.
• Patient experience: An online visit can take a patient about 10 to 15 minutes of their time, compared to the two-hour average for a patient to travel and be seen in an office setting.
• Provider experience: As a result of telehealth adoption, providers will field fewer after-hours calls during evenings and weekends.

Dr. Lyle Berkowitz
Any organizational culture change — such as the implementation of a telemedicine program — is bound to come with some growing pains. However, health system leaders can get out ahead of these issues with a well-planned telehealth implementation strategy that generates buy-in from physicians with metric-based education, alignment of financial incentives, and emotional support for clinicians’ needs.

About the author: Lyle Berkowitz, M.D., is the chief medical officer at MDLIVE.