Virtual Care: Helping Through Winter Surges and Beyond

By Matt Phillion

Every year, as the weather changes and schools start back up, many communities see a surge of illnesses like strep throat, upper respiratory infections, the flu, and of course COVID. These illnesses require treatment and inevitably stress an already burdened healthcare system: the average wait time for an appointment when there are no surges is 38 days.

Those long wait times can have a cascade effect: when a patient, or their caregiver, cannot obtain an appointment in a timely manner, they will often seek care in the ER. This frequently means working with an unaffiliated healthcare provider without access to their complete medical histories.

The past few years have seen a rise in the use of virtual care visits as the world looked for new ways to deal with patients during the pandemic. Virtual care seems poised to stay, though, and may be an opportunity to deal with not just urgent care issues and surges in healthcare needs, but also managing chronic conditions, annual wellness visits, or alternatives for patients with travel or transportation issues to brick-and-mortar healthcare centers.
“I’ve been on the frontline of that cycle of surges for over 25 years while in practice, and I can say we’ve never been fully prepared. It’s not like you can manufacture clinicians and pop them into your office,” says Carrie Nelson, MD, chief medical officer of KeyCare. “Organizations are already stretched, and that’s true now more than ever.”

Delays in care are happening under the best of circumstances, Nelson says.

“When we say it’s at least 38 days for a patient to get an appointment, that’ s not even when we’re in a season where we’re getting slammed, and it’s only gotten worse over time,” she says.

Staffing shortages continue to be a problem as we look for ways to recover from physicians leaving medicine during the pandemic or aging out.

“Clinical practices do have proactive approaches to help people manage things at home through nurse triage lines and such, but there’s still an onslaught every year of people in need of care that surpasses the capacity of existing staff in a practice,” she says.

Where virtual care can help

Nelson sees a lot of variability in the permanent adoption of telehealth systems. Some providers never became 100% comfortable with it, and with the pandemic seen as being in the past, some feel pulled back to the old ways of doing things.

There are providers who prefer to perform brick and mortar care, Nelson says, but even for those who are willing to do both, it’s hard to juggle in-person and virtual visits in the same workday.

“Some systems have set up virtual care teams to manage patients that don’t need to go into the office, and it’s actually more efficient. Those who have built virtual care into the workday reduce time to care for the same number of patients by 10% to 15%,” says Nelson. “There’s a lot we do in person that doesn’t add value. We’ve all been trained that the primary key to a good diagnosis is taking a good history and being deeply curious about just what the patient is experiencing. The physical exam is often less important.”

By offloading common conditions that can be diagnosed easily over telehealth, you free up time to see those patients who truly do need hands-on care.

“Having a virtual partner who can be available 24/7/365 or to handle overflow can advantage a health system in successfully responding to surges “If we know there’s a hot spot in Florida but not Nebraska, we can load balance based on that,” says Nelson.

And, Nelson notes, virtual partnerships can help with the multiple surge drivers we see during the latter part of the year such as Medicare Annual Wellness visits and care gap closure priorities to achieve quality measures.

Organizations with 50-state capability that meet all the necessary logistical and regulatory requirements needed can help balance that load, Nelson explains—and ideally work within a platform that allows for transparency to enable optimal treatment in the context of the patients’ conditions, allergies and medications.

This latter component requires visibility to the medical record between the health system and the virtual care provider. “Being able to share information across a common EHR helps with transparency, but it’s also a patient safety issue: what if the patient has a kidney function abnormality the clinician should know about?” she says. “Many telemedicine solutions are standalone and don’t have access to the EHR.”

Transparency in the health record is important but so is making sure care can be accessed in the first place, says Nelson.

“There are issues with internet bandwidth that impact access equity,” she says. “Different parts of the country or different populations who may not have higher bandwidth or a phone with a strong data plan can experience access barriers to video/telemedicine.

Telemedicine needs versus access needs

We need to look at not just how organizations are providing remote care, but also how they’re handling access demands from their patients.

“During a surge season there are a lot of calls coming into various locations in the health system. This might involve a call center routing these calls to a group of practices. But often, those practices are also getting direct calls. And urgent care is getting an influx of people,” says Nelson. “There are a lot of sources of data that need that can help size the problem. That 38-day wait we talked about earlier—that’s if you can get ahold of someone. Twenty percent of the time the patient can’t get through to anyone.”

Health systems could use this data to help size the demand in a way that lets them know what they’re missing, and what the patients are missing. In this regard, there are a lot of opportunities where virtual care could be even further optimized, Nelson notes.

She also sees a benefit in playing to the strengths of the providers.

“There are people who are truly committed to be expert virtualists and others who want to be brick and mortar ‘office-ologists,’ focusing on the hands-on approach,” says Nelson. “There’s no question that it’s a skill to do an examination and establish a rapport over a telephonic platform. Those are skills that are honed by providers that focus on virtual care.”

Of note, virtual providers don’t just see low acuity patients, Nelson notes.

“It’s a sign of the ubiquitous access problem we have in healthcare. People dial in with something where the provider says: you really do need to go to the ER, or we’re calling 911 for you, or you should go to urgent care right away,” she says.

The industry is getting better at acknowledging the skills of virtual providers, Nelson says, as training evolves.

“While someone who has been more focused on office practice can hop on a visit on video, they may not have the volume of experience to hone and gain comfort with the skills required,” she says.

Nelson notes also the potential for virtual care beyond just meeting surge challenges or handling visits that don’t need in-person time. Patients with chronic conditions often struggle to have their needs met, whether it’s due to lack of appointments, challenges physically getting to a doctor’s office, or any other barriers to care.

“Caring for chronic conditions lends itself nicely to telemedicine,” she says. “People with chronic conditions do need brick-and-mortar visits, but between those in-person times, a virtual visit can be highly efficient given the scant resources we have. You can have more frequent visits with virtualists rather than waiting those two months between appointments to help get your condition under control.”

This enables providers to focus on in-person visits for high-acuity, complex patients who are not candidates for virtual care.

A barrier that does not exist, Nelson points out, is the patient’s interest in virtual care.

“Patients really want this. They’re anxious to use this modality, and that includes patients over 65. Lots of folks in that age range are perfectly comfortable using technology. There’s a perceived barrier that isn’t as significant as some think,” she says.

As we look again at the coming winter months and inevitable surges, Nelson looks at how we could, as an industry, better prepare patients for virtual or at home care.

“I’ve got a wish list,” she says. “I see a future where everybody has a kit in their home where they can test for flu, test for strep, enable a provider to listen to your heart, all the technology peripherals you need. I’d also love to see how we can offload folks from brick and mortar to virtual settings as an extension of those brick-and-mortar settings that lets the patient see someone more regularly for their chronic conditions.”

Regulatory and payment barriers remain for the next leap forward in virtual care, but Medicare has made steps in the right direction, Nelson says, and we’re seeing its impact in areas like behavioral health.

“I think it will become the norm to see virtual visits in other specialties to help patients access care any time,” says Nelson.

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.