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122 12 health system execs outline post-pandemic telehealth strategy By Laura Dyrda, Jackie Drees and Katie Adams T elehealth became a necessary tool for health systems and patients across the U.S. during the COVID-19 pandemic to access needed health- care remotely. A major contributor to the success of telehealth over the past few months was CMS and commercial pay- ers liing restrictions and boosting pay rates for tele- health visits. While some of those benefits may roll back in the future, health systems are planning how to continue scaling their telehealth programs and turn them into revenue generators. Here, 12 top health system executives outline their strategic approach to telehealth post-pandemic. Jonathan Lewin, MD. CEO of Emory Healthcare (Atlanta): e rapid expansion of video telehealth visits at our facility, increasing from a few dozen to over 3,000 per day, or 30 percent of our usual in-per- son visits, in just weeks, and has been a disruptive transformation in the way that we interface with our patients. In a very short time, video telehealth visits have seen tremendous adoption and satisfaction for both our clinicians and our patients. Clearly, this model has many benefits for all involved, and our great hope is that we will be able to continue to see reimbursements from both governmental and com- mercial payers commensurate with the value this brings to patients and society. However, understanding that reimbursement may drop to the point at which many of the services we currently are providing will become cost-prohibitive to continue, we see several areas that will likely re- main across many of our service lines. One area that predated the COVID-19 related acceleration of our telehealth activities that will undoubtedly continue is our work providing consultation to assist physicians managing their patients in distant or rural hospitals; for example, our Emory nephrology program enables dialysis in rural Georgia hospitals without local ne- phrology coverage and prevents urgent transfer of renal failure patients, benefiting the patient and their family along with the local hospital and clinicians. We also will continue our preoperative evaluations in patients who live significant distance from our facil- ities, along with follow up postoperative care when appropriate. ere are many patients with chronic conditions who will benefit from ongoing telehealth video visits. Psychiatry consultation, allowing pa- tients to receive care in their residence, will also be an ongoing offering. Lastly, we have, and will continue to, use video visits when providing care for patients who cannot travel to Atlanta. While excited about the prospects, it is too early in telehealth adoption and experience to fully under- stand what long-term rates should be. Additional- ly, the same professional clinical expertise is being provided under most circumstances regardless of care setting. We therefore encourage CMS and oth- er payers to extend waivers as currently authorized with extension of equivalent reimbursement between in-person and telehealth visits. Martin Doerfler, MD. Senior Vice President of Clinical Strategy and Development and Associate Chief Medical Officer of Northwell Health (New Hyde Park, N.Y.): To start, we do not think that cov- erage is at risk in New York outside of the possible loss of the CMS waiver regarding geographic limita- tions to coverage under current law. at however is a big risk in the face of dysfunctional federal gov- ernment. If that coverage waiver is not made perma- nent, telehealth to fee for service Medicare patients will become a non-covered service. We will have no choice but to notify FFS Medicare patients and offer telehealth services as self-pay. e law is the law and there is no way around it. As for Medicaid and commercial coverage (excluding ERISA covered plans), New York State has coverage parity in place. is does allow payers to reduce rates below payment parity with office based services but our experience, with a limited denominator, in the latter part of 2019 and beginning of 2020 was that we were getting paid at our negotiated rates for of- fice-based services for similarly coded telehealth vis- its. Were this to change we will make this part of our rate negotiations with our major carriers. Medicaid pays parity in New York State. Rob Tonkinson. CFO, Healthcare Division and Vice President of Finance at Baptist Health Care (Pensacola, Fla.): We had a significant, rapid expan- sion of telehealth service in response to COVID-19, and we have found it to be an effective tool for ad- dressing many patients' health concerns and needs in a safe, effective and efficient way. We are hopeful that reimbursement rates will be maintained at current levels. We will be monitoring the situation with all payers and will need to address accordingly if reim- bursement decreases are implemented. Nikki Harper. Vice President of Revenue Cycle at Hospital Sisters Health System (Springfield, Ill.): Pre-COVID we had an active strategic plan at Hospital Sisters Health System to continue to grow telemedicine. During the past few months that was escalated quickly on our timeline to swily provide telehealth where we didn't before (e-visits in OP hospital departments for example). In order to con- tinue serving our patients, we responded by offering those services to keep our patients and staff safe and healthy. We have been fortunate that these solutions and visits are covered currently. In our strategic plan, we will continue increasing our utilization of these services. We have built reports to monitor payments. We have worked with our con- tracted payers to talk through reimbursement and coverage for these services. We are hopeful the ex- panded reimbursement will continue. If the coverage and reimbursement returns to pre-COVID, we will continue to provide what we do now since it's the right thing to do for our patients. We have already secured the technology and have the resources to adequately perform these services. is will contin- ue to be an extension of HSHS in-person services provided. In addition, we are very fortunate to have Dr. Gurpreet Mander, chief medical officer, serving in our system. He has been very active with Illinois telehealth to lobby for expanded telehealth services. We are hopeful that his time and energy working on various committees and many capacities will have a positive impact towards helping CMS and payers continue to pay at the rates they are; and that they will see the benefit to patients in addition to positive financial impact. Aer reviewing the data, we know it's by far less expensive to provide care in this setting so it's a winning situation for the providers, payers and patients. Tim Robinson. CEO of Nationwide Children's Hos- pital (Columbus, Ohio): Even aer this emergency is behind us, telehealth will continue to play an import- ant role in providing care. We must take advantage of the resources we have created and the lessons we have all learned. It will be the responsibility of healthcare, governments, insurance companies and many others to make sure we use our new technologies to help the people we serve in a post-pandemic world. Nationwide Children's Hospital will continue to re- spond to the new telehealth frontier that is already here and that makes accessing care easier for our pa- tients and families because it is the right thing to do. However to make sustainable, long-lasting change, we all must work together. For example, state govern- ments and private insurers should relax certain regu- lations and reimburse for services at rates that would make telehealth sustainable, and broadening the list of treatments and conditions that can be reimbursed has also been effective. Tom Brazelton, MD, MPH, FAAP, Medical Di- rector of the UW Health Telehealth Program and Professor of Pediatrics at the University of Wis- consin-Madison School of Medicine and Public Health: Telehealth is critical to our strategic plan moving forward, regardless of coverage and reim- bursement rates. Healthcare needs to move away from a 'stimulus-response' level of functioning. e reflexive 'no payment therefore no care' is antiquated and fails to tackle the social and economic determi- nants (and inequities) of health and healthcare in our country. Our new normal must include the lessons learned from this pandemic. We'd be foolish not to adopt the principles we've successfully put in place, tested, and adapted to over the last three months – physical (not 'social') distancing, web-based meet- ings, shared workspaces, work-from-home solutions, etc. and that's just on the health system side. From the patient's perspective, the telehealth adop- tion rates have exceeded expectations without a change in the standard of care for those conditions that can be managed using remote technology. Our delivery model is safer for everyone without an ob- servable difference in quality. We are seeing the highest member satisfaction and net promoter scores than ever before since the advent of widespread video visits. With such widespread adoption, we anticipate coverage will actually go up even though reimburse-