While it may sound crazy, the impact of the strategy employed by federal and state governments to “flatten the curve” and reduce the spread of infection in the absence of vaccines has had some unintended and very positive consequences.
It has been widely reported that carbon levels in the atmosphere have been at their lowest levels in the past 30 years and cities normally cloaked in haze are experiencing dramatic reductions in smog and other air pollutants. The impacts of shelter-in-place and the temporary closing of non-essential businesses has had major impacts on the need for vehicular and plane travel over the last 8-10 weeks.
We all realize that the economy will not survive at this reduced transactional level for much longer and regular travel, at some new level will be required to get the economy back on its feet. However, the “forced” requirement for telecommuting and remote work “work-arounds” in many major industries that have historically brought staff in to a central location to carry out their work requirements, will now be changed forever through conferencing platforms and online metrics management that will foster and embrace a remote workforce structure.
Could we be seeing morning and evening commutes in Atlanta, New York City, Chicago, Los Angeles, San Francisco, etc. where traffic actually can move at the speed limit? Can we envision a time when we could be very comfortable interacting with team members and formulating strategies for business development without the need for a physical meeting around a table? I believe this reality going forward will be one of the silver linings forming from the COVID cloud.
They say that “Adversity is the mother of invention”. To come out of this pandemic without learning new techniques and realizing the need for preparedness would be a worse defeat than the loss of life we have already incurred. As we emerge from our “cocoons”, we need to embrace some of the changes that have, in many ways, been forced upon us and see the potential they provide going forward in our new normal.
No where is this more relevant than in healthcare. With the closure of ERs and hospital clinics as a means of reducing unwanted exposure and preparing for the surge, patients and their providers were now isolated and unable to interact for chronic and, sometimes, acute disease management. Something needed to be injected into the healthcare system to facilitate this patient-provider interaction in the absence of face-to-face visits.
Healthcare providers and some insurance plans had been toying with telehealth concepts in the push toward Population Health Management and Value Based Care. Mechanisms to insure patient compliance with discharge instructions and continue to monitor their recovery at home were important tenets of PPACA in an attempt to reduce unneeded rehospitalizations based upon effective post-hospitalization follow-up and care.
The pandemic rushed these telehealth platforms into action to fill the “visit void” that was created via sequestration. CMS quickly promulgated CPT and HCPCS codes and modified the ICD-10 to create a financing mechanism for these visits and acknowledge the importance and effectiveness of telemedicine for patient monitoring and follow-up. And, while we are not quite at the point where remote, robotic surgery is the norm. Even this concept that has been in development for over twenty years, should be coming of age much more quickly than might have been the case just a few months ago.
Ironically, healthcare has always been slow to embrace technology in certain aspects of daily operations. This about how long it took and the pressure it required through government reimbursement guidelines to get providers to move to an electronic health record (EHR). Most other industries were fully digitized for years before healthcare. COVID will usher in a sea change in the way primary care is delivered going forward. The need for office visits for medication renewals, and routine checkups will become greatly reduced and, with expanded connectivity and home-based monitoring devices, may be required only for the most unstable chronic illnesses.
Clearly, with the push for Value-Based Healthcare, Population Health Management, rural healthcare disparities, unneeded exposure to other sick patients in an ambulatory clinic or ER, and a growing independent elderly population, telehealth technology is here to stay and may assist in creating a new, more cost-effective model for primary care.