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With the spread of coronavirus increasing in the US, telehealth can be leveraged, but regulations need to be modified.
Roy Schoenberg, MD, MPH
Over the last week or so, the spread of the novel coronavirus (COVID-19) has increased in the US, causing fear among patients. Health technology, such as telehealth, can be leveraged for remote patient monitoring and virtual consultations, which could prevent the spread from person-to-person, especially among the most vulnerable populations.
Roy Schoenberg, MD, MPH, chief executive officer at American Well, a telehealth company, spoke to HCPLive® about the benefits of telehealth in reducing the spread, regulations that could make such technologies more accessible to patients and healthcare practices, and if the telehealth infrastructure is ready to be a primary tool to help a majority of patients access healthcare.
Editor’s note: The following interview has been lightly edited for style, length, and clarity.
HCPLive: How is telehealth being used for coronavirus?
Schoenberg: I want to start by saying that nobody expected or wanted a pandemic to be the catalyst for the adoption of telehealth. But the reality is that it is exactly that. The best evidence of this is if you heard the White House press conference earlier this week. The first couple of sentences out of Vice President Mike Pence’s mouth were that we need to get the tests and we need to implement telehealth.
So, this has definitely skyrocketed into the main discussion. There's a lot of reasons, but I would say there are 3 that are most compelling. One is obvious: if you are going as a patient—or as a worried American—to interact with clinicians through technology, you are going to get healthcare done and you will have zero risk of either contracting the virus or delivering the virus to the clinicians that you're interacting with. Viruses do not, for now at least, travel over technology. There are a lot of the concerns about what's going to happen if a lot of patient traffic in front of clinicians and hospitals and clinics cause them to transmit the virus. How does that help the virus propel itself to higher levels of contagion versus otherwise? There's no question that telehealth solves that problem.
The second thing is that it is very, very likely that like in China, Dubai, and Italy, we are going to see the virus more prevalent in certain geographies around the country. It tends to spread with geographical epidemic centers, like a little bit what we're seeing now in the state of Washington and California.
The problem is that because it's geographical, it tends to overwhelm certain healthcare systems in those regions much more than it does to the rest of the country. Now, we're very fortunate because we're a very, very healthcare rich country and there are a lot of amazing clinicians and healthcare services that are spread all over the country.
We need a way in those cases, to load-balance. We need the ability to project healthcare expertise into areas that are overwhelmed from other areas that are actually marginally tasked. And the only way to do that, unless you can take physicians and put them into jumbo jets and throw them all over the country—which is not going to happen—is the use of technology.
And if we looked at telehealth as the ability to take healthcare resources from the East Coast and project them in real time to where they're desperately needed in those kinds of epicenters on the West Coast, that is something that telehealth can do. There is nothing else in our arsenal that even comes close to that ability.
So, the power of telehealth to load-balance clinical resources to pull together our efforts and project them to where they're needed is undeniable. But we don't have the regulations that allow us to do that. I think that's one of the other focuses that's happening. But that's the power of telehealth.
The third thing is that a lot of people are thinking about how we treat coronavirus patients and there’s a lot of stuff that telehealth can do there, but the reality is that unfortunately, the coronavirus discriminates. It does affect elder patients in a much more severe way than intersects with any other age group. If we are able, through telehealth, to make sure that those patients who are the most vulnerable are going to be exposed less to environments that may potentially elevate the risk for contracting the virus, we're going to save lives. Even if it has nothing to do with treating coronavirus, if we can allow chronic patients and elderly patients to, especially at this point in time, receive more of their regular care—nothing to do with coronavirus—through technology so that they don't have to sit in the waiting room of a physician office or in the waiting area God forbid in an emergency room or an urgent care center—if we can allow some fraction of that regular care to be rendered to them at home, we will dramatically reduce the risk for getting the coronavirus.
One of the conversations beginning to emerge over the last 24-48 hours is really where telehealth can help us contain the exposure of that population to coronavirus by allowing telehealth to be used for treating their diabetes, heart failure, and asthma. And that's a very active conversation.
HCPLive: How else could this technology be used to limit person-to-person contact?
Schoenberg: There’s a lot of creative thinking about how you can manage patients in the hospital better. Rather than shuttling them around, you can actually bring physicians into their hospital rooms and just kind of limit the amount of physical contact that needs to happen between patient and vectors of healthcare, which may be other people or other care providers. So, there's applications of telehealth for physician-to-physician consults rather than moving the patients around. But the reality is, and don't get me wrong, we are heavily invested in those as well, but when we talk about what things are going to move the needle dramatically at the national level, probably more than anything else would be the ability for chronic patients and other patients to interact with the healthcare system from their home for anything that would make them leave their home to get healthcare. That, just from an impact standpoint, so far exceeds everything else. That focus is very, very important for us.
HCPLive: Earlier you mentioned Mike Pence was encouraging more use of telehealth to attempt to mitigate the spread of coronavirus. Is there anything else that officials can or should do in that regard?
Schoenberg: There are 2 immediate interventions that are going to dramatically allow us to leap forward in our ability to manage this kind of condition or the conditions that will follow in the future along those lines.
One is to change the way Medicare embraces telehealth by way of allowing physicians to be paid to see their patients through telehealth, which crazily enough is still not the case. Physicians are financially incentivized to ask their patients to show up in the office rather than use telehealth. So that needs to be reversed and is the Medicare telehealth payment policy that can be changed literally by a stroke of a pen.
Then the other piece of the puzzle is everything that has to do with the ability of clinician services to be mobilized effectively around the country to this technology, even though in everything else that we do over technology, we don't even think of state lines as a barrier for the Internet. The Internet does not have any trouble crossing state lines in the healthcare, healthcare stops at the state line. That is primarily because physician licensure structure does not allow a physician in California to handle a patient in Nevada, Texas, or Arizona, even though the patient needs desperately to get in front of a clinician and that clinician in California is skilled, trained, and available to treat the patient. The state licensure rules prevent us from allowing them to see each other.
That is also something that at the federal level—and I fully understand the distinction between the federal- and state-level rights—where it's about time for us to think of physicians as a national pool rather than as a state's treasure that some states have more often than other states are very, very poor in.
HCPLive: Are telehealth infrastructures ready for an event where a majority of patients are going to need to contact their physicians digitally instead of in-person?
Schoenberg: The telehealth infrastructure exists and is ready. What's preventing that from happening? Regulations, period. If you allow the patients to be cared for and physicians would get paid for caring for those patients by Medicare, and if you allow physician services to travel across state lines, you will have an entirely different healthcare reality in America overnight.
HCPLive: Do you think that will happen?
Schoenberg: Well, I don't wish for the situation to get worse. Folks are saying that China has literally advanced its telehealth policy and done 20 years of advancements in about 2 weeks. They have realized that without telehealth, there's just no way for them to mobilize healthcare the right way and has embraced telehealth to the nth degree. Are we, and I know that this is kind of tongue-in-cheek, as advanced in our thinking as China? I don't know.