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Making telehealth work for senior patients


Physicians will need telehealth during the coronavirus outbreak, especially senior patients.

The recent announcement by the Center for Medicare and Medicaid Services that it would provide reimbursement to doctors and hospitals for Medicare telehealth visits on a widespread basis, in part to keep seniors healthier by keeping them out of the office, to ensure they get the check-ups they require, and to help with the added diagnostic and treatment demand that the outbreak of the novel coronavirus (COVID-19) will bring to this population, is good news. It allows doctors and hospitals to potentially do quick virtual check-ins with their senior patients, address questions from their senior patients in a timely manner, and even conduct some forms of diagnosis and treatment virtually rather than in person. 

But the availability of payment for telehealth, while a motivating factor for primary care physicians and other specialists at another point in time, will not be enough to address what will quickly become a rising demand for services from this population, both in terms of ongoing health needs and diagnosis and treatment related to COVID-19. Added payment is a downstream intervention that cannot address, at least in the short-term, what is a severe shortage of trained health care professionals, e.g. physicians, nurse practitioners, social workers, and psychologists who can deliver primary and other forms of ongoing care to older adults. The reality is that most hospitals will soon be working at over capacity trying to take care of those affected by COVID-19 in their emergency rooms, intensive care units, and on their floors. 

The U.S. primary care system, broken before this crisis, simply does not have enough doctors or other personnel available to provide ongoing, wide-scale telehealth to their senior patients. It is wishful thinking to assume that the current system, without some dramatic influx of personnel, will have the ability to achieve this goal, particularly in rural areas and crowded cities where the need will become greatest for such telehealth services to be performed. 

Senior patients may also be resistant to using telehealth services, given a lack of availability of appropriate technology in their homes; a personal aversion to or fear of learning and using such technology or speaking by virtually with their doctor; or the desire to involve family members in their care. Certainly, the easiest and most amenable technology to use for delivering telehealth to senior patients will be the phone, and the CMS intent to pay for phone-based care is laudable. But realistically, how many primary care doctors or clinical specialists working out of hospitals will have any time in their day for making what could amount to numerous, five to fifteen minute phone calls to their senior patients? Especially when their in-office patient visits already take up their entire workday.

To this end, upstream interventions are needed to make the expansion of telehealth to senior patients work. One important intervention is to create a vast army of retired doctors, social workers, and nurses who are willing to volunteer their time to help provide telehealth services to senior patients. States like New York and Colorado have already begun recruiting such professionals to help in hospitals as COVID-19 illness spreads. But many retired health professionals can provide telehealth services right from their homes, if we give them the tools and ability to do so. 

We need to think creatively about how to reach these retired professionals quickly over the next month; get them licensed and connected with specific primary care practices and health systems that provide specialty care in their community; link them into patient electronic health records where appropriate; train them in delivering basic triage and consultation services virtually if they require it; and then let them do their thing, communicating back to the regular care providers as they interact with the latter’s patients.  The electronic health record is the perfect technology in this regard, as it facilitates leaving notes for everyone to see, reviewing real time, updated changes in patient status, and getting specific information that can help with any virtual consultation or check-in.

Without this influx of an army of experienced, highly trained health care professionals into our local communities, we can expect that providing additional telehealth services to senior populations to be difficult to achieve.  The crisis is upon us now, and while providing payment for such services is a logical and significant step, and provide health care organizations with resources to ramp up six months or a year down the road, it cannot make much of a difference without the right staffing available in the right numbers to actually provide these services now.  If the incidence of COVID-19 increases in a manner some epidemiologic models suggest, the average physician’s office and hospital in the next month or two across America will become overwhelmed. 

We are already far behind in having enough personnel capacity in our health system to provide what is needed for addressing patients’ health needs during the COVID-19 outbreak. Senior populations, most at risk for this illness, in particular will need virtual care delivery. But it will require an urgent, multi-faceted approach and an influx of experienced person power to get it done.  Providing payment for telehealth is a key success factor for normal times. But these are not normal times. Without added professional capacity and quickly, many seniors will be forced to fend for themselves in the coming months.

Timothy Hoff is Professor of Management, Health Care Systems, and Health Policy at Northeastern University in Boston, MA, a Visiting Associate Fellow at the University of Oxford, and author of the book, Next in Line:  Lowered Care Expectations in the Age of Retail- and Value-Based Health.

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