Telehealth utilization and patient demand in 2023: Best guesses and best practices

Making predictions about the future of telehealth has become a favorite pastime for many across healthcare since 2020: Each surging wave of COVID-19 cases brought an ebb and flow of opinions about the necessity and value of virtual care delivery.

As more of society embraces pre-pandemic normalcy, the simplest answer remains that telehealth will remain in some shape, but the most perplexing question is still, “What will it look like?”:

• Key flexibilities for Medicare telehealth — such as originating site and geographic restrictions, coverage of audio-only services and more — are set to expire 151 days after the end of the declared COVID-19 public health emergency, which was extended to January last month.
• Major players such as Teladoc see positive signs in growing direct-to-consumer mental health services, and telehealth might be a key element for care delivery for the nearly one-third of organizations planning to integrate or add behavioral health services in the year ahead.
• While almost half of medical groups shifted to more telehealth visits during the winter Omicron variant surge last year, recent studies point to a “precipitous decline” in telehealth appointments as patients get back to in-person appointments.
• However, telehealth services and the expansion of broadband internet connectivity remain a priority for many rural areas and regions that experienced physician shortages even before the pandemic.

A Nov. 1, 2022, MGMA Stat poll asked medical group leaders how they think patient demand for telehealth will shift in 2023. Almost half (45%) of respondents said they expect no change in patient demand next year, while 28% reported expecting a decrease, and 27% responded that they expect an increase.

The poll had 572 applicable responses. These results align with an Oct. 19, 2021, MGMA Stat poll that found seven in 10 practices expected patient demand for telehealth to stay the same or increase in 2022.

Healthcare leaders who responded to the poll were asked their top telehealth challenges or changes planned for the next year. Their answers largely centered on:

• Maintaining or increasing reimbursement in the face of lower Medicare physician payments planned for 2023: Several respondents noted patients’ appreciation of telehealth visits and their concerns for some commercial payers not maintaining coverage or otherwise updating fee schedules.
• Preparing for telehealth platform updates or integrations with practice EHRs and/or PM systems, or putting them off entirely due to budgetary constraints caused by increased expenses and inflation
• Winning physician buy-in for telehealth platform changes, as well as updating patient/caregiver resources for using a new platform/app
• Understanding and educating practice staff and providers about regulatory changes expected following the end of the COVID-19 PHE
• Adding new forms of telehealth services — especially in the areas of remote patient monitoring (RPM) or tele-ICU consults for distant hospitals — and advocating for better broadband access in rural areas.

Best practices in utilizing telehealth

The October 2022 issue of MGMA Connection magazine provided two case studies in using virtual care to improve care delivery and outcomes:

Leveraging virtual care options for diabetes management patients

Jill Berger-Fiffy, MS, MHA, FACMPE, senior advisor for Impact Advisors, and Robert Weinstein, MD, family physician and chief of primary care for Signature Medical Group, outlined in their article the rationale behind implementation of a virtual health partner after identifying a care gap for diabetes patients caused by staffing shortages in the group’s endocrinology department.

“While physician recruiting took place, a short-term solution was implemented for continuity of care by an interim endocrinologist and employed nurse practitioner. When this 90-day coverage plan expired, diabetic patients were referred to their primary care physicians (PCPs) for follow-up care,” they wrote. “This contributed to rising panel sizes and a lack of specialized expertise in diabetes care, medication, and insulin management within the primary care network. These gaps required additional internal support by pharmacy and nursing resources.”

Through the addition of a new hybrid care model that included a virtual health coach for patients and a technological platform — guided by a rules engine with the American Diabetes Association Standards of Care embedded with standards of practice for diabetes and nutrition education and behavior change — the group was able to lower the average A1c, weight and LDL levels for diabetes patients. [For more details, read the full article.]

Improving specialty care access, patient loyalty and provider productivity

Lacy Bangert, DHA, CMPE, health administration faculty at Montana State University Billings, presented a detailed analysis of the positive impacts that telehealth interventions can have on patient access and satisfaction, as well as provider productivity, in a rural specialty care setting in her article.

A small, specialty vascular clinic in the Mountain States region faced increasing wait times for new patient evaluation at one location. The inability to meet the increasing demand for specialty vascular services negatively impacted timely patient access to care, measured by patient wait times to schedule a new patient consultation.

By adding real-time audio and visual consultation with a provider, the organization was able to shift limited resources to better align providers with patient demand by location, which helped meet two of the three goals of the telehealth intervention: lower wait times for new patient appointments and improved patient satisfaction scores around appointment availability.

Do you have a telehealth success story to share? Email us at connection@mgma.com.

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Additional resources

• “Flexibilities and policy following the expiration of the COVID-19 PHE” — This member-benefit resource from MGMA Government Affairs details when certain flexibilities and policies would expire upon the end of the public health emergency declaration.
• “Leveraging virtual care options for diabetes management patients” — Read more about how Signature Medical Group in Massachusetts used virtual care to improve access amid staffing shortages.
• “Improving access to specialty care” — Learn how telehealth interventions can positively affect patient access, patient satisfaction, and provider productivity in a rural specialty care setting.
• “Impact of Payment Reductions to Medicare Rates in 2023” — Discover findings from more than 500 medical group practices on the impacts of federal reimbursement cuts looming in 2023.
• “Post-COVID-19 trend watch: Implications for practices” — Integration of behavioral health and digitally enabled care will be major areas of focus in the months and years ahead.