The COVID-19 pandemic reshaped the delivery of healthcare – including the adoption of telehealth, defined as the delivery and facilitation of health-related services via telecommunications and digital communication technologies. Its usage soared as consumers and providers sought ways to safely access and deliver care throughout the pandemic. The care delivery mode offered a boost toward improving access to health care and convenience for patients, filled gaps in subspecialist care, extended access to behavioral health services, and enabled screening and assessment of symptomatic at-risk patients.
As we advance into 2022, it is safe to say that the telehealth floodgates are open and here to stay.
Consumer and physician adoption statistics are compelling. According to McKinsey, telehealth utilization has stabilized at levels thirty-eight times higher than before the pandemic – now accounting for up to 17% of visits across all specialties. Forty percent of consumers say they will continue to use telehealth going forward. And, as of April 2021, 84% of physicians were offering virtual visits, and 57% said they would prefer to continue offering virtual care.
And, as the U.S. healthcare system transitions to a value-based care environment – with its emphasis on improving quality of care, improving efficiency and inequity in care, and containing costs – we predict that the U.S. will see greater integration of telehealth, especially remote patient monitoring and wearables, with in-person care. The use of FDA-approved devices is expected to grow for patients with chronic conditions like diabetes, heart disease, and behavioral health diagnoses, whose continuous engagement is critical to improving their outcomes. For example, an individual’s own remote monitoring of diabetes can help alleviate the resources of a healthcare provider and enable an individual to act earlier.
Downside Risks of Telehealth and Predicted Impact
Yet, even with its convenience and potential to benefit patients, insurance and healthcare organizations would be well served by taking a step back to consider critical areas of potential risk exposure and the predicted impact to their organizations.
Top risks associated with telehealth implementation include lawsuits resulting from misdiagnosis or delayed diagnosis, exacerbated by the increasingly fragmented U.S. healthcare system, and the introduction of remote patient monitoring applications and wearable devices.
Prediction: Legal experts predict that the volume of virtual care lawsuits will increase as telemedicine becomes an increasingly common way for patients to access healthcare.
Telehealth may not be suitable for all conditions; it cannot change the way some care must be delivered and can lead to providers missing ‘soft’ issues that they may be identified in person.
Practitioners must make every effort to give all patients the same care and attention during a telemedicine visit that they would during an in-person visit. Without the opportunity to conduct a physical exam, it can be easier for practitioners to miss information during a virtual visit.
For example, a report from Quest Diagnostics said that 67% of the primary care physicians they surveyed were concerned that they missed signs of patient drug abuse during the pandemic. Only 50% of survey respondents were confident they could recognize signs of drug misuse during telehealth visits, compared to the 91% that said the same of in-person patient interactions.
Missing critical information could lead to lawsuits for claims like those expected for in-person care, such as incorrect diagnosis, inadequate assessment, testing, or procedures, and failure to ensure that the patient understood the diagnosis or recommended treatment.
Prediction: Malpractice experts predict that as the healthcare system becomes increasingly fragmented due to new care delivery models, such as telehealth, we will see an increase in claims resulting from lack of clarity around provider accountability, missed and delayed diagnosis, and missteps in care transitions.
The U.S. healthcare system is incredibly complex and fragmented. Since the advent of the hospitalist model and the ever-increasing trend for many U.S. patients not to have a primary care physician, there is often no single source of information about a patient’s health, creating an environment susceptible to malpractice claims. Patients are often assessed, treated, and monitored by multiple clinicians in multiple facilities. In fact, it has been estimated that, on average, Medicare beneficiaries see seven physicians at four different practices (Pham 2009).
And each time a patient is ‘handed off’ from one physician to another, they are participating in a risk-laden ‘transition of care.’ A notable study found that ineffective care transitions cause 80% of serious medical errors (Solet 2005). And legal experts’ analysis of malpractice claims data shows that care transitions are more likely to result in indemnity payments and significant patient harm than many other types of events that trigger claims.
The use of telehealth platforms, remote patient monitoring systems, and wearable devices could lead to further fragmentation of care.
Tackling the challenge of device and platform interoperability, ensuring secure and reliable data between the patient and provider, and establishing continuous monitoring can be overwhelming for organizations and practices. If the organization is not prepared to properly receive, analyze, and follow up with the data generated by the patient, it can lead to malpractice claims for failure to monitor the patient, as well as failure to provide a proper or accurate diagnosis or to miss a diagnosis.
This has critical implications for healthcare organizations and their insurers. Healthcare organizations must update staffing, informed consent, and security processes to incorporate these new modes of care delivery.
Designating staff responsible for monitoring and quickly responding to incoming data will be critical to helping deliver continuity of care. Establishing informed consent processes that help ensure the patient and doctor have a ‘meaningful’ dialogue when discussing the use of devices and the material risks involved will be necessary. Mitigating the increased risk of cyber and data protection breaches by taking accountability to properly encrypt and secure HIPAA-compliant patient data transmission within their own network – and not just relying on device manufacturers to ensure security – will be critical.
Watch This Space
Though telehealth adoption can improve convenience and access to care, better patient outcomes, and a more efficient healthcare system, the shift is not inevitable.
Regulators will eventually weigh the risks and rewards and decide its fate; a fact that is not lost on the likes of heavy-hitters like CVS, Walmart, Amazon, Teladoc, AARP, and the American Hospital Association who formed a new coalition – Telehealth Access for America. The coalition wants to make sure the telehealth regulations relaxed during the pandemic and Medicare payment rates increased for the same reason become permanent, arguing that 78% of voters are in support. Yet, convincing lawmakers skeptical about quality risks will not be easy.
In the meantime, savvy insurers and healthcare organizations will carefully consider how the telehealth policies and routines they implement might expose their organization to risks. A host of online resources can help, including the Center for Connected Health Policy, which offers tracking tools for pending telehealth legislation, regulations, and reimbursement policies by state. The National Quality Forum is developing a framework for measuring how connected health tools platforms have impacted clinical outcomes. And the U.S. Food and Drug Administration is a reliable source of information to stay abreast of the most current wearable and device alert and recall status.
Pham, H. H. (2009). Primary care physicians’ links to other physicians through Medicare patients: The scope of care coordination. Annals of Internal Medicine, 150(4), 236. https://doi.org/10.7326/0003-4819-150-4-200902170-00004.
Solet, D. J., Norvell, J. M., Rutan, G. H., & Frankel, R. M. (2005). Lost in Translation: Challenges and Opportunities in Physician-to-Physician Communication During Patient Handoffs. Academic Medicine, 80(12), 1094–1099. https://doi.org/10.1097/00001888-200512000-00005.
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