Will a lack of reimbursement end the rise of virtual care?

COVID-19 forced the healthcare system to break through biases against telemedicine and other virtual solutions. Perhaps more importantly, policy makers opened up the means to reimburse providers for using digital tools, eliminating a barrier that made even forward-thinkers reluctant to adopt virtual care before.

But as these policies are withdrawn in the light of a reopened economy, and in-person visits become a viable option for patients again, leaders in the space are questioning the sustainability of virtual care. Will its proven success through the pandemic be enough to engrain it into the system?

As a recent article on the question highlights, there are multiple factors that could eliminate the gains for virtual care, but financial concerns are front and center. It argues that without defined codes, practices lack the incentive to implement virtual care into workflows in a sustained and scalable way. 

But this is taking a too-narrow perspective on the question. Pre-COVID, digital health solutions were growing exponentially, even without the holy grail of CPT codes or defined reimbursements.

Though reimbursement challenges are certainly a handicap to success, the experience of digital solutions in the marketplace showcases three major ways to neutralize the problems, and scale and sustain a digital transition and program.

Wholesale Change

Technology implementation requires a substantial investment of time and resources on the front end—new tools, changed workflows, updated protocols, staff training, etc. In a pilot and play situation, there is no motivation to make these systematic changes that are necessary to the success of the solution. In order for a technology solution to affect real change for patients, there needs to be a practice-wide decision to permanently adopt the necessary system changes.

Virtual health companies and champions need to be mindful of this. To make technology use optional and hope that the use of digital tools and processes continue after a set of extraordinary events occur (e.g., a global pandemic) is implausible. Practices have to change their workflow so that there is no other option — the set-up has to be digital or virtual first.

This is not a reimbursement issue. This is a leadership issue.

Hard ROI

The obvious benefit of virtual care is convenience for patients. At the same time, the benefits that virtual care brings to workflow, burnout, and revenue maximization need to be recognized.

Virtual care, whether synchronous or asynchronous, can automate routine appointments, allow for more high margin procedures, eliminate physician burnout, and can even allow physicians to work from home— a possibility that may have seemed imprudent if not impossible pre-COVID.

All of these benefits have to be quantified into hard ROI, yet virtual care companies and their adopters are stuck fighting a one-dimensional war around CPT reimbursement. Virtual care may be better a priori than other healthcare encounters, but without a hard cost analysis that shows why it is better operationally, practices will be slow to adopt it. Practice managers need to expand their outlook to see how they can transform their core operations, and not just look at CPT reimbursement.

Virtual Care as Focal Point

To drive organizational changes and provider buy-in, virtual care needs to be the main pole in the tent of a practice’s growth strategy. Many health systems have chosen "giving women more options" as a visible, recorded part of their strategy—it isn't just another button in a drop-down menu on a ZocDoc page. If “going virtual” is made the focal point—if it is on the hospital or service line's yearly board report and leadership has to report on how and why they are using virtual care — the practice team will prioritize it.

The pandemic has sped up the process of digital health adoption, but it didn’t generate it — and after the pandemic is passed, we will continue moving forward into the digital future.

About the Author

Juan Pablo Segura founded Babyscripts in 2014 with the vision that internet enabled medical devices would transform the delivery of pregnancy care.