Medical laboratories may find opportunities guiding hospital telehealth service physicians in how clinical lab tests are ordered and how the test results are used to select the best therapies
Telehealth is usually thought of as a way for patients in remote settings to access physicians and other caregivers. But now comes a pair of studies that indicate use of telehealth in inpatient settings is outpacing the growth of telehealth for outpatient services.
This is an unexpected development that could give clinical laboratories new opportunities to help improve how physicians in telehealth services use medical laboratory tests to diagnose their patients and select appropriate therapies.
Dual Surveys Compare Inpatient and Outpatient Telehealth
Service Use
Definitive Healthcare (DH) of Framingham, Mass., is an analytics company that provides data on hospitals, physicians, and other healthcare providers, according to the company’s website. A survey conducted by DH found that use of telehealth solutions—such as two-way video webcams and SMS (short message service) text—has increased by inpatient providers from 54% in 2014 to 85% in 2019, a news release stated.
Meanwhile, a second Definitive Healthcare survey suggests
use of telehealth in outpatient physician office settings remained essentially
flat at 44% from 2018 to 2019, according to another news
release.
For the inpatient report, Definitive Healthcare polled 175 c-suite
providers and health
information technology (HIT) directors in hospitals and healthcare systems.
For the outpatient survey, the firm surveyed 270 physicians and outpatient
facilities administrators.
DH’s research was aimed at learning the status of telehealth
adoption, identifying the type of telehealth technology used, and predicting possible
further investments in telehealth technologies.
Most Popular Inpatient Telehealth Technologies
On the inpatient side, 65% of survey respondents said the most used telehealth mode is hub-and-spoke teleconferencing (audio/video communication between sites), Healthcare Dive reported. Also popular:
Fierce
Healthcarereports that the telehealth technologies showing the largest
increase by hospitals and health networks since 2016 are:
Two-way video/webcam between physician and
patient (70%, up from 47%);
Population health management tools, such as SMS
text (19%, up from 12%);
Remote patient monitoring using clinical-grade
devices (14%, up from 8%);
Mobile apps for concierge services (23%, up from
17%).
“Organizations are finding new and creative ways through telehealth to fill gaps in patient care, increase care access, and provide additional services to patient populations outside the walls of their hospital,” Kate Shamsuddin, Definitive Healthcare’s Senior Vice President of Strategy, told Managed Healthcare Executive.
DH believes investments in telehealth will increase at
hospitals as well as physician practices. In fact, 90% of respondents planning
to adopt more telehealth technology indicated they would likely start in the
next 18 months, the news releases state.
Most Popular Outpatient Telehealth Technologies
In the outpatient telehealth survey, 56% of physician
practice respondents indicated patient portals as the
leading telehealth technology, MedCity
News reported. That was followed by:
Hub-and-spoke teleconferencing (42%);
Concierge services (42%);
Clinical- and consumer-grade remote patient
monitoring products (21% and 12%).
While adoption of telehealth technology was flat over the
past year, 68% of physician practices did use two-way video/webcam technology
between physician and patient, which is up from 45% in 2018, Fierce
Healthcare reported.
The graph above, taken from the Definitive Healthcare 2019 survey, shows the percentage of telehealth use among surveyed outpatient settings. “The results show how telehealth continues to be one of the core linchpins for providers,” Kate Shamsuddin, Definitive Healthcare’s Senior Vice President of Strategy, told Healthcare Dive. (Graphic copyright: Definitive Healthcare.)
MedCity News reports that other telehealth technologies in
use at physician practices include:
Mobile apps for concierge service (33%);
Two-way video between physicians (25%);
SMS population management tools (20%).
Telehealth Reimbursement and Interoperability Uncertain
Why do outpatient providers appear slower to adopt
telehealth, even though they generally have more patient encounters than
inpatient facilities and need to reach out further and more often?
Definitive Healthcare reports that 20% of physician practice
respondents are “satisfied with the practice’s current solutions and services,”
and though telehealth reimbursement is improving, 13% are unsure they will be
reimbursed for telehealth services.
The Centers
for Medicare and Medicaid Services (CMS) states that Medicare
Part B covers “certain telehealth services,” and that patients may be
responsible for paying 20% of the Medicare approved amount. CMS also states
that, effective in 2020, Medicare
Advantage plans may “offer more telehealth benefits,” as compared to
traditional Medicare.
“There is not only a need for more clarity around reimbursement policies, but also a need for more interoperable telehealth solutions that can be accessed through electronic health record or electronic medical record systems, as well as a better understanding about what types of telehealth options are available,” said Jason Krantz (above), CEO, Definitive Healthcare, in the outpatient telehealth survey news release. (Photo copyright: Definitive Healthcare.)
The increase in telehealth use at hospitals—as well as its
increased adoption by physician offices—may provide clinical laboratories with opportunities
to assist telehealth doctors with lab test use and ordering. By engaging in telehealth
technology, such as two-way video between physicians, pathologists also may be
able to help with the accuracy of diagnoses and timely and effective patient
care.
As inpatient care declines, outpatient care expands, signaling a shift from where physician orders for medical laboratory tests originate
It’s a well-established fact that the year-over-year increase in the volume of outpatient procedures is consistently greater than 8%, while the annual growth in inpatient admissions is at or below 3%. Clinical laboratory managers and anatomic pathologists are aware of these facts.
MEDACorp, a strategic knowledge resource and subsidiary of Leerink Partners, a Boston-based investment bank that focuses on the healthcare industry, conducted a quarterly survey of hospital administrators from 47 hospitals in June of this year. The purpose was to evaluate healthcare utilization trends for different types of medical facilities.
According to the survey, the “ utilization trends for both [quarter-over-quarter] and [year-over-year] are decelerating across all four sites of service.” However, hospital administrators report the use of inpatient and other hospital services did not fare as well.
“The results are also modestly positive for facilities, with the slowing 0.7% increase in inpatient procedures (IP) utilization still higher than consensus of ~flat (sic) for the coverage group. Significant mix shift continues as IP mix is down and the outpatient procedure (OP) mix is up across all service lines, supporting our recent analyses of an accelerated push to ambulatory sites of service,” the survey noted.
The survey revealed:
Inpatient services increased by just 0.7% during the second quarter of 2018, down from 1% growth during the second quarter of 2017;
Ambulatory surgery center utilization grew by just 1.4% during the second quarter of 2018, down from 2.2% for the same quarter in 2017; and,
Emergency department utilization increased by 0.9% in the second quarter of 2018.
“It was even weaker than many of us expected,” Ana Gupte, PhD, Managing Director, Healthcare Services at Leerink, told Modern Healthcare. “It’s pretty clear there’s no volume rebound.” (Photo copyright: Leerink.)
Inpatient Top Surgeries Predicted to Keep Moving to Outpatient Settings
The Leerink survey found that orthopedic and cardiac procedures are leading the trend of shifting clinical procedures from inpatient to outpatient care. For example, heart surgeries were performed in outpatient settings 9% of the time over the past year and are expected to increase to 12% during the next year. Inpatient heart surgeries are expected to decrease 1% over the next year, moving from 82% to 81% of surgeries performed.
Inpatient hip procedures also are projected to drop from 77% to 75% over the course of the next year, while outpatient hip procedures are expected to increase from 17% to 19%. The survey respondents also expect other surgeries including urological, gynecological, spine and knee procedures to move to outpatient settings over the next year.
Forty-five percent of the respondents in the survey named baby boomers aging into Medicare as the most important driver of hospital utilization. Fifteen percent attributed the trend to the effects of the Affordable Care Act (ACA), and 13% cited the improving US economy as driving the use of outpatient medical facilities.
The graphic above, taken from the Leerink MEDACorp survey, illustrates a shift in healthcare procedures from inpatient to outpatient settings. Along with the surgical relocations are changes in reimbursements as well, which directly impacts clinical laboratories revenue streams and billing procedures. (Image copyright: Leerink.)
The survey respondents were from different regions and disparate population areas:
49% of the surveyed facilities were located in metropolitan areas;
40% were in suburban areas; and,
11% were in rural areas.
In addition:
32% were in the South;
26% were in the Northeast;
21% were in the Midwest; and,
21% were in the West.
Most of the facilities used in the survey were community hospitals, which accounted for 62% of the environments. Thirty-two percent of the facilities were academic medical centers, while the remaining 6% were other types of facilities.
The majority of the respondents for the survey were C-suite executives. In hospital settings that would include the Chief Executive Officer (CEO), Chief Financial Officer (CFO), Chief Operating Officer (COO), and other Chief titles, and, of course, hospital administrators.
Clearly, this type of downward trend could negatively impact clinical laboratories, pathology groups, and other service lines in hospital networks. Fewer patients equal less revenue for hospitals, which could eventually lead to budget cuts. A responsible medical laboratory manager will be prepared for these possibilities.
