Follow the money: Why virtual doctor visits at BayCare, Tampa General have caught on during the pandemic

Health care technology professionals have been working for years to get patients and physicians to embrace virtual visits over the internet.

The Covid-19 pandemic was a pivot point to bring telehealth to the forefront, according to panelists at Disrupt the Bay, a conference focused on healthcare technology.

Jason Swoboda

Telehealth has been around for years, and advances in technology have made the patient and the provider experience a lot more seamless than what it used to be, said Jason Swoboda, associate director of emerging technology and health innovation at Tampa General Hospital.

“There were roadblocks for adoption, whether that came from the government with reimbursement or limitations on the telehealth platforms because of HIPAA [patient privacy] restrictions. Patients were used to the traditional face-to-face type of visits and our providers are used to that as well,” Swoboda said. “Technology was the easy one. The adoption of all the stakeholders was the roadblock. Covid changed that in a very quick fashion.”

He cited several factors. A rapid shift to work from home made many people more accustomed to video conversations. Providers wanted to keep infectious patients out of their office and away from other patients. No in-person visitation policies at hospitals spurred the adoption of video visits.

In addition, insurance companies and regulators expanded the number of services available, lifted geographic limits, waived some privacy rules and made reimbursement for telehealth consultations on par with conventional in-person visits, according to a report in Fierce Healthcare. In March alone, use of telehealth jumped 4,300 percent year over year, that report said.

On Aug. 3, the Centers for Medicare & Medicaid Services proposed changes to expand telehealth permanently for Medicare beneficiaries. Private insurers generally follow CMS regulations.

Reimbursement is key, said Dr. Alan Weiss, chief medical information officer and vice president at BayCare Health System.

“We had almost no uptake mostly because no one would pay for it.  … With payment reform came usage,” Weiss said.

Alan Weiss

BayCare also developed a technology solution to keep Covid patients away from staff and other patients and to help doctors, who were getting overwhelmed with phone calls, texts and emails.

“We created triage tools. Those tools help to tell patients you need to be seen but not in one of our clinics. We were trying to keep people away from the clinics. So we stood up very quickly a self-triage tool within our system so that patients could get advice,” Weiss said. In addition, “We created a chat bot that allowed patients who had Covid to watch their symptoms over time. If you started having worse symptoms, we called you, we brought you in, we got you supplies. We quickly created tools to help support our staff in all of these efforts.”

BayCare ramped up other electronic solutions, such as remote monitors to measure blood pressure and oxygen levels. When a nurse or doctor sees a patient is not doing well, they can bring the patient in-house or send them additional medications, Weiss said.

Tampa General Hospital’s data science team partnered with IBM on a big data project that used infection, morbidity and utilization rates to order personal protection equipment, the clothing and other materials front-line workers need to keep from getting infected.

“It’s important to not order too much, that you order just enough. I think that helped impact the supply chain and it will help the future of healthcare as well,” Swoboda said.

To keep infectious people out of its facilities, the hospital installed thermal scanning kiosks to measure individuals’ temperatures at key locations, and it has a high-volume scanner at its main entrance for team members. Tampa General is looking at building an infectious disease hospital and to prepare for that, it has partnered with a vendor to do Covid tracing.

Dealing with Covid-19 has not been cheap, Weiss said.

“Most healthcare systems that I know of have lost millions, or tens of millions, or hundreds of millions of dollars. A lot of that is due to a decrease in visits. Some of it has been the suspension of elective surgeries during the worst of the epidemic,” Weiss said. “There are systems that have furloughed, or laid off, or fired  employees. A lot of system have put off capital improvement projects and technology projects. All of these things are to reduce the costs outside the system.”

Other cost-saving initiatives include reducing excess testing and decreasing the length of hospital stays, a measure that not only could improve reimbursements, but also keeps patients from being in the hospital longer than necessary.