Telehealth’s impact on clinic staffing models post-COVID-19

• When we get on the other side of the COVID-19 pandemic, the “new normal” will be different from the world we left in mid-February in 2020.
• It will be difficult to justify not continuing telehealth as part of the new normal because of the investment to get telehealth up and running and because many patients will have received quality care via telehealth.
• Broader usage of telehealth presents an opportunity to rethink care delivery models.

We will get through COVID-19. And at the risk of stating the obvious when we get on the other side of it, the “new normal” will be different — in ways both positive and negative — from the world we left in mid-February in 2020. Some of these changes will reveal themselves to us over time. Others are already obvious.

One of the obvious, positive changes is that it will be hard to put the “telehealth horse” back in the barn.

• Providers (both large systems and small, and independent practices) have invested too much, too quickly to stand up telehealth capacity to turn those capabilities off.
• Too many patients will have experienced high-quality, convenient care via expanded telehealth.
• Until there’s a vaccine for COVID-19, we need the ability to keep sick people in their home (or asymptomatic COVID-19 carriers separated from those who might become critically ill) unless they absolutely need ”hands-on” care to prevent secondary flare-ups.

So when the national health emergency ends, and CMS rolls back the telehealth expansion, I fully expect to see a coalition of providers, health plans (as many of them are now providers), patient advocates, consumer groups and public health workers band together in an aggressive push to have Congress make the necessary legislative changes to the Medicare program to make telehealth just healthcare. Dr. Stephen Klasko, CEO of Jefferson Health, makes an elegant case for the new world in this opinion piece published in Modern Healthcare.

Takeaway

What’s less discussed is how this will impact clinic footprints and staffing models.

I suspect that unless your system is deeply involved in population health like an Oak Street, Iora or ChenMed (and even COVID-19 might make these groups rethink community space that is part of their care management strategy), you’ll see a downsizing of both primary care clinic square footage and clinical staffing. Some of this will be in response to the cost pressure health systems are facing as they exit the other side of this with weakened balance sheets. But much of it will result from a potentially more cost-efficient care model that rises to the surface as a result of the COVID-19 crisis.

A friend of mine is the lead physician for one of a large regional health system’s small (under 20 providers) off-campus primary care clinics. Without getting into the details, the entire support staff was exposed to COVID-19 as a result of a non-patient care encounter (social distancing people … social distancing).

Now, most of the nurses, techs and administrative staff are quarantined at home (not even bothering with testing due to a shortage of supplies) for two weeks.

Fortunately, as of this writing, none of them are exhibiting symptoms. Unfortunately, they currently are not productive. And the clinic was closed for several days to allow for it to be decontaminated with the remaining support staff redeployed to one of the system’s hospitals.

Despite this, patient care has continued. The system’s central scheduling department was able to reach out to the handful of patients that required in-clinic visits and either moved them to virtual visits or rescheduled them. And the physicians have continued seeing patients virtually from makeshift home offices. Based on this experience, the lead physician believes he/she could optimally manage his/her patient panel with only two days in clinic per week.  

What does that mean for the future?

I will admit, this is one anecdote, so I’m speculating here based on a 20-minute conversation with someone in the throes of navigating their small corner of the COVID-19 crisis.

But it’s not hard to imagine that if (when) the telehealth expansion is extended into ”normal times” by Congress, the system will re-evaluate its model for primary care clinics. It may include a smaller clinic footprint (when the lease is up), with physicians rotating days in the office and sharing space. So there’s reduced rent expense (or if the system owns the medical office building, there’s the potential to rent the square footage and generate additional income). With fewer patients being seen in person, they’ll need fewer nurses and techs to triage them. And depending on the telehealth system used, the clinic many need fewer administrative support staff.

While the system would probably want to keep a nurse and/or tech working virtually to act as care navigators/coordinators, they probably wouldn’t need as much clinical support staff and could redeploy them to other areas of the system.