How MedStar Health Went from 10 Virtual Visits Per Week — to 4,000 Per Day

Before COVID-19 began spreading across the U.S., MedStar Health was scheduling about 10 telehealth visits per week.

During the height of COVID-19, that number increased to nearly 4,000 visits — per day.

“Things have tailed off, but [they] certainly won’t ever go back to where they were,” David Brennan, MedStar’s director of telehealth initiatives, said on a Tuesday webinar hosted by BlackTree Healthcare Consulting. “It’s been frantic — and it’s been a ride. That’s all I can say.”

MedStar Health is an integrated health system that offers a wide range of services — including home health care — in the greater Baltimore and Washington, D.C., areas. Brennan has been there for over two decades.

The telehealth director has been vying for a bigger telehealth footprint in health care for even longer than that, however. A man ahead of his time, he was writing to the U.S Centers for Medicare & Medicaid Services (CMS) to try to get policymakers to expand who could administer telehealth in the early 2000s. 

“I did quite a bit of research in the very early days of telerehab,” Brennan said. “And I co-authored a letter to CMS in 2000 or 2001 trying to get occupational, physical and speech therapists listed as eligible telehealth providers.”

A public health crisis was what allowed telehealth to make significant headway in health care — two decades later.

Usually, around nine people worked in the remote-services department for MedStar. By the end of March, just two weeks after a public health emergency was officially declared, 100 people were working exclusively on telehealth.

The uptick in telehealth kept infections down and family members connected to loved ones. Additionally, telehealth tools also kept MedStar’s personal protective equipment (PPE) supply from running low.

A lot of the virtual volume that MedStar is seeing now is from physical and occupational therapy visits, Brennan said. But telehealth has increased across the entire health system.

They are considering it a mostly permanent transformation and not a temporary shift. MedStar’s remote-visit mentality has been altered.

“If the visit is appropriate and can be delivered safely, securely and at a level of high quality, then by all means, go ahead and see that patient remotely,” Brennan said. “It’s been a large transformation.”

Pedal to the metal

The dramatic, unexpected surge in remote services was certainly an obstacle for many home health providers across the country.

But it has also allowed many organizations to expose their clinicians to the value of telehealth. In the past, some clinicians have been skeptics on telehealth technology.

“One of the things that we’ve seen is the clinical embrace of virtual care,” Patty Upham, VP of clinical services at Health Recovery Solutions, also said on the webinar. “Before, we saw some people with some hesitancy or who really like the high-touch aspect of their job [wonder] how a virtual visit compared to an in-person visit.”

Hoboken, New Jersey-based Health Recovery Solutions is a provider of telehealth and remote patient monitoring solutions.

During COVID-19, clinicians had no other choice but to deal with their patients remotely, and learn the skills that go with it on the fly.

That forced adoption of telehealth may turn out to be beneficial down the line — especially if the U.S. sees a second wave of cases later in the year.

Or if Sen. Susan Collins (R-Maine) gets what she wants. In late May, Collins said she was working on a bill to allow home health agencies to be compensated for telehealth visits.

“I do think that having an advocate like Susan Collins is definitely going to get us over the finish line, and we’re really excited about it,” Upham said. “Because we’ll see [even] better adoption. And when we see better adoption, we’ll see better standards. And it’ll become more integrated in just how health care is provided.”

That’s why home health providers may want to keep a long-term view when deciding how much effort to put into telehealth operations right now.

Even if that’s frustrating in the meantime for agencies that have seen their financials take a significant hit.

“Home health, in particular, has been hit hard with the high Low Utilization Payment Adjustment (LUPA) rates and missed-visit rates, yet [agencies] are still taking care of the patient,” Upham said. “They’re still taking care of the patient using the [telehealth] technology … because it’s right for the patient and provides good outcomes.”