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 Welcome to a recap of this Weekend Health It Live. My name is Bill Russell Healthcare, CIO Coach, creator of this Weekend Health IT episode podcast. Videos and collaboration events dedicated to developing the next generation of health IT leaders. Uh, we have two sponsors for today's show, Sirius Healthcare, who has been gracious enough to sponsor every episode since we started the Covid series, and that has enabled us to produce daily shows.

And VMware, who was our. First channel sponsor for the show, and they have stepped up to help us to expand our offerings to these live shows. I greatly appreciate these pioneers who support the show's mission to develop the next generation of health IT leaders. Special thanks to VMware and Sirius Healthcare for making this show possible.

Uh, the last time we did a live show, I did not put it out any portion of it out on the, uh, podcast channel. Uh, and I've received some feedback from you guys. . That you would like at least a portion of it out there so you can get a glimpse of what's going on. And if you wanna watch the whole show, you can go over to the YouTube channel.

That's what we're doing here. I'm giving you a couple clips from the show so you get an idea of what we talked about. And uh, if you wanna watch the full show, go over to YouTube. You can watch the rest of the show. Here we go. Uh, we have a great panel of participants for today's shows. We have, um, we have a view from DC and we have a view from the chair that is the CIO's chair.

Uh, we have, um, Mari Vickis and Andrew Tomlinson are here from Chime as our representatives in the Capitol on all things health it. And we have three clinicians on the ground, uh, Stephanie Lars, C-I-O-C-M-I-O, of Monument Health. Pravin Chopra, CIO for George Washington University and Hospital and Al Alberta Orel, the CIO for Rady Children's in San Diego.

Good morning everyone, and welcome to the show. Mari, we'll start with you. Um, you know, the reason Telehealth has didn't take off prior to this was funding and then the second reason it didn't take off was culture. Well, we seem to have plowed through this culture because we, um. You know, quite frankly, we just had the world's largest telehealth experiment, uh, that we could possibly have.

So a lot of patients and a lot of, uh, clinicians have been introduced to telehealth and the response has been relatively good. Um, now it just comes back to the funding and, uh, with so much positive feedback. Uh, you know, what needs to happen at this point at in, in DC in order for them to see the value, understand the value, and uh, to appropriate the right funds in the right areas to, uh, to fund telehealth's future.

I. Well, um, first off, bill, thanks so much for having us and for having our members because I have a saying that in Washington, hearts and minds are one, one story at a time. And so it's really important to get the messaging out a about. Like regarding this and the success stories. So I thought I would start with a little bit of level setting in terms of, you know, how, um, how we actually got here and what, you know, what we can expect for the future.

So a lot of folks have used this analogy. I, I don't really necessarily, I. You know, like the analogy that much, but you can't put the toothpaste back in the tube, but unfortunately you can. And I am an optimist, so I think that there is a lot of room ahead for us to make some impactful changes in Washington regarding this, but it's not gonna be a feta complete.

So the first thing I'll say is I'll give credit to the lawmakers for acting swiftly. They definitely acted quickly. No, was it perfect? Nothing's ever perfect. Um, so it began on March 6th with the first, uh, installment of funding, which happened in the first stimulus package, and then in the third package known as the CARES Act, there was, um, a lot of flexibilities were actually codified temporarily, so again, just for under the pandemic.

Um, and, and there was also some money for, for the SEC, which I'll, I'll let Andrew get into in a moment. What I wanted to share with folks is that the reason this is possible is for two reasons. Um, there's the Stafford Act, the national emergency was declared, so that has to happen. And then also HHS announced, um, a public health emergency.

So two conditions have to be met in order for, you know, for these waivers to move forward. And so essentially that is what has happened. So the waiver, the public health emergency waiver is up for renewal every 90 days. It was last renewed on April 26th. It is up for renewal again on July 25th. So, if I had a message for anyone who's listening who wants to see these flexibilities continued is reach out to your lawmakers.

Because at the end of the day, this is gonna be a, a very much a congressional play. There are some maybe limited, uh, tweaks that we could potentially see from the administration, but right now I think that's, you know, what we're looking at. And there have been, you know, dozens of bills that have been introduced.

And we could talk about a little bit about some of those. But, um, maybe before I get too far into that, I'm gonna hand it off to Andrew to talk about, um, some great, you know, interest from the Federal Communications Commission. Yeah. I think one of the, the big pieces that Maurice touched on is it's not just about being able to have access to the telemedicine services themselves, whether that's the

The software side services are patients being able to access it through their providers, but it's being able to make sure that people even have the broadband and internet access necessary to be able to utilize these services to their full extent, some of the, the regulations and the policies within.

The Centers for Medicaid and Medicare Services and HHS rely on the use of both audio and video technology to be able to deliver these telemedicine services. Not everybody has broadband to be able to do that. Not everybody, you know when you start talking about the access to the internet, it's not even just the ability to have a two a video communication.

You're talking about people that can't stream a YouTube video. So the Federal Communications Commission, as part of the CARES Act, received funding through the C Ovid 19 telehealth program. To help providers stand up their telehealth services on the inside, but they also have a connected care pilot program, which is gonna be continuing on, and at some point in the summer we'll be fully opened up, which is gonna help

To give people access to high speed internet within their provider communities. And I, that's a huge piece of this conversation that needs to continue as well, that it's about having good internet access as well as having access to being able to bill and reimburse and the provider side requirements to make sure that telemedicine is something that can continue into the future.

Yeah. And, and Stephanie, we'll start with you. I'd like to hear from the providers of if, if the funding goes away in July, . Um, what, how, how will your health system think about telehealth? How will they either continue it? How will they pair it back? Uh, where will they continue to apply it? Um, I realize it's a tough question and it's a second.

Well, yeah, it's actually an easy question for me right now because our peak is July. Okay. That's where we're forecasting is our peak is going to be later in the summer, or, you know, potentially late. Maybe it's moving back to late June. Um, but it's probably July. Um, and so if it's not safe to bring patients in.

we're, we're not gonna bring them in and we'll have to find ways to deliver care. So, I mean, I think we'll be forced to continue to do some telemedicine. Um, whether or not we're able to get some of the reimbursement for it, I hope we don't end up in that position because, again, while other areas in the country may have already peaked and are looking at reopening, we are not.

Yeah, that's an interesting point. I'm, I'm gonna change the question on you, but that's a great point and I'm gonna change the question by saying post pandemic, right? So I, it is, I'll just say that 'cause we don't know what the date is. Um, post, post pandemic. If all of a sudden all the allowances that have been made go away, how will you guys think about telehealth?

Or will we snap back to where we were? Well, I mean, we had a plan for how that was gonna be incorporated into specialties. Again, we can still do things like bring a patient to a clinic that's 10 miles from their home instead of a hundred miles from their home. And do you know, a, a telemedicine visit in a specialty situation?

So, we'll, we'll go back to the construct of the plan that we were . Ready to roll out based on the limitations we had at the time and, and hope that we can continue to evolve the conversation, um, and learn and, and generate data to help support it. Alber how about you guys in San Diego? Yeah, so I, I would, uh, say we would be, uh, pretty much along the lines of, of, uh, Stephanie's comments.

I mean, the reality is, um, you know, whether we like it or not. If we cannot, uh, generate a margin, there is no mission. Right? That's, that's just, uh, a fact of life. Um, and, and so, uh, there've been instances, for instance, uh, where telemedicine has allowed us to do things like do cochlear implants for patients who in the past were not good candidates 'cause they could not.

Drive daily, the two hours each way, uh, to to provide their, their kids the, the therapy necessary to, to, uh, uh, train that, that implant right. To, to allow them to hear exactly. And, and we don't see us pulling back on things like that. But, uh, but certainly, uh, for, for areas where, where. Um, this has become basically a, a matter of efficiency or satisfaction If the, if the dollars aren't there, um, it just doesn't make business sense to continue to provide a service at a loss that, that we can't afford.

Right? So, so we would hope that, uh, that those, those, uh. Changes are, are something that have proven, uh, in this, as you mentioned, uh, large experiment that they work. I think, um, uh, our providers and our patients are, are showing us now that things are getting back to normal. Uh. Um, what are the things that, uh, would be sustainable in that way?

Because quality is not compromised and because the service is good. And what were the things that need to get back to, to, uh, an onsite ? Uh, face-to-face type of an encounter because, uh, while telemedicine might have, might have, uh, allowed us to get over the hump, it just wasn't optimal. And, and, and so, um, you know, I, I think, uh, there is an opportunity here to, to trust in.

Our providers who I think have shown across, not just at Rated Children's or in San Diego, but across the country, uh, they've shown their commitment, uh, to our communities, uh, to do the right thing and, and to, to, uh, kind of let us figure out, uh, um, how things, uh, turn out to be and not, not remove those, those, uh, uh, regulatory.

Um, opportunities that, that, uh, have been put in place, uh, so that we can, we can, uh, finish, uh, through, there's plenty of studies that have been started over the last, uh, eight weeks, uh, that are collecting tremendous amounts of data that are going to show not just the immediate satisfaction or, or effectiveness, but long-term impact of, uh.

Of, uh, this, this way of practicing medicine. And, and, and I think until we have that data making changes would be premature. I think, uh, we should, we should sustain the, the, uh, the changes that have been, uh, enabled and, uh, and let this, if you will, experiment, run its, its course before, before, uh, we pull, uh, anything back.

Fantastic. Uh, Pravin, same, same kind of question for you. I mean, d you have San Diego, we have, um, uh, North Dakota, we have, uh, we have DC and, and you know, what, what would the impact be in a major metro like DC uh, where you're, you're, you're really seeing, uh, people, you have the haves and have nots equally represented in dc Um, you know, what would happen if telehealth funding would be pulled back?

I think the question is, I think that we actually started with that thinking to feature of telehealth and we have a group here and I think we pretty much believe, I think that the future is optimistic. Uh, we know, I think we are thinking, I don't think it's going to go back to the way it is. I think there are a lot of receptivity out there.

The question is how do we shape the changes in the policy as it relates to how we provide care and how do we get paid? I think too, I think, uh, Marie and we had a lot of conversations. I think that's how we have to focus on. I agree with, uh, uh, uh, uh, and uh, Stephanie. I think we have to make it a sustainable business model.

And we thought about like what does a, like, where does the funding come from? There are three areas we think the funding is going to come from. The easiest of all that is payment parity. How can we maintain the payment parity in some confined world? I don't think it is gonna stay the way it is. Uh, if you couple that with policy and licensure issues and place of service and you put, try to put the, uh, uh, the technology, HIPAA and privacy concerns that, that, that has been relaxed a little bit.

I think they will regress as they should, but ability to maintain payment parity and also not only at Medicare, Medicare level, but also at other provider levels. So that to us is important and I think it. That doesn't happen. I think it'd be very difficult to sustain it. Number two is grants. There is AFCC grant out there, uh, which is, uh, helping with telehealth and we applied for the grant.

And number three is we talk about the strategic bet and, and we are talking with strategic bet here. Do we believe that a hybrid model that telehealth is going to increase the capacity? We know that we have a lot of demand and we have a huge, a lot of wait times. So how do we increase, uh, make it at 24 plus seven models?

So how can we expand? The the hours and, and we are seeing that. I think there are ways in which we can have a hybrid model whereby we improve accident, make it easy. And I think there's a lot of factors in terms of patients not coming here. They're not, uh, spending for parking. They're not take, talking the day off and it provides socioeconomic benefit.

And we can partner with, uh, the, the state DC here to fund that. Not only that. It is a good business model. If we can increase our visit by say 15%, 10%, or 15% in a new every model that will pay for itself. How do we do that? For example, I know, uh, we did that at uh, my previous, uh, uh, VO Jefferson. We saw that if you look at, uh, post-surgical visit, it's part of, uh, a global fee.

So we pay one fee for the entire global fee, and we were able to get a postsurgical, uh, uh. With it, uh, online, so guess, and the physicians told us, I said, you know what, initially I used to reserve an hour to meet with the patient after surgery, and now I can do the entire in 15, 20 minutes. So I think that is going to be another way for us to think about how do we expand the capacity?

And you have to assume that there is a, a volume and demand out there, and we believe that there's a demand out there and we want to think about how can we make it a. A strategic bet, uh, uh, and create a, a business case to be able to, uh, keep it going in the new direction. And, and the other thing that we're thinking about, there's a value of the data.

And I think, Stephanie, you said that in my mind and I, we have talked to a lot of politicians here, and I'm newbie in terms of talking to politicians. A lot of you might have a lot more experience, but it's about, I think the winning hearts and minds and with data, I think it really helps. And we are thinking about what is the value of data and also in doing the competitive studies and what is the value from research perspective.

And if we can do that, I think we'll be able to shape the, the, the future of policy and payment in an effective way. We don't know how it's going to look like, but we wanna take an active role given the proximity with both, uh, national and local, uh, policy makers. Couple of rapid fire questions to, uh, close this and then, uh, Mari and Andrew, I want you to think about what we would, uh, tell or, or ask of Chime members in order to build the story, right, the data and the story.

Think about that. That's what I'm gonna end up closing with, but couple rapid fire questions. Um, if funding goes away for this, will consumers pay for it? Do. Is there an appetite? They've experienced it. They like it. Some like it are. They are. Is it, is there a case where you're getting 20 bucks over here, you're getting 20 bucks over here and we sort of make up the gap?

Uh, I ask, you know, what, what do you think the, is that an opportunity? I. I'll, I'll, I'll go first. Uh, we, we are seeing, uh, you know, we see about 60% of our volume is Medi-Cal, which is the, uh, California Medicaid. Uh, I don't think they have that luxury. Uh, so I think there, there are some consumers who, who have that luxury and they will pay for the convenience.

I think, uh, a big portion of, of the population we serve, unfortunately, uh, do not have that, that ability. And that's a children's hospital. How about, how about, uh, Stephanie Pravin? Yeah, I mean, I, I think I would agree we've got a population, um, of, of patients who have very limited, uh, financial resources.

And that's not probably something, I mean, again, and I think that really lends itself more to something like a urgent care on demand. There can be the occasional, you know, dermatologic or something. I just wanna see a dermatologist right now and I can't get into the specialist. Um. But again, I, I think that, uh, further divides maybe the haves and the have nots when it comes to how we're able to provide care.

And I'd like to see us not go in that direction, that if it's something we think is good for patients, we should be doing it for all patients and make it work within the payer construct that we have and not, um, create different avenues for patients with different financial means. And I, I would agree. I think it is, is all one size does not fit all.

And what we have seen it, I think consumer are more likely to pay for specialty, uh, access sooner than later than for primary care, urgent care. I have seen it. I think the, the business model is not there. The margins are not there. And, and the consumer will not, uh, uh, uh, they're not willing to pay for, uh, kind of a primary care, urgent care kind of visit, however.

I have, we have seen like, for example, psych that people are willing to pay. Uh, and for, uh, dermatology, I think people are willing to pay and we are finding it out for. A subspecialty consult for direct to consumer model. I think there's a, a, a propensity to pay for a, a segment of consumer. The question is how can we create within and I, we used to work in retail and we had a different value proposition for different segment groups.

The question I ethical question that we have. The social question, do we have is, can we create a, a multimodal, uh, uh, uh, path here Where certain people are, are, are who can pay, will pay, and the other people, and how do we work with our payers to make it affordable for them? All right, second rec rapid fire question.

How important is it to keep the ability to practice telemedicine medicine across state lines and, and take those barriers down? Huge. Well, absolutely critical. Yep, absolutely critical for us. Yeah. And so that's a, that's state's. Um, how will this, so will this move us more rapidly away from fee for service and towards population health?

And I, I say that from this perspective. Um, you know, Kaiser does a million telehealth visits a year. While the reason that we all know the reason they do a million telehealth visits a year is 'cause they get paid to keep people healthy and keep 'em out of the hospital. So they're, they're getting paid either way.

Um, is that, is that the way that this really transitions is that we, we really move those models forward? Well, I'm, I'm an economist by background, so yes, I think live is about incentives and if you align them correctly, uh, you'll get the outcomes you, you are aiming for. And if you don't, you won't Money talks.

That's what I hear you saying, al there. Right. Um, and any anybody disagree with that? I mean, I mean, when, when the alignment's there, it, it just, it really does work. And I, and I haven't looked at, uh, Kaiser's numbers since March 1st, but those, those are the numbers. Last year it was, you know, it was some amazing number of telehealth visits.

What I, I think I agree with alignment, so to me, but alignment is the, ever since I came into healthcare, alignment is the most complex thing to achieve. To me, I, I, I think I'm optimistic about it, but I think there's a lot of things that have to be, uh, worked out for it to become the, the main catalyst to move towards, uh, uh, from fee, uh, away from fee for service.

Yeah, I mean, I think one of the important things to remember about Kaiser is they are the full ecosystem, right? It's they're paying themselves. Yeah, they are the insurance company and they are the provider. Um, it's a much different scenario. Um, you can be part of an ACO or something like that. It's still not the same because it's still two buckets.

You're just sharing the risk and not every health system and every location is gonna be in a position to really own the full ecosystem of being both the payer and the provider. And so, you know, I think that is a point of . Um, of distinction that Kaiser has been able to do a lot of great things and have had that great data actually for several years.

Um, but that is a unique, um, way to set it up and is not necessarily reproducible even in an ACO model when the alignment may be there. Well, let me talk you, uh, last question for the three of you. Uh, and then, and then we'll close with, uh, what we can do as Chime members. Um, and, and that is, uh, uh, you know, is what's going on today, crisis management.

Is that going to, um. Be the same environment. Here's, here's the question. The question is, clinicians, clinician, clinicians today cannot see patients face to face in, in a lot of cases. Therefore, they adopted telehealth. Well, it's one thing to sit in front of your computer and do 20 telehealth visits.

That's another to do. Physical visit, telehealth visit, physical visit, telehealth visit and whatever. And we, we implemented this, I implemented it incorrectly a number of years ago where, you know, we were looking at clinicians and saying, yeah, you could do both. You know, it's, and we just know that that is a very hard model.

Are we gonna get pushback from them when there is that, uh, when we go back to seeing physically and virtually? Well, I think your whole point, I think you just made the point yourself there, right? I mean, if you set it up right. That won't happen. We have the, our places that are most successful are doing block scheduling.

So the physician spends the entire morning sitting in their office doing telemedicine visits while their colleagues are using the exam rooms and the nursing staff. And then in the afternoon they switch. So, I mean, I think, I think it's all about implementation. Yeah. Yeah. I would, I would add to that, um, you know, in, in a number of specialties we're seeing, uh, severe shortages, right?

And I, I, I forget if it was, uh, Pravin or Stephanie who earlier said some of their specialties were, were scheduling people weeks and weeks out. Right? And, and what we're seeing is, is, uh, telemedicine is allowing some of our. Of our more experienced physicians who are on the brink of retirement to rethink that retirement and say, well, maybe I can continue to, to work for a few hours a week or what have you in this mode, in a telemedicine mode.

Uh, continue to do something I love, I'm good at. I just don't wanna do this at the pace that I was doing it earlier. And so, and the same thing with . With, uh, young parents, um, et cetera. So I think, um, this, uh, if we do it right, it will not only, uh, enable us to, to continue to provide this service. It will continue, it would enable us to, to really, uh.

Generate a, a, a force multiplier in our, in our, uh, clinical workforce. Um, at least for, for a while. So, so I think there is, there is plenty of opportunities. I'm a glass half full kind of a guy. And, and, and I think if we, if we do this right, uh, we'll see a multiple benefits. Fantastic. Yes. Pravin. Just adding to it.

Just adding to it. I think it is, to be very frank. I, I think we heard a lot of feedback from, uh, uh, uh, providers across specialties. They said, I'm a convert. I think we need to keep on doing it. But I'm not sure how, because they are sharing the things that are working out really well. What's the things that are not working out well?

And they're also researchers, so they're actually analyzing their own workflows to think about what is working and what is not working. And we kind of created the slogan. Uh, it has to be, we are calling more like a, a physician and provider driven and professionally enabled. So, uh, we have a task group, uh, which basically is called the, the future of Telehealth.

And, uh, we are 50% of that, uh, uh, group is, uh, physicians who volunteered to drive this forward. And, and I believe that, I think there is a willingness and, uh, a readiness, an engagement for us to, uh, make it better than it was, uh, three months ago. Absolutely. Uh, Mari Andrew, I, I, I wanna leave you guys with the, the last word.

What, um, you know, what, what can the Chime members do? How can we, uh, help to build the, uh, the story around, uh, future funding of telehealth? Uh. Well, um, we are actually going to be launching a survey, which I am not always, like, I'm always hesitant to clog our, um, members' inboxes more, but in this case I think we, again, we need some data and we need some stories, so.

We'll probably be doing that in the next, you know, two weeks. So keep your eyes open for that. Um, contact us. We're also happy if you're, you know, if you're busy, you can ask your staff who have a lot of expertise in telehealth to contact us. So we wanna start collecting that evidence base. So be on the lookout for that.

And I don't know if Andrew wants to add anything else to that. And I think when you talk about stories, you know, Stephanie has talked about some of the challenges when it comes to virtual care, and Bert and Pravin have talked about how it's experienced in their areas. This is an opportunity of time for innovation when it comes to virtual care.

So we need to hear the good and the bad, the the great solutions that you've come up with and the things that you've tried that didn't work. It's really important for us to be able to understand the policy and how the policies need to be enacted because, uh. Everything doesn't fit everyone as Stephanie was mentioning, and so it's really important to understanding what works for who and what doesn't work for those others.

Fantastic. You guys did not disappoint. You're a fantastic panel. Uh, I love the back and forth. I I tried to stump you a couple times and I appreciate, uh. Appreciate all the answers. That's all. That's all for this week. Special thanks to our sponsors, VMware Starbridge Advisors, Galen Healthcare Health lyrics, Sirius Healthcare and Pro Talent Advisors for choosing to invest in developing the next generation of health leaders.

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