A Virtual Cardiovascular Care Program for Prevention of Heart Failure Readmissions in a Skilled Nursing Facility Population: Retrospective Analysis
The past few months of the coronavirus disease-2019 (COVID-19) outbreak have brought seismic shifts in the fabric of our lives and in medicine. As clinicians, health care systems and communities have risen to the challenge of providing care in the era of a pandemic, and “care as usual” has been upended and reinvented. Amid social distancing and stay-at-home directives, something remarkable has happened to the practice of medicine. Spurred by necessity and supported by urgent regulatory changes, the door has opened for telehealth as a primary mode of outpatient care delivery.
Across the United States—and globally—people with outpatient care needs, ranging from preventive care to routine visits to advanced disease management, are not being seen in person. Unfortunately, some are simply waiting it out, meaning that appropriate prevention and optimized care are not happening. For others, telehealth is emerging as a viable (and for some, the only viable) way to get care. After more than a decade of painfully slow adoption, telehealth is now a household word.
In response to COVID-19, U.S. clinical practices rapidly adopted some form of telehealth as a primary way of providing outpatient care, dramatically reducing or eliminating office presence. Concurrent regulatory changes supported by the American College of Cardiology’s (ACC’s) Health Affairs Committee, such as relaxation of state-line telehealth restrictions and shifting reimbursement to equivalence with in-person visits, have also spurred the uptake of telehealth. A MedAxiom survey of cardiology practices found that 75% of all outpatient encounters moved to telehealth as of March 30, 2020; a remarkable shift within just 2 weeks (1).
Will This Moment Last?
It can and it must. This moment of telehealth use and acceptance can last, because we have shown that patients and providers rapidly adjust to televisits. It can last because we have the technology to meet patients where they are and to do so with efficiency and cultural sensitivity. It can last because lawmakers have urged parity of payments for telehealth visits to protect patients and health care workers. And, it must last because it is a method to reduce health disparities and improve health equity by decreasing barriers and increasing access.
Telehealth gives options to meet all patients’ needs, particularly those in rural or remote areas, those with limited mobility or financially constrained time, and/or those with limited access to reliable transportation. Telehealth can allow patients to remotely access services, to seek expert advice and second opinions—without the stress and opportunity cost of travel—and to actively engage and manage their care. Telehealth must last because it can allow for a more comprehensive team-based approach to maintain wellness with data at patients’ fingertips, thereby increasing their engagement, autonomy, and agency.