Swiss Army Scalpel: Telehealth and the Surgical Practice of the Future

ACA, MIPS, MACRA, Telehealth, Hospital Employment, EMRs, Shared Risk. These are just a few of the acronyms and terms infiltrating our everyday lives as physicians and surgeons. The terminology can be daunting and frustrating, but in the end, the goal is improved patient care and reduced cost. As evidence-based medicine has evolved, so has the push toward improved “quality of care,” which has in turn brought a myriad responsibilities for physicians and surgeons. To balance these opposing forces, doctors will need to adapt their practices to evolving technology in order to compete. Each physician practice will need to be more like a startup company, nimble and able to pivot with an increasingly connected world. At the same time, we’ll have to learn to become more like a Swiss Army Knife, having a tool for every role we may play on a daily basis, such as Doctor, CEO, CMO, IT Compliance officer, Quality officer, Financial Officer, Board Reviewer, etc.

Our initial reaction to all these pressures was to run to an employment model, giving up our autonomy as physicians. This, quite clearly, has led to plenty of dissatisfaction. Now, the challenge for us all is to find out how we can move toward better patient care in a way that fosters our independence. The answer lies in the various technologies that are evolving around us and how we can wear all the hats needed to lead our solo or group practice in a lean, cost-effective, low-overhead, patient-centered, quality driven care model that creates value and effectively puts the “doctor-patient relationship” first. Every time. Always. No exceptions.

Telehealth, the Medical Utility Tool

Telehealth, the disruptor and the enabler, will be the key to reclaiming the doctor-patient relationship that physicians and patients desire.

While EMRs have proven to be a lightning rod of dissatisfaction, mobile telehealth has the potential to unify patient education, lifestyle modification, preoperative optimization, consultation scheduling, post-surgical follow up care, chronic illness maintenance, and all other aspects of healthcare delivery. No longer will the consultation be limited to the physical office. By breaking down these barriers, we can potentially provide patients with the access to care they desire on demand, with improved efficiency, and with lower costs.

This is in stark contrast to the current model, which relies heavily on direct, synchronous communication between all involved parties, often resulting in the proverbial “phone tag.”

To compare the old versus new model more closely, let’s take a look at the workflow revolving around patient access to specialist care. Often, specialists are located in metropolitan areas far away from remote patients, and they often have long waits to see them in person. Many times, all records aren’t present at the initial visit, and the first consultation is left incomplete. Patients often make multiple phone calls and leave multiple messages to schedule appointments and get records to the specialists’ offices. Other times, information becomes distorted as it makes its way through the many avenues of communication. All of these things lead to a lack of confidence in the doctor-patient relationship and are ultimately costly.

In contrast to this classical model, for example, my team is developing a novel “virtual hernia center” model that creates a virtual practice to give access to anyone, anywhere, anytime at low cost. The communication is asynchronous for most secretarial-related work, which enhances patient satisfaction and access. Complex hernia care requires an extensive team that involves scheduling appointments, obtaining records, medical weight loss services, smoking cessation, and radiologic imaging, to name a few. Any break in the seamless integration can lead to a bottleneck in the workflow, confusion, and ultimately has the potential to impact outcomes and quality of care.

To remedy the coordination issue, we used a combination of telehealth solutions to manage the practice efficiently, with low overhead, and with improved patient satisfaction. First, at the level of the initial appointment scheduling we use a mobile app-based solution that has allowed patients to contact us directly through HIPAA secure text messaging, schedule an initial consultation, upload reports, and ask questions that the entire team sees in a group chat, allowing everyone to see the responses and ensure communication is complete and accurate. We also use an app and web-based telehealth solution that allows patients to perform the entire initial consultation from the comfort of their home. Using this same platform, we can provide patients with real-time coaching for lifestyle modifications. The system utilizes patient generated data via FitBit, FitBit scale, and iHealth blood pressure cuff and glucometer to allow our team to monitor and foster lifestyle modification in a real-time manner. Postoperatively, we use an app-based wound management system to closely monitor surgical wounds remotely. This helps us catch and intervene with potential wound complications early in the postoperative period. Ultimately, all of these tools enhance the efficiency of patient care. They also increase patient satisfaction, improve perceived quality of care, and potentially reduce costs in numerous ways, from patient out-of-pocket costs to limiting complications from poor communication.

The Future of Freedom

From a marketing standpoint, these services are breaking down the party lines that have been established through consolidation of healthcare systems into ACOs. These vertically integrated systems are controlling referring practices of their employed physicians through contractual obligations in their employment agreements. As with most business consolidation and vertical integration, there’s been little evidence that these practices have improved efficiency, quality, or cost of healthcare. However, disruptive models like telehealth allow patients and physicians alike access to each other and specialist care regardless of affiliation and with a more patient-focused feel.

As telehealth emerges in the marketplace, traditional brick and mortar practices may no longer be replaced by employment contracts but by nimble private physician practices that use technology to provide efficient and quality patient care with low overhead. Practices like these will no longer be squeezed out by high overhead costs and monopolization of referral pools by large systems that force employment agreements. As a result, we may see a swing back toward the private practice that doesn’t have the same large business feel and business prioritization principles.

It’s unlikely we’ll truly eliminate the in-person office visit, but the reality is that mobile-based telehealth solutions are changing the landscape of physician practice models and enhancing the patient experience. That’s why the future of telehealth is so exciting.

Paul Szotek, MD, FACS is director of the Indiana Hernia Center, Clinical Assistant Professor of Surgery at Marian University School of Osteopathic Medicine, www.indianahernia.com , @PaulSzotekMD, @indianahernia, pszotek@indianahernia.com

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