Telemedicine Continues to Benefit Small Solo Practices

The COVID-19 pandemic is ushering in a new wave of telemedicine enabling physicians to maintain quality of care without an office visit. Moreover, the widespread use of telemedicine has helped small independent primary care practices (SIPs), which are defined as those with 5 or fewer clinicians. SIPs provide primary care for a substantial proportion of the US population, and SIPs who were early adopters of telemedicine are benefiting significantly.

Up to 42% of smaller clinics switched to telehealth during the height of the pandemic, said Sristi Sharma, MD, a preventive medicine physician at UC Davis in California, who has been tracking telemedicine trends.

“Telehealth practice helped providers in small independent solo practices continue to manage their patients during the pandemic,” Dr Sharma said. Smaller practices were able to adapt quickly to telehealth during this period despite uncertainties about reimbursement and policies during the pandemic.

Solo practitioners are expected to build on their investment in telehealth through improved infrastructure, tools, and training, she said. Telehealth waivers granted by the state and federal agencies have been extended and are being reevaluated for the long-term, Dr Sharma said. In addition, there are significant federal investments being made to improve the broadband capacity in the country via the 2022 Infrastructure Investment and Jobs Act. “All of these are synergistically going to assist the solo practitioners to maintain and expand telehealth services to provide care for their patients,” Dr Sharma said.

The rapid transition from in-person care to telemedicine visits at the start of the COVID‑19 pandemic did not adversely affect the quality of care and even improved some aspects of it. Further, telemedicine may help reverse trends over the past 30 years showing a decline in the number of SIPs. Government mandates and advanced alternative payment models have been difficult for SIPS, who have limited resources for implementing the systems changes necessary to meet current quality standards.

Telemedicine Evolving, Improving

During the COVID-19 pandemic, routine blood pressure assessments decreased because of global disruptions to medical care delivery. Telemedicine successfully filled that gap. “I anticipate that the practice of medicine will continue to include widespread use of telehealth in the future, especially for ambulatory care,” Dr Sharma said. “Apart from patient and provider preference, there are other factors. They include supportive state and federal requirements, focus on improving telehealth infrastructure, and continuous innovation in the field that will ensure that telehealth is the future of medicine.”

A new study has found that a remote hypertension program successfully supported patients through the pandemic in achieving their blood pressure goals. The study, published in the Journal of the American Heart Association, demonstrated the potential for remote programs to provide more effective and equitable care for hypertension, as well as other chronic conditions. The program provided care when patients needed it most, and the program demonstrated the efficacy of a team-based approach through an entirely remote management system, according to the researchers.

The study included 1,256 participants with 605 enrolled in the program during the 6 months before the March 2020 pandemic shutdown and another 651 were enrolled during the 6 months after March 2020. Patients received a digitally connected home blood pressure monitor, which enabled them to collect a more complete and accurate set of measurements than those obtained in an office visit.

An evidence-based clinical algorithm analyzed home blood pressure recordings and guided pharmacological decision-making. It included a team approach with trained patient navigators, pharmacists, and supervising physicians working together to implement a therapeutic strategy with each patient. The rates of achieving goal blood pressure improved to 94.6% during the pandemic compared with 75.8% pre-pandemic. “Telehealth has the potential to make health care equitable and accessible to almost 90% of US adults, including those in the medically underserved communities, owing to their use of smartphones,” Dr Sharma said.

The pandemic has offered all practices, large and small, an enormous opportunity in the form of telehealth. Both patients and physicians like the format, said John Machata, MD, a board-certified family physician in Wickford, Rhode Island, who has been in practice for 39 years (12 years as an SIP) and is retiring as of April 1, 2023. He said independent solo practices continue to be gobbled up by large groups, which are usually operated by hospital networks. While telemedicine may help SIPs, even greater efforts are needed to protect solo practitioners.

“Patients deserve choices,” Dr Machata said. “Do we want patients’ only choice to be cared for by overworked doctors seeing as many patients per hour as possible because bean-counter bosses treat medical care like an assembly line? Small practices offer patients the ability to receive personal care at a relaxed pace.”

Both business skills and telemedicine have not been high priorities for medical school training programs. Unless this changes, overall care could be negatively impact, Dr Machata said. “Given that two-thirds of graduates are employed after their education, the incentive to teach business skills continues to fade,” he said. “Medical schools seem content to permit insurance companies and bean counters to control the business side of medicine.”

This article originally appeared on Renal and Urology News