As the U.S. begins its recovery from the COVID-19 crisis, evidence strongly suggests that there will never be a return to “normal” for healthcare providers and HIM professionals, but rather a return to a “new normal” that we all should prepare to embrace. The crisis demanded that new methods of patient engagement be adopted, which led to a dramatic shift in the types of patient encounters documented, changes in coding guidance from CMS, revised rules governing HIPAA Privacy and Security, and infrastructure changes to accommodate new patient visit types for coding and billing. HIM professionals should prepare for the following predictions in the wake of the COVID-19 pandemic.
Prediction #1
There will be a surge in previously postponed treatment.
Non-emergency or elective healthcare treatments or procedures such as preventive care visits, chronic disease management and elective surgeries have been postponed to free up both physical space and clinical workforce in preparation for surge care access during the crisis.
Surveys from the American Medical Association (AMA), eHealth, The Advisory Group, Canaccord Genuity and others show that as restrictions to patient access are lifted and the availability of vaccines and therapeutics increases, patient volumes will begin the return to previous levels.
The AMA encourages surgeons to communicate regularly with patients until elective surgeries open back up again. “Patients need to know that your surgeons are here for you,” said Karen J. Brasel, MD, MPH, a professor and trauma surgeon at Oregon Health & Science University. “In my system, surgeons are seeing patients and answering patient questions through electronic media. They are still working, offering virtual visits and responding both synchronously and asynchronously to patients.
Prediction #2
Many patient visits and coding demands will shift from hospital to outpatient locations.
According to healthcare consulting firm Surgical Directions, patients will be cautious about returning to the hospital for elective procedures. The current daily media barrage highlighting hospitals overloaded with COVID-19 volume will undoubtedly fuel patient concern even after the pandemic begins to subside.
This means that the out-migration of procedural care to ASCs, urgent care clinics and physician offices will accelerate, as a direct result of COVID-19. It has been estimated that 50% of procedures performed in the hospital before the pandemic could be moved to an outpatient facility. Although it is likely that hospitals will experience a brief surge in patient procedures when the pandemic subsides, long term there will likely be a significant loss in elective volume to the ASC and physician office. This is where HIM leaders have an opportunity to chart a new course for cases and coding teams. This migration will require an increase in coding support and expertise not needed previously for those outpatient facilities.
Prediction #3
Telemedicine and telehealth will be more widely utilized.
Prior to the coronavirus pandemic, only 24% of U.S. healthcare organizations had an existing virtual care program as of January 2020. As the COVID-19 crisis has led to an enormous increase in the use of telehealth, experts are predicting more than one billion telehealth visits to occur this year.
CMS will now pay for more than 80 additional services when provided via telehealth, including emergency department visits and initial nursing facility and discharge visits. Physicians can also evaluate Medicare beneficiaries using any type of phone. Home health and hospice providers can provide more services using telehealth, if it is appropriate to do so and doesn’t replace needed in-person visits.
New digital technologies including self-triage and screening tools have helped reduce the healthcare demand surge and ensure that critical cases get the necessary in-person care. Other technology tools such as remote monitoring devices and electronic messaging have helped less critical patients continue to care for themselves at home.
All of this innovation has given telehealth advocates—who have long argued that HIPAA was crafted before the advent of this technology—the opportunity to prove that these channels can be used for care management and coordination, provided they are used correctly.