Posted by Georgia Scott
For decades, the nation’s healthcare organizations have paid some of the highest employee salaries of any industry, outside of sports and entertainment. That alone should be enough for recruiters and organizations to hire who they want, when they want. And yet, with the doctor and nursing shortage, the growing demand for telemedicine, as well as the labyrinth of changing laws regarding telehealth have forced hiring teams to rethink what they once took granted.
Telehealth has been around since 1997 but it wasn’t until COVID-19 that a torrent of need, demand and access to telehealth created a number of logistical, financial and legal headwinds for providers, recruiters and healthcare organizations. Below is a look at how telehealth has changed how healthcare organizations and physician recruiters operate.
Modernization and widespread use of synchronous and asynchronous care
Telehealth, telemedicine and telecare, as well as specialty-specific iterations like tele-neurology and tele-endocrinology, among others, are all widely expanding versions of remote healthcare. Synchronous care happens live, in real time, between a provider and a patient - or sometimes a patient’s caregiver. They can take the shape of video calls, audio only calls, and to some degree, secure text messaging to answer patient questions.
Asynchronous care is when a patient or doctor submits health-related messages, data or other content for the recipient to review to respond at a later time. Examples include messaging with follow-up instructions or confirmations, images sent for evaluation, mobile health with wearable devices and remote patient monitoring (RPM).
Both types have dramatically changed the healthcare industry. Traditional brick-and-mortar hospitals must now compete with an onslaught of highly popular online only practices.
Innovative programs to reduce ER visits
The emergency room is where telehealth really makes an impact. Kaiser Permanente facilities in Virginia, Maryland, and Washington, D.C. and the Utah-based Intermountain Healthcare group developed novel telehealth programs, such as 24/7 video access to doctors who can quickly assess the problem, offer guidance and, if necessary, send relevant medical information to the ER, and remote patient-monitoring programs that combine telemedicine and home monitoring for blood pressure, diabetes and other chronic diseases. With telehealth-based programs like these, physicians can solve problems 60% of the time. This helps to cut down or improve the efficiency of ER visits, which otherwise can cost patients 12 times that of going to a physician.
Increased Uuse of Electronic Health Records
Since the 1960s when the Mayo Clinic became the first to use electronic health records (EHRs), technology has transformed how doctors and healthcare organizations can access patient records across different providers. Today, with the widespread use of telehealth, healthcare organizations have grown extremely reliant on comprehensive, workflow enhancing EHR platforms. While this is great for the continuity of patient care, it adversely impacts the doctor’s time.
Currently, physicians spend nearly five hours working with EHR for every eight hours they have scheduled with patients. As a result, recruiters have to glean how physician candidates feel about dedicating so much time away from patients, if it might lead to burnout, whether they can function well with remote teams, and even the candidate’s ability to write clear, unambiguous communication regarding orders or clinical decisions.
Displacement of doctors
As time consuming as daily EHR can be, the initial setup and training can be worse. Many independent physicians quickly learned that purchasing and mastering an approved ambulatory or outpatient EHR system for a private practice to maintain a patient’s complete medical history was prohibitive. Particularly when factoring in the cost of other, equally expensive, HIPAA-compliant telehealth software. For them, it made more sense to join a hospital where EHRs are cross-departmental, in-patient systems that come with training and a staff of IT support. In fact, according to the American Medical Association, the share of U.S. doctors in private practice dropped below 50% in 2021.
Payment structure
Invoices for online doctor visits and outpatient testing often include facility fees. Patients complained, but hospitals found that without facility fees, they were losing money. Some organizations charge such exorbitant facility fees that eight states (Colorado, Connecticut, Ohio, Texas, Indiana, Minnesota, Washington and New Hampshire) are implementing or are considering limits on facility fees, as well as requiring organizations to notify patients if a facility fee would apply. Recruiters should know if facility fees will affect how physicians are paid. Medicare reduces the physician payment when a facility fee is charged.
Virtual care-specific training
Large healthcare organizations and small private practices faced the same challenge: once telehealth was in place, how do you best interact with virtual patients? Telemedicine challenged providers to rethink their "bedside manner" to ensure a good patient experience. In many cases, they also found it necessary to provide education for using patient portals and, sometimes, even how to turn on their webcams or troubleshoot their internet.
Additionally, there was a learning curve on how to best respond to direct messages from patients and to have a clear cut-off time when physicians could not be contacted. Many proactively created lists of frequently asked questions so patients would know how to log in and exactly what to expect. For physicians working remotely, HIPAA-compliant home security became paramount.
Recruiters who once only had to discuss basic onboarding now had to be prepared to outline expectations and training around telehealth.
Legal Parameters
Telehealth is heavily regulated, with each state mandating its own policies. For healthcare organizations operating in multiple states, and physicians conducting telemedicine across state lines, this meant they had to keep track of every nuance or risk of violating the law. Most of the guidelines that were implemented during COVID are set to expire at the end of 2024. As a result, physician recruiters have to be mindful of how job opportunities and scopes of support might change beginning January 2025.
Change in incentive packages
For providers that work on a fee-for-service basis, in which they are paid for each test, procedure, and treatment they provide, their income rides on the overall quantity of services. These doctors would lose money in healthcare systems that proactively implement telehealth programs and reduce ER visits, specialty referrals, hospital admissions, and surgeries. Recruiters should be prepared with alternative compensation models.