During the COVID-19 pandemic, outpatient telehealth appointments at Vanderbilt University Medical Center reached a peak of 2,700 in one day as clinicians worked to ensure patients received uninterrupted care as the public health crisis continued.
In response to the pandemic, Tennessee legislators passed a law in August 2020 requiring health insurers to cover telehealth the same way they would in-person care until April 2022. Legislation to remove the bill’s expiration unanimously passed both the State House and Senate this month and is headed to Gov. Bill Lee’s desk where it is expected to be signed into law.
This news comes as Sara Horst, MD, MPH, associate professor of Medicine, has been named the new medical director for Telehealth Ambulatory Services for VUMC. Horst succeeds Michelle Griffith, MD, assistant professor of Medicine, who recently moved to her hometown of Pittsburgh, Pennsylvania, to join a medical practice and be near family there.
Griffith, who was named to her telehealth leadership role in 2018, was instrumental in the rapid implementation and adoption of remotely connecting VUMC clinicians and patients, and she worked closely with the Medical Center’s telehealth staff, IT personnel, clinicians and leadership to make continued, responsive improvements to the Medical Center’s telehealth processes.
“The transformation in our practice pattern has been astounding, providing a new level of access and service for our patients,” said Kimryn Rathmell, MD, PhD, Cornelius Abernathy Craig Professor of Medicine, chair of the Department of Medicine and physician-in-chief for Vanderbilt University Hospital and Clinics.
“I am incredibly grateful to Dr. Michelle Griffith for enabling us to make this large shift and doing so with such grace. We are still on a strong, upward trajectory, and I’m delighted that Dr. Sara Horst will be guiding us in the next phase.”
Horst, a gastroenterologist specializing in the treatment of inflammatory bowel disease, had been working with Griffith and Amber Humphrey, senior director of VUMC Telehealth, to develop a telehealth program within her provider group right before the pandemic began.
At that point, the majority of the telehealth encounters at VUMC followed a clinic-to-clinic model in which clinicians connected with patients or other providers at other clinic locations for consultations and care coordination. With the pandemic, the majority of telehealth visits transformed to a direct-to-patient model, which meant clinical providers were connecting virtually with patients — often from the safety of their homes — for appointments.
In March 2020, Horst quickly stepped in as the pandemic began to help facilitate the delivery of telehealth throughout VUMC, often serving as a troubleshooter and trainer for other clinicians as they became familiar with telehealth technology and a different way to deliver patient care.
As medical director, Horst will support ambulatory telehealth efforts throughout VUMC; work with clinical leaders on protocols to ensure telehealth is delivered in a manner that meets all compliance, quality and standards of care; develop and track quality metrics related to telehealth; and communicate national and state telehealth regulatory updates to clinical staff.
“I’m excited about this challenge,” Horst said. “Telehealth has changed how I practice medicine, and I’ve been a longtime proponent of this. I plan on ensuring we continue to make telehealth as facile and useful for providers as possible.”
Many states, including Tennessee, as well as the U.S. Centers for Medicare & Medicaid Services (CMS), temporarily waived rules early in the pandemic requiring licensed clinicians to hold a license to practice in the state where their patient is located. Some states have begun rolling back waivers, limiting the ability of medical providers to conduct certain virtual appointments.
Providing telehealth is a priority for VUMC, and it was added to the institution’s Pillar Goals in fiscal year 2017 (FY 17). At that time, the goal was simply to increase the number of telehealth visits annually to 6,368. In FY 21, with the catalyst of the pandemic, there were 202,183 ambulatory outpatient visits, significantly exceeding that year’s reach goal of 184,000. In FY 22, VUMC clinicians are on track to complete approximately 177,000 telehealth ambulatory visits, fewer than the previous year but still surpassing the FY 22 reach goal of 140,290, Humphrey said.
The decrease in telehealth appointments in FY 2022 can be attributed to many reasons including a steadily reduced risk of COVID-19 transmission due to vaccination and other factors; patients’ need and readiness to see clinicians in person; and the loss of some states’ licensure waivers related to telehealth.
Patient feedback continues to confirm telehealth is a valued health care option, with consistently positive scores and comments received both through the Press Ganey patient satisfaction surveys and through Advise Vanderbilt, an online community that provides feedback through monthly surveys.
“Overall, the message is telehealth is here to stay, especially at the state level where we have a lot of opportunity,” Humphrey said.
“VUMC is also continuing to monitor what’s happening at the federal level in relation to telehealth provision for Medicare enrollees and will respond appropriately.”
In mid-summer 2022 there is a planned video platform enhancement for telehealth, still securely housed within My Health at Vanderbilt, and Horst is looking forward to working with clinicians to determine how telehealth fits best within their specific clinic workflows, pandemic or not.
“In our clinic, our return visits are approximately 30 to 40% telehealth now,” Horst said. “We’re very high utilizers, and we serve a specific population that telehealth works well for. Every day when I talk to patients, they’re just so grateful they still have the option for telehealth and that we make it so available.”
“Telehealth matters,” said Rathmell. “It is a technology that has the disruptive potential to truly change how we engage in patient care and achieve our goals of creating a healthier public. We will need to adapt and learn how to apply this tool to that best effect, and I’m excited to see what the future holds.”
