The COVID-19 pandemic initiated a tidal wave of telehealth and telemedicine usage across the country and around the world. Organizations and practices that had previously saturated geographic regions with ambulatory clinics, are now under tremendous pressure to adapt as visit volume has shifted from in-person to telemedicine, and it is not likely to return to pre-COVID levels. Those looking to grow their practice will find new opportunities — namely, the ability to leverage their own telemedicine platforms to consumers and provide virtual care to patients outside the “brick and mortar” and payer restrictions that existed yesterday. We anticipate that many providers will downsize both primary and specialty care square footage and clinical staffing. These downsizings are in response to the cost pressure health systems face as they enter the other side of this crisis with weakened balance sheets and the mass adoption of more cost-efficient telehealth models.

With a telehealth visit, 95% of a patient’s time is spent face-to-face with the doctor, compared with less than 20% of a traditional visit, in which most time is spent traveling and waiting. With that said, it is not a surprise that physician practice models will continue to change dramatically as they move to virtual care. The impact will likely reduce the use of exam rooms, MOBs will have high vacancy levels, waiting rooms will become obsolete, and revenue streams historically controlled and enjoyed by health systems will suddenly become controlled virtually by providers and caregivers. Based on current COVID-19 practices, several physicians interviewed believe they could optimally manage their patient panel with only two days in clinic per week. Therefore, re-evaluation of your primary care clinics is a need-to-do initiative, considerations should include smaller clinic footprints, higher rates of rotating staff sharing office and exam space, clinic consolidations, and reduction of clinical and administrative support staff.

For example, the average six-provider family medicine practice could add an additional 800 virtual visits or 600 in-person visits to their panel each year for every 10% shift of volume to virtual visits. From a physical space perspective, if the practice chooses to maximize their provider productivity by backfilling with the 600 in-person visits, the practice still needs less exam room space than before the shift to virtual care. Clinic consolidations and the reduction of future real estate needed will help lower overhead costs and maximize revenue per square foot.  Additional clinic and exam room modifications to consider include:

  • Collaboration between call centers for registration, scheduling, vitals and check-in before transferring telehealth calls to the provider who is likely located elsewhere.
  • Drive up check in.
  • Wait in car; reduced and separate waiting rooms.
  • PPE application prior to entering front door of clinic, and handwashing stations with no-touch services.
  • Minimal offices needed since telemedicine providers are working remotely (from home or centralized call center).
  • Bigger data and electrical closets.
  • Telemedicine technology counters/tables/consult spaces to provide and educate patients on using in-home equipment.
  • Exam rooms sized to accommodate family members or friends who accompany the patient to minimize the number of people in the waiting room.
  • Multi-functional exam rooms that house supplies needed for multiple types of patient interactions, i.e., POC testing, lab draws, education/teaching, counseling, scheduling and payment;
  • Exam rooms equipped for telehealth services to allow physician/staff-patient consults virtually, these may include multi-disciplinary team consults, patient teaching, behavioral health support, etc.

While much of the conversation around Telemedicine has focused on the staff/provider-patient interaction, that is only one process of many that must be executed well, in order to achieve a high level of staff engagement and patient satisfaction.  Most of the steps that go into an efficient and effective in-person patient visit must occur in the virtual environment as well, but perhaps in different ways.  Patients still need to be scheduled, pre-registrations completed, insurance authorizations obtained, and out-of-pocket costs communicated.  The speed and access provided by virtual visits will demand that these pre-visit activities happen much more quickly so as not to delay the visit.  Staffing models for the pre-visit functions need to be assessed and adapted to this new virtual environment.

Given the rapid  provider adoption of telemedicine, high level of patient satisfaction, increase in access telemedicine offers, and current, while temporary, reimbursement by CMS, it is likely the telemedicine train has left the station.
101 W. Broadway, Suite 101
San  Diego, CA 92101
Debbie Jacobs, Director West Region