Healthcare practitioners have had to change the way they run their practices, and many say these new procedures could be here to stay. Chris Gandhu, a High Net Worth Planner with TD Wealth, and Dr. Adam Stewart, a family physician from Madoc, Ontario, talk to Kim Parlee about what the future of our healthcare practices might look like.
Print Transcript
[MUSIC PLAYING]
- Adam, I'd like to start with you, and the question is, how has medicine changed over the last few months? And if you could, maybe, what's the good and what's the bad?
- Yeah. First of all, thank you for having me. And I think it's definitely catapulted virtual care at least two or three years into the future, both for patients and doctors who might have been reluctant to pick up doing video visits or telephone visits or email prior.
So this has good things and bad things. One thing, we're seeing more phone calls, more ability to do email and virtual video visits. So it's increased the modality, the number of modalities we're using to see patients. And we're realizing that maybe not every patient needs to be seen in person, and that has capacity implications on the good side. We're realizing we can increase our capacities to see more patients, and that speaks to the benefits of the health care system as well.
That said, there are some drawbacks that are in this pandemic. Some patients do need to be seen in person. And every patient encounter now is a balance of-- there's this added layer of decision making for the doctors. It's a mixture of added logistics and safety. So, for example, we have to think about, is this patient safe to assess over the phone or do I need to bring them in? Can it wait? Is this diagnostic center open for a chest x-ray? Will they see a person with a cough? Is this specialist open?
So there's a lot of challenges as well. So I think, by the end of the day, I speak for all most of us physicians is that we're now seeing a lot of decision fatigue because of this extra layer of decisions that are being put on this every day.
- Yeah, and we're seeing-- that's a good point. I feel like everything takes four times as much effort and four times as much planning for simple tasks. And I'm sure that it gets amplified in your world. Can I ask you, though, what changes that you've seen that the patients like? I mean, are you seeing patients happier with the way things are working right now?
- So there's some definite benefits that have turned to some really patient-centered care. And I think a lot of patients just love the idea of having a quick phone call instead of having to come in to the office in person. And to amplify that, we live in-- or I practice and live in a rural area, and some of my patients are having to travel 45 minutes or an hour or two hours to some of the bigger cities for their specialist visit each way.
So that's-- they would normally have to take a half day or a day off of work, whereas now, if it's going to be a quick little follow-up with a specialist, I think they're really appreciating the fact that they could do a quick five-minute phone call, maybe, or 20-minute phone call and not have to take that whole day off work. So I think that's been a tremendous benefit for patients.
- Chris, I want to bring you in the conversation. I mean, we heard Adam talking about what it means for his practice as a doctor and for patients. But when you take a look at business efficiencies-- and I know you work with a number of doctors and dentists-- what are you seeing in terms of these efficiencies? What are being found?
- Right. So telemedicine does have the ability to significantly reduce costs for physicians. So, for instance, we don't need that traditional clinic with a large waiting area and multiple patient rooms anymore because we're doing everything through telemedicine. And of course, because patients are checking in online, perhaps you also don't need the front reception staff.
And as Adam has verified and I've anecdotally heard, seeing patients virtually also leads to efficiencies because you can see more patients during the same allotment of time. And that, of course, increases the top-line revenue for physicians. And Kim, just the way you and I are working from home right now, if telemedicine does open the door for physicians to work from home, well, that has its own benefits and efficiencies associated with it.
- Adam, I mean, what challenges are you facing, though, to have all those systems work the way that Chris talks about, because we know that, end state, it would be nice to have all those things in place. But I'm sure there's some data infrastructure or even coding or how things are put together that probably, I'm going to guess, are not in place quite yet to actually make all those things work.
- So I think definitely-- Chris's point-- there's efficiencies to be made here. But there's also this other workflow of patients who do need to be seen. And there's some challenges in terms of getting-- implementing virtual care where just getting connected, it's taking 15 to 20 minutes extra sometimes to get this new technology that doctors aren't used to and patients aren't used to. So in these early stages, there is a bit of a slower pace. But I think that that can be improved.
Speaking to that, the technology platforms could be improved. The ones we have now that are kind of mandated by the government in order to use their full spectrum of fee codes, at least in Ontario, is-- it's not so user friendly or intuitive for patients and doctors. So there's improvements to be made there for sure. But I believe it definitely can come.
Along a second point is that the billing codes need to really catch up to what is going on now. So there are some makeshift billing codes that Ontario has done to help remunerate doctors for telephone calls. But there's technology now that patients can email me and a photo of their rash or skin spot and I can reply back or staff could-- I could relay some advice to the staff to then call them. But the way the current payment structures are set up, physicians aren't remunerated unless they're actually speaking to the person on the phone or seeing them in person. So those things need to catch up to the needs today.
And as a final note, I'll just say, living it-- all of this technology assumes a few things. It assumes that patients have a computer or a smartphone device so that they can afford it. And it assumes they have high-speed internet for the case of for video-- virtual consulting. And for people like myself who practice in a rural, elderly, impoverished area, those aren't given. So there still has to be this other workflow that needs to be considered.
- Yeah, that's a lot of infrastructure that has to be overcome. I mean, again, the end could be great, but there's a lot that has to happen in between. I know one of the things that has to be managed in all this too is the regulatory side. You talked a bit about billing, Adam. But, Chris, I mean, from your standpoint, any thoughts on just those types of things that need to go into place?
- Yeah. I mean, Adam has raised some very good points. And really, who needs to step up here is now the third stakeholder in this, which is the government. So billing codes are a great example because the system is geared towards sort of face-to-face interactions and billing for that. But now, of course, there's a very different reality.
And as Adam alluded to, there is a lot of technological investment and training and retraining that goes at both ends for the physicians and perhaps the patients too. So it's proper for the government to step up and offer their assistance in that regard.
Plus, there is some sort of interjurisdictional issues, Kim. So if I just make up a hypothetical example, let's say we have a physician in Alberta with a clinic in Alberta. And perhaps she likes to spend her summers in Kelowna on the lake. Who wouldn't? And so she is in Kelowna, but has a telemedicine practice where she's seeing patients in Alberta and maybe as far as Ontario. Who's going to remunerate her? Is it BC? Is it Alberta? Is it Ontario? We don't have that figured out yet. So I think we're all looking out for the government to step up and make this process more easy and seamless.
- Yeah, there's a lot that has to happen in terms of a catch-up-- you're right-- in terms of-- you know, the technology's one piece, but it's the regulation. And Adam, I mean, on that point, too, when I think about where you're billing from and what province, which Chris brought up, but also, I guess, just privacy and consent, I mean, how do you do that in a virtual practice?
- Yeah, so that's a really good point, because even before COVID, our practice was trying to move towards email-- communicating with patients on email or these secure portals. And that takes explicit consent per the regulations right now because patients have to be aware that their email isn't 100% secure. So speaking from our practice, we've been actively trying to do this for probably three to five years, and we still do not have every patient's consent or decline. So these things take time.
And this is a family doctor's office that we're working in. So we're seeing our patients quite regularly. I can only imagine the logistics for specialists. So there is some hint of and some policies being made where, perhaps, if the family doctor gets consent, then that is transferred to the specialist office as well. Things like that will go a long way in terms of helping us move quickly into this next generation.
- What about the financial considerations? I mean, Chris, from the clients that you work with, how should-- Adam's talked about three to four years he's been building and getting ready for this virtual but not there completely yet. But what other ways should health care practitioners prepare for all of this?
- Right. So Kim, what we have really are a bunch of knowns and then a few unknowns. So what we do know is that, because of social distancing and the quarantine, visits to doctors and dentists are down from pre-COVID levels. So that may mean opening up your practice to telemedicine just to get some visits and some revenue flowing.
For dentists, especially, and the allied health professionals who rely on individuals that are employed and their employer-sponsored health coverage to pay for their billings-- well, we have some dramatic unemployment numbers in Canada now, and they may have to adapt their billing practices to account for this new reality.
Those are the knowns. The unknowns really are-- I mean, when we think about provincial and federal governments spending not tens, maybe hundreds of billions of dollars for COVID, well, where is that money going to come from? Who's going to pay for this? And there could be multiple solutions. But one of the options on the table for sure will be increasing current tax rates or perhaps introducing a new tax altogether.
And I think the best way to prepare for that unknown is to be proactive. Just as you would for your business where you have a business plan, have a personal financial plan in place. Build in these contingencies, these unknowns, and then educate yourself on tax strategies, some that perhaps you can take advantage of today and some perhaps that may be most suited if these contingencies come into play.
- Adam, I'll give you the final word. Any final thoughts and things that you're contemplating as you're preparing for the next few years?
- Well, as we've said earlier, it's an exciting time in that there's definitely some opportunities to fast forward technology. And I am kind of interested in, like Chris was alluding to earlier, how can I increase the capacity of my practice without necessarily having-- needing the physical space? I just wrote an article actually for MoneyTalk that came out today or yesterday, today, about how I might be triaging and scheduling my patients differently based on modality-- like, telephone, email, in-person, video-- and urgency. Maybe they need to be seen the first thing Monday morning. Maybe that can wait till Thursday afternoon when it's less busy. So I'm excited to see this as it moves forward.
- Great insight. Really valuable conversation. And thanks to both of you for joining us.
- Thank you.
- Thank you very much.
[MUSIC PLAYING]
- Adam, I'd like to start with you, and the question is, how has medicine changed over the last few months? And if you could, maybe, what's the good and what's the bad?
- Yeah. First of all, thank you for having me. And I think it's definitely catapulted virtual care at least two or three years into the future, both for patients and doctors who might have been reluctant to pick up doing video visits or telephone visits or email prior.
So this has good things and bad things. One thing, we're seeing more phone calls, more ability to do email and virtual video visits. So it's increased the modality, the number of modalities we're using to see patients. And we're realizing that maybe not every patient needs to be seen in person, and that has capacity implications on the good side. We're realizing we can increase our capacities to see more patients, and that speaks to the benefits of the health care system as well.
That said, there are some drawbacks that are in this pandemic. Some patients do need to be seen in person. And every patient encounter now is a balance of-- there's this added layer of decision making for the doctors. It's a mixture of added logistics and safety. So, for example, we have to think about, is this patient safe to assess over the phone or do I need to bring them in? Can it wait? Is this diagnostic center open for a chest x-ray? Will they see a person with a cough? Is this specialist open?
So there's a lot of challenges as well. So I think, by the end of the day, I speak for all most of us physicians is that we're now seeing a lot of decision fatigue because of this extra layer of decisions that are being put on this every day.
- Yeah, and we're seeing-- that's a good point. I feel like everything takes four times as much effort and four times as much planning for simple tasks. And I'm sure that it gets amplified in your world. Can I ask you, though, what changes that you've seen that the patients like? I mean, are you seeing patients happier with the way things are working right now?
- So there's some definite benefits that have turned to some really patient-centered care. And I think a lot of patients just love the idea of having a quick phone call instead of having to come in to the office in person. And to amplify that, we live in-- or I practice and live in a rural area, and some of my patients are having to travel 45 minutes or an hour or two hours to some of the bigger cities for their specialist visit each way.
So that's-- they would normally have to take a half day or a day off of work, whereas now, if it's going to be a quick little follow-up with a specialist, I think they're really appreciating the fact that they could do a quick five-minute phone call, maybe, or 20-minute phone call and not have to take that whole day off work. So I think that's been a tremendous benefit for patients.
- Chris, I want to bring you in the conversation. I mean, we heard Adam talking about what it means for his practice as a doctor and for patients. But when you take a look at business efficiencies-- and I know you work with a number of doctors and dentists-- what are you seeing in terms of these efficiencies? What are being found?
- Right. So telemedicine does have the ability to significantly reduce costs for physicians. So, for instance, we don't need that traditional clinic with a large waiting area and multiple patient rooms anymore because we're doing everything through telemedicine. And of course, because patients are checking in online, perhaps you also don't need the front reception staff.
And as Adam has verified and I've anecdotally heard, seeing patients virtually also leads to efficiencies because you can see more patients during the same allotment of time. And that, of course, increases the top-line revenue for physicians. And Kim, just the way you and I are working from home right now, if telemedicine does open the door for physicians to work from home, well, that has its own benefits and efficiencies associated with it.
- Adam, I mean, what challenges are you facing, though, to have all those systems work the way that Chris talks about, because we know that, end state, it would be nice to have all those things in place. But I'm sure there's some data infrastructure or even coding or how things are put together that probably, I'm going to guess, are not in place quite yet to actually make all those things work.
- So I think definitely-- Chris's point-- there's efficiencies to be made here. But there's also this other workflow of patients who do need to be seen. And there's some challenges in terms of getting-- implementing virtual care where just getting connected, it's taking 15 to 20 minutes extra sometimes to get this new technology that doctors aren't used to and patients aren't used to. So in these early stages, there is a bit of a slower pace. But I think that that can be improved.
Speaking to that, the technology platforms could be improved. The ones we have now that are kind of mandated by the government in order to use their full spectrum of fee codes, at least in Ontario, is-- it's not so user friendly or intuitive for patients and doctors. So there's improvements to be made there for sure. But I believe it definitely can come.
Along a second point is that the billing codes need to really catch up to what is going on now. So there are some makeshift billing codes that Ontario has done to help remunerate doctors for telephone calls. But there's technology now that patients can email me and a photo of their rash or skin spot and I can reply back or staff could-- I could relay some advice to the staff to then call them. But the way the current payment structures are set up, physicians aren't remunerated unless they're actually speaking to the person on the phone or seeing them in person. So those things need to catch up to the needs today.
And as a final note, I'll just say, living it-- all of this technology assumes a few things. It assumes that patients have a computer or a smartphone device so that they can afford it. And it assumes they have high-speed internet for the case of for video-- virtual consulting. And for people like myself who practice in a rural, elderly, impoverished area, those aren't given. So there still has to be this other workflow that needs to be considered.
- Yeah, that's a lot of infrastructure that has to be overcome. I mean, again, the end could be great, but there's a lot that has to happen in between. I know one of the things that has to be managed in all this too is the regulatory side. You talked a bit about billing, Adam. But, Chris, I mean, from your standpoint, any thoughts on just those types of things that need to go into place?
- Yeah. I mean, Adam has raised some very good points. And really, who needs to step up here is now the third stakeholder in this, which is the government. So billing codes are a great example because the system is geared towards sort of face-to-face interactions and billing for that. But now, of course, there's a very different reality.
And as Adam alluded to, there is a lot of technological investment and training and retraining that goes at both ends for the physicians and perhaps the patients too. So it's proper for the government to step up and offer their assistance in that regard.
Plus, there is some sort of interjurisdictional issues, Kim. So if I just make up a hypothetical example, let's say we have a physician in Alberta with a clinic in Alberta. And perhaps she likes to spend her summers in Kelowna on the lake. Who wouldn't? And so she is in Kelowna, but has a telemedicine practice where she's seeing patients in Alberta and maybe as far as Ontario. Who's going to remunerate her? Is it BC? Is it Alberta? Is it Ontario? We don't have that figured out yet. So I think we're all looking out for the government to step up and make this process more easy and seamless.
- Yeah, there's a lot that has to happen in terms of a catch-up-- you're right-- in terms of-- you know, the technology's one piece, but it's the regulation. And Adam, I mean, on that point, too, when I think about where you're billing from and what province, which Chris brought up, but also, I guess, just privacy and consent, I mean, how do you do that in a virtual practice?
- Yeah, so that's a really good point, because even before COVID, our practice was trying to move towards email-- communicating with patients on email or these secure portals. And that takes explicit consent per the regulations right now because patients have to be aware that their email isn't 100% secure. So speaking from our practice, we've been actively trying to do this for probably three to five years, and we still do not have every patient's consent or decline. So these things take time.
And this is a family doctor's office that we're working in. So we're seeing our patients quite regularly. I can only imagine the logistics for specialists. So there is some hint of and some policies being made where, perhaps, if the family doctor gets consent, then that is transferred to the specialist office as well. Things like that will go a long way in terms of helping us move quickly into this next generation.
- What about the financial considerations? I mean, Chris, from the clients that you work with, how should-- Adam's talked about three to four years he's been building and getting ready for this virtual but not there completely yet. But what other ways should health care practitioners prepare for all of this?
- Right. So Kim, what we have really are a bunch of knowns and then a few unknowns. So what we do know is that, because of social distancing and the quarantine, visits to doctors and dentists are down from pre-COVID levels. So that may mean opening up your practice to telemedicine just to get some visits and some revenue flowing.
For dentists, especially, and the allied health professionals who rely on individuals that are employed and their employer-sponsored health coverage to pay for their billings-- well, we have some dramatic unemployment numbers in Canada now, and they may have to adapt their billing practices to account for this new reality.
Those are the knowns. The unknowns really are-- I mean, when we think about provincial and federal governments spending not tens, maybe hundreds of billions of dollars for COVID, well, where is that money going to come from? Who's going to pay for this? And there could be multiple solutions. But one of the options on the table for sure will be increasing current tax rates or perhaps introducing a new tax altogether.
And I think the best way to prepare for that unknown is to be proactive. Just as you would for your business where you have a business plan, have a personal financial plan in place. Build in these contingencies, these unknowns, and then educate yourself on tax strategies, some that perhaps you can take advantage of today and some perhaps that may be most suited if these contingencies come into play.
- Adam, I'll give you the final word. Any final thoughts and things that you're contemplating as you're preparing for the next few years?
- Well, as we've said earlier, it's an exciting time in that there's definitely some opportunities to fast forward technology. And I am kind of interested in, like Chris was alluding to earlier, how can I increase the capacity of my practice without necessarily having-- needing the physical space? I just wrote an article actually for MoneyTalk that came out today or yesterday, today, about how I might be triaging and scheduling my patients differently based on modality-- like, telephone, email, in-person, video-- and urgency. Maybe they need to be seen the first thing Monday morning. Maybe that can wait till Thursday afternoon when it's less busy. So I'm excited to see this as it moves forward.
- Great insight. Really valuable conversation. And thanks to both of you for joining us.
- Thank you.
- Thank you very much.
[MUSIC PLAYING]
