Credit Suisse https://www.credit-suisse.com as part of their Healthcare Disruptive Technologies & Innovations series, recently hosted Linda Branagan PhD, Director of Telehealth Programs, at the University of California San Francisco (UCSF) https://healthinformatics.ucsf.edu/telehealth for a virtual meeting with a small group of investors.
UCSF uses Zoom for essentially all of their telehealth visits. UCSF’s partnership with Zoom since 2016, has been used for telehealth via a University of California wide services agreement which was already in place and has resulted in very attractive pricing for UCSF. By way of background, UCSF is comprised of 3.4K faculty members, including dentistry, pharmacy, and nursing faculty. In any given month, ~2.2K different physicians use telehealth.
UCSF does not focus on urgent care telehealth, which Ms. Branagan attributes to UCSF’s “bread and butter” being specialty and subspecialty care. Such interactions with UCSF typically do not start with urgent care symptoms ) e.g., cold/flu, bronchitis, strep throat, etc.).
From 2015 through most of 2017, UCSF was averaging well under 500 video visits per month. Beginning in 2018 and continuing in 2019 and into early 2020 (prior to the acceleration due to COVID-19). However, there was a steady increase in average monthly visits reaching ~ 3,600 video visits in February 2020 (~2.5% of all visits).
UCSF then conducted just under 30K visits in March 2020 while April saw a 16.5x increase in visits relative to February (just under 60K monthly visits) where 62% of all non-procedure visits were done via video.
Encouraging utilization has continued in 2021 where January had just under 55K video visits (~2.7K video visits per clinic day) with volumes in February on a similar trend. Video visits are currently trending between 30-35% of ambulatory volumes. Ms. Branagan believes video visits have the ability to stay in the range of 30-35% even post COVID.
Pre-COVID, UCSF decided to offer telehealth to Medicare patients and assumed the cost for five years. With telehealth volumes relatively low pre-COVID, the lack of reimbursement did not equate to an enormous amount of money being lost,
However, now if reimbursement returns to pre-COVID levels, Ms. Branagan does not believe UCSF could continue to offer telehealth to Medicare FFS patients considering the way that telehealth volumes are trending. UCSF would continue to offer telehealth to commercially insured patients and Medi-Cal, which Ms. Branagan notes has always been supportive of telehealth.
Apart from reimbursement, Ms. Branagan views state licensing laws as an important component to advancing telemedicine adoption. Just recently, there was bipartisan legislation introduced in both the House and Senate to continue to allow care to be delivered across state lines via a provider is fully/validly licensed in one state legally throughout the course of the pandemic. While this flexibility is only temporary, Ms. Branagan sees it as a big deal given that Congress has effectively admitted that Congress has it in their power to oversee provider state licensing laws
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