Managing virtual health care risks in the digital health revolution

Take-up of digital health services has grown dramatically during 2020 in response to COVID-19. Social distancing requirements have resulted in more health and wellness providers relying on technology to deliver virtual services to patients, and previous user reticence to adopting such services has evaporated almost overnight.

As people get used to remote consultations and tech-enabled monitoring of chronic illnesses, it is generally recognized that the digital health revolution will outlive this pandemic. The speed of change and adoption has been remarkable, but as reliance on technology in health care provision becomes normalized, opportunities are opening across the wider health and wellness umbrella, not previously foreseen.

Here, we consider how the expansion of digital health is creating new risks and a new claims environment for health and telehealth providers, concluding with tips to help these professionals adapt.

Faster adoption

Through broader acceptance of virtual health care, we have likely reached the adoption tipping point where digital health will become a mainstay of health provision in the U.S. beyond the COVID-19 crisis. Anecdotally, hospital clients have told us that from undertaking a few thousand teleconsultations a year prior to 2020, since the pandemic, they have been undertaking a similar number weekly.

This information is backed by a McKinsey study published in May that saw the adoption figures for telehealth rise from 11% in 2019, to 46% of consumers in 2020. This was accompanied by a rise of between 50 and 175 times more patients being seen virtually.

Likewise, there has been significant growth in the mHealth sector — wearables, apps, and mobile technology that provide access to health care support and monitoring — particularly to help the ongoing management of long-term, chronic conditions.

Regulatory relaxation

Federal and state responses to the COVID-19 crisis this year have eased some of the previous regulatory constraints to the adoption of digital health in the U.S.

For example, the federal Coronavirus Preparedness and Response Supplemental Appropriations Act, passed in early March, enables the Health and Human Services Secretary to issue temporary waivers of Medicare coverage requirements for telehealth services.

One of the provisions relates to the “originating site” requirement that restricts reimbursement to patients receiving treatment in a physician’s office, clinic, hospital, etc., and once waived enables Medicare patients to be treated remotely at home.

However, the regulatory picture remains complex, particularly where individual states undertake their own initiatives, and the dynamic nature of the current environment makes it hard for providers to keep up with regulatory changes. It can be assumed that if digital health remains a key element of health service provision post the pandemic, then federal and state regulations will be reconsidered and adapted accordingly.

Evolving claims environment

In line with the uptick in the adoption of digital health services, we are starting to see an increase in claims. As digital services develop, so too do some of the risks, and a new claims environment is taking shape.

Traditionally, when we consider negligence in the professional liability space, we look at whether there was a deviation in usual standards of care. Historically, one of the first questions on a digital health-related professional liability claim tended to be whether it was appropriate or reasonable to use a virtual service to provide care.

But, over the past few months, as digital health services have become normalized, these questions have become less relevant. However, with an increasingly aggressive plaintiff bar, we anticipate a wave of claims relating to a different outcome or diagnosis if the patient had been seen in person.

There are few set standards that have been tested in the courts, and possible claims scenarios need to be considered.

Best practices for providers

Based on our experience since the outbreak of COVID 19, here are 10 suggestions for medical professionals who are providing virtual health care services:

1. Speedy connection: Make sure your service providers have fast internet connections to interact with the users. Nothing can be more frustrating than discussing confidential information with a user, and the service cuts out!
2. Proven platform: Choose a trusted virtual service provider to interact with your clients. Proven platforms offer more reliable networks and data security measures that will protect you in the long run.
3. Retain professionalism: Maintaining professionalism with clients of your service is essential. This includes only communicating through the agreed application channels. Avoiding texting or messaging clients through other social media apps is recommended.
4. No distractions: If video is included in the virtual interaction, make sure the caregiver’s environment has no personal items in view or other distractions (family members, pets, etc.) and they are dressed professionally.
5. Lag time: Delays can occur even with the best virtual video platforms. Keep this in mind when speaking with users. A good rule is to wait 2 seconds before speaking to ensure the user is finished with their sentence.
6. In-depth screening application: These are critical prior to service for capturing as much information as possible about a patient’s health. Since many of these interactions are with first-time users, the provider lacks the patient history and rapport that develops through regular in-person visits.
7. Informed consent: Securing patient consent ahead of a visit is often a requirement – and a best practice for telemedicine regardless of your location. Tell patients their rights, explain what the telemedicine process entails, and educate them on their responsibilities.
8. Verbal and non-verbal cues: These are important to show the user you are listening. With a virtual app, we don’t have as many visual clues of a patient’s status, so it is important to help them feel that they are being heard and understood.
9. Red flags: Have a list of conditions that should not be evaluated through a virtual consultation. If a patient is exhibiting chest pains, shortness of breath, fainting, etc., those individuals should be directed to go to the ER or see their doctor in-person.
10. Follow-up can be critical: If there are post-appointment follow-up needs, make sure the patient has a clear understanding of the next steps to alleviate any confusion about follow-up activity.

Risk awareness

Given the exponential growth in the industry, it can be hard for digital health businesses to have a 360° view of risks that they face. Some businesses have decades of expertise in health care and have found themselves pivoting into the virtual world.

Other businesses may have a strong foundation in technology but are new to the complexities of the health and wellness space. As these businesses grow, they are more likely to encounter one or more of the claims scenarios highlighted above.

The digital health revolution offers many opportunities and promise, but experienced insurance partners and specialist expertise is required to avoid costly and long-tail claims. Detailed understanding and risk management planning are needed to navigate this new risk environment.

Keri Marmorek is Miscellaneous Medical & Life Science Claim Focus Group Leader at Beazley. She can be reached at keri.marmorek@beazley.com.

Related:

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• COVID-19 accelerates the adoption of telemedicine in aging services
• Social distancing and telehealth: The impact of the coronavirus