Reducing Cardiovascular Risks During COVID-19 - Episode 10
Deepak Bhatt, MD, MPH: One thing worth talking about is something relevant for all phases of care: folks who have cardiovascular disease but aren’t in the hospital or folks who have come in with cardiovascular disease and are COVID-19 [coronavirus disease 2019] positive and survive all that. How do we perhaps use telehealth to enhance their care, keeping the healthy out of the hospital and keeping those who have survived hospitalization healthy and perhaps keeping them from coming back again, either with COVID-19, a cardiovascular complication, or some sort of health ailment. What do you think beyond what’s going on now? Lots of doctors are doing telehealth visits. Fortunately, at least for the time being, it seems reimbursement has kept up with that. If that goes away, telehealth will disappear in this country, I think. Assuming that it’s being reimbursed appropriately for the time, energy, and resources invested, what else can we do beyond just the telehealth visit to either maintain cardiovascular health or prevent complications?
C. Michael Gibson, MS, MD: I personally think telehealth is here to stay, particularly given that it’s being reimbursed. Patients love it: They don’t have to travel, and they can do it from the comfort of their home. There are some studies this week showing that, if you just turn your neck to the side and look, you can do just as good of a job with a video camera in assessing the JVP [jugular venous pressure] as you can at the bedside. I’m sure we’ll see a host of other add-ons to come out to assist with telehealth, such as things to oscillate and all that.
It’s interesting. The physician time is getting reimbursed, but talking to hospital administrators, what’s happening is that they’re not getting reimbursed for the cost of the rooms and all the infrastructure at the hospital or the cost of having fellows. Those fellows go in to see the patient with you, so the cost of the educational system is not being paid for.
They’re not making money on telehealth. Most systems are actually losing money as a health system: not the doctors, but the health system is losing money. As 1 person said to 1 of my friends, “Well, Doctor, we get paid $27 for your time with the patient, but we get paid $35 for the parking.” It’s that kind of issue.
On the other hand, the future is going to be more and more app based. We’re seeing that in everything. We at the Beth Israel Deaconess Medical Center are certainly predicating our whole HEARTLINE study based on apps with patients getting on every day. It takes their wearable, and it looks at how often they’re standing, how often they’re sitting, how mobile they are, and how many steps they’re getting in. The complexity of all this is going to continue to increase with oxygen saturations and heart rates. For monitoring some of our heart failure patients and getting our older patients moving around, that’s going to be a powerful tool.
The new Apple Watch comes with a true single-lead EKG [electrocardiogram], not just a laser to detect irregular heartbeats. When you put your fingers on it, you get an EKG. Finally, they then type in answers to questions. I can imagine that, in the future, your visit will have information from a wearable; maybe too much information. The next question is going to be this: What’s important? We don’t yet know. Is all this stuff that’s asymptomatic relevant? We don’t know that, but you’ll see some tools to help sort out all that below the tip-of-the-iceberg information that we haven’t even been looking at. That’s probably a bit of the future.
Deepak Bhatt, MD, MPH: You’re right; that is the future. Whether we want it to be as physicians or not doesn’t even matter because the technology is here. It’ll get better. Patients love it. Healthy people love it. The penetration of those types of technologies will be such that we will have no choice as physicians other than to react to those data. If we can do it with actual evidence, such as what you were trying to generate in the HEARTLINE study, that will make all the difference and make integrating that type of data useful and help care instead of impede care. Congratulations on that study.
Transcript Edited for Clarity