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More video visits and more doctor burnout: How the pandemic has changed health care in Colorado

Highlights from The Colorado Sun’s panel discussion on the future of health care

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Recently, The Colorado Sun convened a panel discussion on the future of health care in the state: How the coronavirus pandemic has changed the way we all receive care and how it will change the industry.

If you missed the event, it’s still well worth your time to check it out. The full video of the event is posted on YouTube.

Here’s a snapshot of major discussion points.

The pandemic has fundamentally changed the way health care is delivered.

In-person visits to the doctor are back after the shutdowns of spring 2020, but telehealth and video visits — along with emails and live chats — aren’t going away, especially since, in some cases, virtual visits have cut down on patient no-shows and improved access to care.

“As soon as COVID hit, within about a week, we had to get to almost 100% virtual,” said Dr. Jeff Krawcek, the president and executive medical director of Colorado Permanente Medical Group, which provides the doctors for Kaiser Permanente Colorado.

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One key reason for the explosion in the use of telehealth during the pandemic — besides the need to provide medical care while preserving social distancing — is that Medicare began reimbursing doctors more widely for telehealth visits. That meant that medical providers who had been reluctant to use telehealth could now jump in.

But it also meant doctors needed some new training.

“It almost in some ways feels like the old-fashioned house calls,” Krawcek said. “But we really had to retrain our physicians, really silly things like what your background is, what the lighting is, how to really stop and address the patient.”

Dr. Autumn Orser, senior vice president of health informatics at Peak Vista Community Health Centers, said her system needed to figure out which services worked best for telehealth and which didn’t. And Sharif Abdelhamid, Denver Health’s director of patient experience and advocacy, said providers had to work hard to make sure the virtual visit didn’t feel so remote.

“I think some of that human connection, we’ve had to figure out how to do that better through technology,” he said.

The pandemic has highlighted the huge importance of patient trust.

Doctors can provide better care when their patients trust them. And people are more likely to trust doctors if they feel a connection with them.

This is as important in Denver — where Denver Health has 20 in-house interpreters serving patients who speak in 120 different languages or dialects — as it is on the Eastern Plains, where Peak Vista is placing an emphasis on recruiting for open positions, including one for a doctor in Limon, from within the community.

Dr. Autumn Orser, senior vice president of health informatics at Peak Vista Community Health Centers speaks during the Colorado Sun’s virtual panel on the future of health care on Sept. 28, 2021. (Screenshot by John Ingold, The Colorado Sun)

“Getting somebody from another state to come in and work there is really tough,” Orser said. “But if we can work with a community and work with people who are trained and hire those people into the positions, then it’s a win-win for everybody because the community already trusts those people because they know them.”

Large systems are also working to build trust with patients by making sure patients feel represented among providers.

“Really our goal is that our medical group looks like our patient population,” Krawcek said.

Building an inclusive health care system is also an evolving process. Abdelhamid mentioned how Denver Health is preparing to care for refugees arriving from Afghanistan. That means the health system must add some new capabilities.

“We’re really trying to gear up our language services in Pashto and Farsi,” he said.

The pandemic has worsened burnout among doctors and nurses

The flipside to building patient trust is the stress doctors feel when they don’t have it.

Krawcek said doctors have been stunned during the pandemic to find that patients they have worked with for years are suddenly angry with them and posting negative reviews about them because the doctors tried to encourage coronavirus vaccination. That, in turn, can lead to compassion fatigue, something that doctors and other health care providers struggle to even acknowledge, let alone deal with.

Krawcek mentioned a conversation he had where one employee said, “Physicians don’t get to have compassion fatigue. Isn’t that what you went to medical school for?”

Orser said doctors at Peak Vista are struggling with the same thing — how to stay enthusiastic about your job when it has become a place of so much stress and anger.

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“Burnout among physicians and advanced-practice providers has been a problem for a long time,” she said. “And that has been exacerbated significantly over the last 18 months.”

One way Peak Vista is trying to combat that is to give doctors the freedom to work on passion projects. That might mean getting more involved in care for conditions they are especially interested in. Or it might mean seeing patients in Peak Vista’s “walk with a doc” program, where visits can take place on a stroll outside.

“Really working with providers to know what is going to excite you and get you up in the morning and keep coming back,” she said.

The pandemic has accelerated innovation.

Remote monitoring of vital signs? Collecting health data from Fitbits and Apple watches? Yep, that’s the future of health care. But COVID, with its emphasis on distancing, helped bring the future to right now.

“My guess is in the future that we’ll be offering that for everybody,” Krawcek said.

The pandemic also may have spurred a shift in how health systems think about their patients.

“For a long time we have shied away from thinking of patients as consumers,” Abdelhamid said. “And I think that has prevented us from being able to drive improvement as quickly as a non-health care industry.”

Editor’s note: Kaiser Permanente Colorado was a sponsor of the panel discussion but did not have control over the selection of the panelists or the questions asked.


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