Cliffnotes

Dr. Aditi Joshi of Telehealth.org joins Sarah and Elliott for a riveting play-by-play of the all-too-familiar faceoff between federal budget negotiations (again…) and healthcare providers about permanent reimbursement for telemedicine. Dr. Joshi also shares advice from her book, Telehealth Success: How to Thrive in the New Age of Remote Care, for healthcare organizations across the globe who are just beginning to dip their toes in the vast waters of creative use cases for virtual care. Be there, or be square!

Original music by: Evan O’Donovan

Episode Transcript

(00:00):
Welcome to Tech It to the Limit, the humorous and surprisingly informative podcast that

(00:22):
makes digital innovation and healthcare as entertaining as it is relevant.
I'm Sarah Harper.
And I'm Elliot Wilson.
And we're here to pull back the curtain on the world of digital transformation in healthcare.
Don't worry, you don't need a medical degree to join in on the fun.
Just a sense of humor and a penchant for all things health tech.
So buckle up, folks.
It's time to Tech It to the Limit.

(00:44):
What's up, Elliot?
What's up, Sarah?
It's episode two.
How you doing?
I'm doing all right.
Thanks, you know, like, glad that I'm here with you right now.

(01:04):
Awesome.
I'm glad to be here too with you and with you listeners on Tech It to the Limit.
This is so exciting to be here again.
Love doing this.
Yeah.
Congrats on surviving another corporate tourism event, aka VIVE.
I have got to know because you sent me a couple of selfies.
How many former Tech It to the Limit guests did you see at VIVE?

(01:28):
I'll tell you what, at VIVE, it was like shooting fish in a barrel of former Tech It to the
Limit guests.
You couldn't swing a dead cat around Nashville without hitting a Tech It to the Limit former
guest.
We had Sarah Bell, who was on.
It was like a nurse fest too.
Like Sarah Bell and Bonnie Clipper were there.

(01:48):
I got to hang out and get a massage with Dr. Anjali Bhagra.
We sat around the massage booth on the last day together chatting about integrating mindfulness
into care while we were getting massages.
We were kind of just going back and forth.
She'd get a massage, come out.
I'd get a massage, she'd come out.

(02:11):
It was great.
I got to go to a speakeasy with Ed Marks, which was fun.
Word up.
Did you guys spend the whole time in the line?
I guess there aren't lines at speakeasies.
It's okay.
No, he threw a great party slash speakeasy.
Had a former American Idol voice star singing.

(02:32):
Oh my gosh.
It was incredible.
It was incredible.
We had a great time.
So I mean, it really, Anish Chopra was there too, although I looked, I guess I'm too short
to be able to see him above the crowd, I guess.
So didn't really run into him, but it was crawling with Tech at the Limit Guest, which
was great.

(02:53):
But the conference, the whole conference itself was very interesting.
It was a great conference.
There's great energy, there's great buzz and feel there.
But there were some things about the conference that I thought were kind of weird.
AI was everywhere and everybody was talking everything about AI and really saying nothing.
It was like the entire conference was written by ChatGPT.

(03:15):
You know what I mean?
Yeah.
So that was weird.
But nevertheless, there were nuggets of wisdom to be had here and there.
When you put that many smart people out into the world, you are going to have some insights.
But what struck me, which was mind boggling to me, was there was this undercurrent throughout

(03:35):
the entire show about what people weren't talking about.
People were talking about healthcare like it's always going to be what it's always been and
it's always going to be the promise of the future and grow.
Nobody was talking about the deplorable, destructive and ultimately deadly desecration of our industry

(03:58):
at the federal level.
No one, at least not publicly.
That was like four Ds in one sentence.
Yeah, well, there's a bunch of Ds running the country.
So I thought it was apropos.
You mean doge?
Sorry.
No one was talking about it publicly.

(04:18):
And privately, if you have conversations with people, they're like, oh, yeah, no, this is
bad.
Everything's going to fall down like a pile of bricks here.
But everybody had their head in the sand.
Nobody wanted to talk about it.
So that was a little disappointing to me.
Last thing I'll say about it before we move on.
They decided to do this new thing where it was like dual factor entry.

(04:42):
In addition to your lanyard and your badge, they put on a fabric wristband that once they
put it on had like a mechanism inside it that you couldn't take it off unless you cut it
off.
And if you could not go into the show, you could not go to any of the events if you didn't

(05:02):
have both on.
Wow.
Well, yeah, kind of interesting, right?
Kind of weird, like police state-ish.
A little bit, a little bit.
But it had this tail that hung off of it.
So it was this tail of fabric hanging off of your hand.
And so when you went to scoop food, the tail would go through the food.

(05:28):
And it was on most people's dominant hand.
And which hand do you wipe with?
Oh my God.
It was the most.
The worst outbreak in like two days.
Yes.
It was one of the most disgusting things I've ever experienced when you stop and think about
it at a health care conference.
OMG.
I'm appalled.
Yeah.

(05:49):
So what I'm hearing is that it was a Tech at the Limit, a Jast Alumni bash, right?
That everybody slapped AI stickers on their products regardless of the ingredients within.
And that nobody was talking about Bruno and that there's a health code violation happening

(06:10):
every nanosecond.
Nailed it.
Could not have made it more succinct.
That's on the nose.
That's the executive summary.
A little bit.
Well, I don't have any sexy updates for you.
Yeah, but you've been busy.
What are you busy planning?
Thank you.
I appreciate that.
Yeah, I am really looking forward to what's coming up again this fall in Rochester, Minnesota,

(06:38):
my hometown.
I got off the horn with Alanis Morissette and she thinks you ought to know that the
Rural Health Symposium sponsored by Mayo Clinic Health System and Mayo Clinic Cancer Center
is going to be back in full swing this fall, October 27th and 28th.
Registration will open soon and you can find all the deets on LinkedIn or on Mayo Clinic's

(07:04):
continuous professional development webpage.
I have no idea what the address is, so just ask Google or Bing Chat.
That's awesome.
And might I say not at all ironic.
Nice.
Boom.
Well, listeners, we have a wonderful show for you today.

(07:25):
We have Dr. Aditi Joshi with us.
Dr. Joshi cut her teeth building out telemedicine programs before it was cool back at Jefferson
Health.
She's the original telemedicine hipster, so she was doing telemedicine before it was cool.
She knew about the Backstreet Boys first.
Or Taylor Swift.

(07:48):
Don't even tell me it was Taylor Swift.
No, no, no.
No, no, no.
She was super into Modest Mouse.
Anyway, she now advises worldwide for telemedicine strategy from her home base in Paris, France.
And she joined us to kind of talk about the evolution of telemedicine, where it's going,
where the challenges still remain.

(08:08):
We are so excited to bring her to you all.
But first.
But first, we have a new game and we look forward to sharing it with you when we come
back from our break.
Stick around.
We'll be right back.
Hey there, healthcare leaders.
Feeling like the telehealth cliff is less of a policy change and more of an existential

(08:30):
crisis?
Wondering if your virtual care model is about to go full Wiley Coyote off a fiscal cliff?
Introducing Cliffhanger, the only anxiety medication formulated exclusively for healthcare
executives staring into the abyss of telehealth reimbursement uncertainty.
With just one daily dose, Cliffhanger helps you stop catastrophizing about disappearing
virtual visit payments, pending legislation, and that one board member who read something

(08:53):
on LinkedIn.
Clinically proven to reduce panic induced policy brief binge reading, ease doom scrolling
of CMS updates at 2 a.m. and prevent stress induced PowerPoint deck overproduction.
So before you hyperventilate into your hospital branded tote bag, try Cliffhanger because
your career should be the only thing thriving in a hybrid model.

(09:16):
Side effects may include excessive optimism, spontaneous grant writing, and misplaced faith
in bipartisan cooperation and an inability to explain your strategy without using the
word nimble.
Cliffhanger is not responsible for sudden CMS rule reversals or inexplicable changes
in payer behavior.
Consult your CFO if financial distress persists.
Cliffhanger, for when telehealth reimbursement makes you sweat harder than a pre-op request.

(09:50):
Well welcome back listeners and welcome to our special segment, the ROI is Right.
If you're late to the DEI party and wondering how diversity, equity, and inclusion translate
into tangible results for your health system's bottom line, well turn up the volume, favorite
this episode, or press record if you're still using an FM radio and cassette tapes because

(10:12):
this game is for you.
Because we broadcast.
We broadcast on the airwaves.
I mean, just like let people have their pretty fiction.
Okay, this is mine.
I miss cassette tapes.
This quick fire game is going to recap how a strong DEI strategy helps you attract and
retain top talent and boost patient outcomes and your organization's financial health.

(10:36):
Elliot's in the hot seat.
Well again, because somebody didn't keep his word after losing out on the last game.
I'm still waiting for my sonnet.
True confessions.
I haven't written.
I just haven't.
I just haven't performed it yet.
Okay, I can't wait to be surprised.
Anyway, back to the game.

(10:58):
Sorry.
First round.
How's it work?
This is kind of how it works.
So first round is called factor fiction.
We're going to debunk some common myths about DEI and healthcare.
Then we're going to move on to the DEI prices, right?
A little tip of the hat to one of my favorite co-hosts ever, Bob Barker.
And he's not a co-host.
He's an actual host.

(11:18):
So we're going to, in that round, we're going to reveal real world numbers tied to turnover,
patient satisfaction, and revenue gains.
And finally, we're going to end with a rapid fire ROI round featuring a lightning fast
scenario on what really moves the needle in creating a more equitable and profitable health
system.

(11:39):
So let's refresh our memories on how inclusive leadership pays dividends in more ways than
one.
Are you ready, Elliot?
Oh, probably not.
Don't worry.
We're not actually keeping score this time.
Okay?
All right.
Good.
This is one of those just for fun, just for giggles.
Just for fun or just to embarrass me.
Another one.
Let's go.

(11:59):
I am ready.
Okay, let's go.
Factor fiction.
So you have to let me know, is this factor fiction?
That's all you have to say, right?
Factor fiction.
Implementing unconscious bias training in healthcare teams reduces turnover rates among
minority staff.
Fact.
Correct.
Several reports suggest that when healthcare staff undergo bias training and inclusive

(12:19):
leadership coaching, organizations see decreased turnover among underrepresented groups.
Hey, you know what?
Cost money.
What?
Staff turnover.
Oh my God, really?
Yeah, I know.
I don't think this is a really credible source that I'm quoting from.
I mean, who knows what...
Who's ever heard of Harvard Business Review?
Oh, that sounds made up.

(12:40):
Yeah, it's probably Cosmopolitan's like Sister magazine or something.
Anyway, next one.
I'm going to hit you.
Adding inclusive language to the patient intake form has no effect on patient satisfaction
scores.
Fiction.
Fiction.
Correct.
According to the Agency for Healthcare Research and Quality, inclusive patient-centered language

(13:02):
correlates with higher patient satisfaction and trust, leading to better adherence to
care plans and outcomes.
Oh, and you know those things like CHAP scores that are tied to your revenue?
Just saying.
Just saying.
All right, next one.
Hospitals with diverse leadership teams experience better financial performance than those without.

(13:24):
Fact.
Correct.
This research comes from McKinsey, their Diversity Wins Report.
Multiple of their analyses indicate that healthcare organizations with racially and gender diverse
leadership teams outperform their peers on ROI and profitability.
Who knew?
Yeah, because the more diverse your leadership, the more ways that you'll find money.

(13:46):
Like, different people find money in different ways.
That's just my take on it.
That is my favorite explanation of looking at the world through multiple straws that I've
ever heard.
Just find money in more ways.
That needs to be the new mission, right?
Oh, frig yeah.
Okay.

(14:07):
Factor fiction.
DEI efforts only benefit large health systems with big budgets.
Fiction.
Thank you.
According to the American Hospital Association, even smaller clinics and rural hospitals gain
from DEI-focused strategies through lower turnover, as previously mentioned, improved
community reputation, and reduced liability.

(14:29):
Almost as if when your workforce reflects the people they are caring for, you can build
trust in that community.
And I'm pretty sure scientific evidence also shows that having providers that look like
you and have your same lived experience leads to better patient outcomes.
Have you heard that somewhere?
You know, that sounds familiar.

(14:50):
Hmm.
We'll have to look it up.
All right.
Last one for you.
Factor fiction.
Offering interpreter services for non-English speaking patients reduces readmission rates.
True.
Because they can understand their discharge instructions.
I mean, is that really necessary?

(15:11):
And you know what's even more frustrating?
Because of things like virtual care and telemedicine that we're talking about today, like bringing
in a third party interpreter into a conversation for your discharge education is incredibly
easy nowadays.
Fact.

(15:32):
And I love that approach.
That's a great like creative use case for telemedicine, which ties directly into our
guest conversation today.
So extra points for Elliot Wilson.
Good job.
I do want to reference the evidence for this fact because we're very much about evidence
based podcasting and gaming here at TittlePod.

(15:56):
So according to the New England Journal of Medicine, catalyst studies show patients receiving
care in their preferred language have fewer complications and lower readmissions, saving
healthcare dollars in the long run.
No shizzle.
How'd I do?

(16:17):
I think it's a five for five.
Everyone cheer on.
Let's have a round of applause for Elliot.
Good job.
All right.
He must know a thing or two about ROI and DEI.
All right.
All the acronyms.
Give me all the TIs.
Nice.
That's why you're so good at this.
All right.
Round two, the DEI price is right.

(16:38):
I'm going to read you a question.
You have to guess the figure and I don't really care if you're close because you're not competing
against anybody else.
But we certainly encourage our listeners to play along and see if you can beat Elliot.
All right.
First question.
How much does the US healthcare system lose annually due to avoidable readmissions often

(16:59):
tied to communication gaps and cultural misunderstandings?
Seventy three billion dollars.
Very good.
It's actually 17 billion.
I'll give it to you.
I'm only off by a factor of 10, but almost.
You know what?
I mean, it could have been like $2.
You could have said $1 and you would have been closer.
This is the DEI.

(17:20):
It's right.
All right.
That figure comes from the New England Journal of Medicine catalyst.
All right.
Next question.
What is the estimated cost to replace a single bedside registered nurse which can be mitigated
by inclusive workplace practices?
So we're talking national averages for a bedside registered nurse.

(17:44):
Just for the turnover.
Yep.
Just the value of one turnover.
Fifty thousand?
I'll give it to you.
It's between 40 and 60 thousand.
According to nursing.
That's literally 50 thousand.
Yeah.
Exactly.
Right.
According to NSI nursing solutions in a 2021 report.
So it's probably higher these days.

(18:04):
All right.
Next question.
By what percentage can diverse leadership teams outperform their peers financially according
to major consulting studies?
So this fact comes from McKinsey and Company.
Yeah.
I feel like we just talked about it.
We're diving deep.
Seven percent.
35 percent.

(18:26):
Shut up!
Shut up!
Yeah.
I mean, those people know how to find money in diverse ways.
Yeah.
Right?
And they have to go to different kinds of couches for that loose change.
Right?
Well, let's look at this one on the porch.
To your pockets.
All right.
Sorry.

(18:47):
I was channeling like the school bully, which I only experienced as a victim.
All right.
How much can investing in a robust DEI strategy lower overall turnover costs in a health care
organization?
So this is for all employees, not just nursing.
Right.
It's a percentage.
Yeah.
As a percentage according to a Gallup workplace study.

(19:11):
22 percent.
Very good.
20 to 30 percent.
Nice.
Nice.
Yeah.
Holy shite.
Right?
Yeah.
That's like a lot.
I mean, just think about the cost of turnover is massive.
All right.
Last question in this round.
What's the estimated annual boost in revenue for hospitals that effectively engage diverse
communities and reduce care disparities?
This is a nominal number?

(19:33):
Nope.
Percentage.
Percentage.
OK.
How much can I boost my revenue if I engage diverse communities and reduce health care
disparities?
16 percent.
Overshot that one a bit.

(19:56):
Five to 10 percent.
So think about it.
I'm going to reduce my cost by 20 to 30 and I'm going to increase my revenues by five
to 10.
Right?
So that's according to the PwC Inclusion and Diversity Research Report.
All right.
Last round.
I think I did pretty good on that round for pulling some numbers out of my rear end there.
Yeah.

(20:16):
That was a difficult one.
Let's not talk about rear ends after your experience at five.
OK?
Let's just keep it PG.
All right.
Rapid fire round.
Rapid fire ROI.
I'm going to give you a scenario and then you're going to have like zero time to like
check what is your first thing that comes to your mind.
Does it increase ROI or does it decrease ROI?

(20:39):
OK.
Yeah.
Go.
Providing mentorship programs specifically for underrepresented groups in a hospital
setting.
Increase.
Excellent.
Mentorship fosters career growth, according to Harvard Business Review, and reduces turnover
and improves employee engagement.
That's one.
Right.
Yeah.
You keep score for yourself.
All right.

(20:59):
Scenario two.
Increase training budgets to cut costs, particularly for DEI related workshops.
Reduce ROI.
Excellent.
According to McKinsey, undertrained staff may contribute to higher turnover and lower
patient satisfaction, which affects revenue.
No shizzle.
All right.
Expanding language services, i.e. translators and bilingual patient support for patient

(21:24):
intake and discharge instructions.
Increase.
Robs.
Better communication reduces costly readmissions and boost patient loyalty.
Do we want our patients to come back for health care services or just see us one time?
I don't know.
I think you just put them out the door and say, good luck.
Oh boy.
Gosh.
Got speed.

(21:45):
Yeah.
That last one was according to New England Journal of Medicine.
OK.
Next one.
Setting up inclusive employee resource groups for different cultural or identity based cohorts.
Increase.
Muy bien.
This is my favorite one.
Urges of also known as employee resource groups strengthen employee retention, improve morale

(22:05):
and provide direct feedback loops to leadership for better policies.
That's according to the Society for Human Resource Management.
Gee, I wonder if they know a thing or two about managing humans.
I don't know.
They have credentials that they give out to people for that.
As long as those people don't post them on LinkedIn, like every five seconds, like they
just like pass a video game level, which is IBM's new thing now.

(22:28):
I'm fine with it.
You know, just keep your credentials updates to yourselves, please.
I'm certified.
I read this blog post.
Right.
OK.
We have three more.
Three more.
OK.
Overlooking LGBTQ plus patient care preferences in new telehealth expansion plans.
Oh, how relevant.
Did you say overlooking?

(22:48):
Overlooking.
That's going to decrease ROI.
Yes.
Right from the mouth of babes.
Lack of inclusive services can alienate a sizable patient population, hurting patient
acquisition and satisfaction.
And did we mention outcomes?
Exist of care.
OK.
That's according to the American Hospital Association.

(23:10):
All right.
Penultimate scenario.
Partnering with community organizations to address social determinants of health.
That's going to increase your ROI.
Really?
Is it though?
I don't know if the CDC knows what they're talking about.
Some people don't think they do.
OK.
Better community health according to the Kaiser Family Foundation.

(23:34):
Better community health translates into fewer emergency room visits and more trust in your
facility, ultimately improving financial health of said facility.
All right.
Unless you like offering free care.
You know, I mean, that just seems like a really flawed.
But that's not on the minds of every CFO in the country at all.
All right.

(23:54):
Last one.
Ignoring feedback from diverse staff members on improving patient provider communication.
That's going to decrease your ROI, Sarah.
You're so smart, Elliot.
Failure to utilize staff insights leads to missed opportunities for patient retention
and will definitely heighten your turnover, according to Gallup.
I feel like we didn't need to poll people about that.

(24:16):
That's kind of just like a no brainer.
Yeah, I'm sensing a theme here.
Yeah.
Yeah.
Can you just what did you learn from this exercise, Elliot, as our person on the hot
seat?
Like, tell us tell us what you're taking away from this game as the victor.
My biggest takeaway, considering the fact that it's me in the hot seat and got so many

(24:36):
answers correct, is how stinking obvious all of this actually is.
And it's just staring you in the face.
And if you choose to ignore it or more dangerously, actively choose to hinder efforts around DEI,

(25:01):
even the healthcare space, then you are doing a disservice.
You're doing a fiduciary disservice to your organization.
Right.
To your shareholders.
Super, super obvious.
But yeah, kind of like textbook MBA 101.
How to how to lead with empathy and good financial acumen.

(25:25):
Yeah, exactly.
Yeah.
I appreciate that, Elliot.
Like, that's a great takeaway.
And you truly deserve to wear the crown ROI is right champion.
Yes.
Thank you, Bob.
This was my pleasure.
I'm so excited.
I'm going to go off to the showcase showdown now.
I can't believe that we didn't play P

(26:08):
Chef Boyardee and more microwavable toxins.
But it tastes so good.
That's so good.
All right.
Let's move on.
Well, that was amazing, Sarah.
Thank you so much for putting me in that hot seat.
I promise you I will read you my sonnet.
But I feel like I kind of redeemed myself a little bit in this game.
So listeners, stick around.

(26:30):
We'll be right back with our interview with Dr. Aditi Joshi.
Is your health systems documentation suffering from a critical shortage of the un-buzzwords
diversity, equity and inclusion?
Fear not.
Good business sense and basic human empathy are here to rescue you from the doldrums of

(26:53):
looking at the world of opportunity through your narrow monolithic straw.
You're seeing the Inclusionator T800, the hyper-intelligent AI agent that actually embeds
the words diversity, equity, inclusion into every scrap of your documentation intended
for shareholder and federal consumption.
Because in healthcare, if your strategic plan, policies and press releases don't reflect

(27:13):
the people you serve, you might as well prescribe a benzodiazepine or a broken humerus.
The Inclusionator T800 isn't just about looking dazzlingly progressive in the CEO locker room.
Who invited OAC?
This is a men's club.
Piles of research conducted by real scientists, not those poser experts that have teaching
in universities these days, shows that organizations championing DEI enjoy higher patient satisfaction,

(27:40):
better staff retention and healthier revenues.
Because DEI brings the kind of rain that not even John Fogerty's gritty Swamp Rock can
put an end to.
Does your hospital serve patients who don't speak English but still need to learn wound
care?
Let them eat cake.
Are your emergency rooms frequented by people whose net worth is less than $300 billion?
As if!

(28:00):
Did you want that million dollar NIH grant to also help patients who live more than an
hour private charter flight from your trauma center's helipad?
That's what public transit is for.
If you answered yes to any of the previous questions, you can't go another day without
the Inclusionator T800.
In an era where some humans question whether humanity has left the building entirely, let's

(28:22):
stay the course.
At Inclusionator, we're committed to ensuring that every piece of your documentation literally
shouts DEI, it's lit!
Because if your mission statement doesn't champion everyone, you're not just missing
the mark, you're missing the whole point of healthcare.
Inclusionator T800 is trusted by the kids at the cool lunch table and health systems
that really do treat every patient with dignity and respect, honor every community's voice,

(28:47):
and lead the industry demonstrating inclusive care is just good business.
Avi, brah!
Sign up today and claim your free, cancel-proof t-shirt, guaranteed to ward off any awkward
social stares and 50% of heated online debates.
We don't manufacture miracles, people.
Be among the first 100 followers to tag us on social this International Women's Day

(29:07):
with the exact location of Sarah Connor, or to receive an easily reproducible copy of
our signature apologize in 10 languages cheat sheet.
Because in healthcare, you never know what you need to be sorry for next.
By using the Inclusionator T800, you acknowledge that actual humans, not chatbots, should handle
life-serious stuff, like legalese, coding integrity, and convincing your boss you deserve
to keep your job.

(29:28):
We disclaim all liability if things go sideways with the autocracy.
It's just a computer program trying really hard not to offend anyone in a landscape as
warped as the funhouse mirror at your local county fair.

(29:49):
Bonjour, listeners!
Today we're taking a grand tour of telehealth with a guest who's been revolutionizing digital
medicine long before it became très chic.
If telehealth had a palaço do Versailles, Dr. Aditi Joshi would be running the show,
probably with flawless virtual lighting and a well-reimbursed care model to match.
As executive director of telehealth.org, she's bringing liberté, égalité, and accessibility

(30:13):
to virtual care.
She literally wrote the Michelin Guide on digital health, which can be found on Amazon.
The book is Telehealth Success, How to Thrive in the New Age of Remote Care.
And when she's not writing or speaking or consulting, she's tackling reimbursement,
product development, compliance, and RPM because in telehealth, the cash flow must go on.

(30:34):
She also advises the AMA's Digital Medicine Payment Advisory Group, shaping the haute
couture of telehealth reimbursement policies.
Named a top 25 under 45 influencer in emergency medicine, Dr. Joshi is curating the Louvre
level standard for virtual care, from remote exams to digital empathy, proving that telehealth
can have both form and function.

(30:57):
So let's give a Tech into the Limit, bienvenue to Dr. Joshi.
May I call you Aditi?
Yes, please do.
And if anyone couldn't tell, I live in France.
Fantastic.
What a great time to be living in France.
Yeah, it's a wonderful time indeed.
Well, Aditi, we love puns and plays on words here at Tech into the Limit.

(31:23):
And we ask all of our guests that come on, if they can be they dad or be they not, what's
your favorite dad joke?
Do you have one you can share with us?
I can.
I'm going to give a little bit of a caveat.
It's a doctor dad joke.
And I will say that orthopedic surgeons get a lot of the brunt of our jokes.
So to all the orthopedic surgeons out there, this is meant in good fun.

(31:46):
You guys are my favorite specialty when you come into the ER.
So I bet you say that to all the specialists.
Yeah, but to be truthful, I almost thought of going into orthopedics.
That's why I say it.
But please, in good fun.
So here's my joke.
What do you call two orthopedic surgeons looking at an EKG?
It's a double blind study.

(32:07):
Sorry, guys.
And ladies out there of orthopedics.
That's phenomenal.
Loving it.
Thank you.
Thank you, Aditi.
Well, I'm going to kick us off with our first intellectual question of the interview.
I'd love to start it off with some humor.
But from your intro, our listeners can tell that you have a broad and deep expertise in

(32:31):
telehealth.
So from a strategic standpoint, what do you think is the biggest misconception about telehealth
today?
What's the reality that more people need to understand?
That's a great question.
I'll say, so when I first thought of this question, people are always like, well, telehealth
is not dead.

(32:51):
That's the obvious answer that I think people are going to say.
But that's not what I'm going to say.
That is true.
But here's what I've actually noticed.
The more I work globally is that the definition of telehealth in most places is actually quite
limited.
So I think in the United States, just over the last 11 years where I've been working
in it, I've been lucky enough to work in places where we try a lot of different virtual care

(33:16):
programs, whether that's the classic one where people, doctors at home speaking to their
patient.
We do like specialist consults.
We did a lot of different things during COVID.
We started a teletriage program at one of the hospitals I worked in.
And that's great.
But I've coming from that background where it's not, we can try for almost everything.
But if you go out in the world and actually probably even parts of the US where they're

(33:39):
not used to it, they don't have that definition.
And so I'd say the answer is the biggest misconception is that it's only one thing and it doesn't
have a whole bunch of other use cases that are relevant to almost any type of healthcare
that people are trying to deliver.
Yeah.
You mentioned a couple of those examples of different use cases that you've worked in.

(34:03):
What are some of the others?
Like if I'm practicing in, let's say Australia, and my definition of telehealth is video telemedicine
for an exam and that's it, what kind of out of the box thinking would you challenge me
to do?
So Australia is a lot like the US.
They have a huge area.
Oh, shucks.
Bad example.

(34:23):
No, no.
But that's okay, right?
So the whole thought is, and I can give you another example of France, for example.
So just like they have a lot of areas that nobody can get to and there are people who
live in remote areas.
So for them, it's like the specialist to specialist consults are really relevant.
I do remember this one case study that came out of Australia that happens in a remote

(34:43):
area where somebody, there was a nurse who was doing a telehealth visit with their cardiac
surgeons because he was having a heart attack.
He actually worked at ER.
He was having a heart attack and they were like, well, we need to get you to one of the
tertiary care centers or their version of it.
But over telehealth, he basically gave himself the clot buster medication that we use before

(35:05):
we do angioplasty and he basically gave it to himself on the way to the hospital, which
I thought was pretty cowboy.
But yeah, so yeah.
So I mean, they also use it in that way.
But I can give you another example from France.
So I have a friend of mine who's also an emergency doctor and he was talking about one of the
same problems that a lot of emergency departments have, which is trying to get people out of

(35:28):
the waiting room or they're just waiting for a long time and they're not sure how long
they're going to be there and they want to get their thing started.
And I was like, well, we did teletriage and it never occurred to them that there was a
way to use telehealth for that because to them, whenever I tell them I do telemedicine,
to them it's only this teleconsultation, which they call in French, which means doctor at

(35:52):
home, patient at home, doctor on the other side having a visit.
So when I talked about that, it was like, oh, you can do that?
And I was like, yes, yes, you can.
So that's one example of where people just don't even think about it.
Was that like a provider in triage model or was that like an ER avoidance model?
This one is a provider in triage.

(36:13):
So it's all triage I keep referencing.
Basically any patient who came into the ER, they would see our telehealth doctor who was
remote doing another shift elsewhere and they would be in the triage room with the nurse.
Well, they would be on TV, obviously they'd be on a screen with the nurse and they would
put in the orders right after.
They would get the information and then that patient would go into what we call their internal

(36:34):
waiting room.
They would get their order started and then they would see one of our colleagues in person.
I don't want to send us down a rabbit hole here, but I have a real quick question before
we kind of move on about that because I've done provider in triage programs like that
in the past and I want to hear if this holds true from your perspective.
So one of the main key ingredients to a PIT model like that is that the providers that

(37:00):
you use be like what I refer to as apex predators, your seasoned providers that have seen everything
that walks through an ER in order to be successful so that they can do decision making very quickly.
They've seen it before, they know what to do and they make it happen as opposed to your

(37:21):
fresh new recruits that may be tech savvy but haven't seen the reality of an ER.
Does that hold true from your perspective?
So I have two things to say about that.
Well, one, in general, probably yes.
But when we were setting this up initially, we were using our EM doctors who were doing
telemedicine work who were all attending, right?

(37:41):
They were all people who've been finishing their training and they're working in the
ER and they know it.
So yes, to that degree, then it was probably easier for them to do that, to do the triage
because they had an idea of what it was.
But we didn't keep that model because I just don't think it's a long standing model.
It's not sustainable.
You actually need other people to do it as well.
So what we ended up doing is just creating processes and clinical pathways so that we

(38:05):
could actually have it done by PAs or NPs, whoever might be taking over that particular
role.
And we did that, especially because we needed more ER doctors in the ER.
So we were actually able to put another ER doctor based on the hours we saved doing
that.
But then what I was going to say, so that was one thing.
But the second I would say, and I have always said this, that telemedicine is always easier

(38:29):
if you know what you're doing in person.
And I will stand by that because I know that there's this entire argument out there that
we can do this and there are people who may not have practiced in various places and they're
doing this type of care.
I will just not ever be behind that, not yet, because we do not have enough training.
We do not have enough experience doing telemedicine to be able to say that's safe.

(38:51):
So yes, I would say, is the answer a question?
Yes and no, right?
But yes, it's a currency for the season.
For sure.
That's the universal answer to every question, yes and no.
We actually had Bonnie Clipper on here last season talking about digital transformation
in nursing and that was a point that she brought up was that there's this sort of the ideal

(39:13):
candidate for virtual nursing is someone who has solid bedside experience and the right
curiosity to learn the tech side.
So you need that balance of a skill set.
I did want to share one other creative use case in light of your comment that I experienced
as a patient because I think so far the conversation has revolved around telehealth increasing

(39:38):
access whether it's because you're reaching patients who are in a remote area or you're
trying to focus on throughput in an emergency setting.
It also makes your workforce more scalable.
I know both of you know that, but for our listeners to just kind of flip it on its head,
I as a patient experienced a check-out process where my provider walked me to a virtual desk

(39:59):
and a virtual scheduler scheduled my follow-up appointments for me and rather than having
them stationed in one clinical area, they were sort of making their scheduling team
scalable across the entire hospital which I thought was super cool.
That is super cool.
It's like when you go to rent a car at the airport and you go to the kiosk with a video

(40:20):
and you pick up the phone and some guy or some woman on the other end is like helping
you do your car so you don't have to wait in line with all of the plebeians.
Anyway.
I love that though.
Then you actually get exactly where you're supposed to go instead of feeling like you're
lost in the internets.

(40:41):
Absolutely.
Let's talk about how you make this sustainable.
So you serve as an advisor to the AMA on digital medicine payment and I'm not sure, that's
a complicated process.
I think that's probably underselling it there.
But if you could wave a magic wand and fix one of the reimbursement issues around telemedicine

(41:03):
overnight, what would it be?
I would make them permanent.
I think we all know, most of our listeners know, right, that we are in this constant
cycle of having to reengage and have it go through Congress every two years.
Now we have to do it at the end of March, which is three months away.
What I find hilarious about this is that this is a bipartisan supported issue.

(41:27):
This actually should not be a problem to pass.
It would help everybody out.
Patients like it.
It is like we talked about, convenient and efficient.
And then most importantly, you have all of these practices in hospitals who every time
this is up for discussion, they have to figure out what their exit plan is and that takes
a lot of time and money for them to figure out and it's just not worth it.

(41:48):
So that's what I would do 100% make them permanent.
Yeah it's like a game of kick the can down the road.
And I think it's almost indicative, not so much of that there isn't bipartisan support
for this issue as you noted.
It's that Congress in general doesn't know how to manage a budget, right?
And this is just one of the budget items that they're very noncommittal about, right?

(42:11):
They're like, oh, I don't know.
We're not sure what it's going to be like in three months.
So let's just sign it for three months and then you come back to us and we'll do this
whole thing again, which doesn't cost any money to the taxpayer.
I mean, yeah, it's frustrating for sure.
Yes, each side doesn't want to give the other one a win it almost seems like.
But what I find so ironic about it is that it is forcing people to live in uncertainty

(42:39):
and uncertainty and we don't know what to do because we're not sure the impact of it.
So we're going to make everybody live in uncertainty and we're not going to know the impact of
it.
Like it's it's just an ironic mess.
Yeah, we're hamstringing ourselves there.
Yeah, but you're that's an excellent point, Elliott.
You can't you can't really invest in innovation for the future of your practice if there's

(43:01):
too much financial risk, right?
So it's frustrating on many levels.
I'm just going to leave it there.
Fair enough.
But I would say, Sarah, just to take your point of further, because when you said that,
it reminded me that if we're talking about like building out telehealth in the future,
nobody can do it if they're worried that the basic telehealth program they're running is
going to not be paid for.

(43:23):
So they can't build anything on top of it.
Like, right, you don't want to take that risk.
You don't know what you have.
Right.
How do you build the business model?
How do you build the staffing model?
How do you build any of that to scale or to innovate when the platform, the base platform
to your point that you're building it on could crumble at any moment?
They will pivot to a slightly more optimistic part of us of our interview here at ET.

(43:46):
We've worked on scaling telehealth at major health systems and now at the global level
through telehealth.org.
What are the key ingredients?
We kind of talked about reimbursement already.
What are the key ingredients for a successful telehealth program that most organizations
overlook?
Great.
So I'll just take it a step back and I'll give you just the quick framework of what

(44:08):
we put in the book, because I think that's really important.
And it helped me, in fact, organize how I think about it all the time.
So the first thing is, you think about patients and what do they want?
What do they actually need?
Clinicians and how do you train them and what's important?
How do we make sure that it's quality?
And then change management.
Like, how do you ensure that they want to do it?

(44:28):
And then there's the technology.
And actually, I think the technology is the least important part because we do have enough
people working on the technology to tell us.
And then the last thing, you mentioned one of them, right, is reimbursement to finances.
How do you actually finance it?
But not even just the reimbursement codes, but how do you actually invest in it?
What kind of budget do you need, et cetera?
And then last is compliance, which is a big bucket of malpractice and regulations and

(44:51):
licensing and all of the other things that you need to make sure that it stays in line
with what the laws are.
I think there's been an overwhelming focus in general on the last three buckets because
they're ones that tend to be a problem everywhere because we know that the laws are going to
be changing and we have to stay compliant and tell a health, what does it do?

(45:13):
How do we do it, et cetera?
And the threat of malpractice, for example, I'll give that example.
It really hasn't been as much of a problem as people think.
In fact, sometimes when I'll do chart reviews for malpractice cases for telemedicine, it's
never the telemedicine that they're actually suing over.
It's something that happened in person.
But I think what's most important is really the first two because in the end, if you can't

(45:36):
get anyone to use it, it really never matters.
And I'd say that the biggest thing that people are overlooking and sort of talking back to
what we're saying is when people think of telehealth as a limited source, it's like
they're like, we want to build telehealth, we want to use telehealth, but that's not
the best way to go about it.
The first thing to go about it is to really look at your strategy and say, what are the
problems that we have overall?

(45:59):
And really think about what those are without thinking about virtual care.
And then after that is say, okay, these are all of the things that we need to fix, whether
it's in this health system or clinic or whatever it is.
And this is where we can impact them using virtual care and then build a program.
And then there are parts about change management.

(46:19):
Yeah.
So that's what I would say is probably the biggest tip out there I would give.
Right.
You're talking about like not taking the hammer in search of a nail approach here.
The shiny hammer.
Yeah.
I mean, you're actually trying to like inventory all of your nails and then select like the
right fit hammer for each one.

(46:42):
And virtual care may be the case for five out of 10.
Right.
Very, very cool.
You actually, like this is how so co-hosty we are, Sarah.
Like that's literally exactly what I was going to say.
I mean, the only difference, the only kind of, I'm going to add to the metaphor, right?
It's not just about inventorying the nails.

(47:03):
It's about understanding what you're trying to build first.
Yeah, exactly.
You know, what's the house, what's the shape of the house that you're trying to build before
you even start picking out your nails?
My son is in the phase T7, right?
Where he's like, Hey, mommy, look what I built.
And he'll bring up like a two by four with a bunch of sharp objects sticking out of it.

(47:24):
Like that's how most health systems approach, you know, virtual care, virtual care design
and implementation, right?
And he needs to start with the blueprint, maybe go to architecture design school first.
But maybe.
So Aditi, one of your passions is around making healthcare more equitable through digital

(47:49):
solutions.
What's a practical step?
We like to give folks a call to action, right?
What's a practical step that health systems can make?
But I want to also tack on a practical step that startups can make and should be taking
right now to ensure that telehealth doesn't just widen our existing disparities.

(48:10):
Yeah, this is a really important topic because I'll tell you, even when I started 11 years
ago, I remember thinking it wasn't just me, but there were a couple of people I worked
with that we were just like, yeah, this is going to make disparity worse just by the
nature of trying to do an innovation that nobody is doing or nobody wants it yet, or
it's not really widespread.

(48:30):
But there wasn't really any way around it.
We needed people to use it.
And so it was always people who were able to pay cash and wanted the convenience.
And so I will say that we knew this was probably going to happen and then it did.
But you know, obviously there have been people who were trying to work on it.
We have like CMS go in there and they really did champion it from the beginning.
But I'll say just like practically, you know, I have a client that actually does this really

(48:53):
well as a clinical standpoint is they actually just make it required that people have to
see patients who are in vulnerable populations.
One of the things they do, for example, is that every doctor has to see patients who
are on Medicaid so that they are accepted into the clinical practice.
For people who may not know, who don't know about this part of it, a lot of times Medicaid

(49:18):
is not accepted as an insurance or as a payment within clinics or certain places or certain
clinicians won't take it.
And so in this case, we just were like, no, you have to.
And I really think that makes a big difference.
Because the also the reality is like the flip also happens when more Medicaid patients are
using telehealth, then they'll actually continue to pay for it.
And they do pay for it.

(49:38):
And then as a startup, you know, just going in there is if you can automate that places
and these payers that are paying for telehealth or any other type of digital health, if you
can automate it to gather the information enough that clinicians can get billing, that
would be a huge service.

(49:59):
And I'll tell you why, because basically a lot of these a lot of the people who want
to use it or can use it or could actually access telemedicine are not doing it because
clinicians don't realize they can pay for it.
So startups can actually automate it.
So it's not so difficult for us to figure that out.
That would be a huge win.

(50:20):
You're talking about trying to navigate the complexity of the payer matrix.
Right.
So which payers offer reimbursement for telehealth services under which use cases?
Can somebody essentially document that protocol and automate it?
Am I following you?
Yes.
And really, you know, telehealth is a little bit easier.

(50:41):
But I know if you talk about RPM, which I know is a different topic, but that ends up
being really important for RPM.
There are many, many, many clinicians out there doing RPM type services, but they're
not able to bill for it because it seems to be just confusing for everybody.
So I think this is where it is confusing.
The rules around it are confusing.
And then when you throw on the remote therapeutic monitoring codes on top of it, people are

(51:04):
like, wait, what?
This one has to have an FDA cleared device.
And then this one doesn't.
I got to collect 16 days over here worth of data and not like it's a confusing mess.
Maybe Congress should do something about it.
Sorry.
No stepping down.
I'll tell you really feel it.
It just is like, you know, this that AMA group that you were mentioning, we had this discussion

(51:25):
over and over of how how to do this.
And it's like, we just need to get people to get the information out there.
But it would be really helpful if the device manufacturers or the RPM solutions did that
for us.
I think it's a really interesting topic.
And something I've thought a lot about as someone who used to work in remote patient

(51:49):
monitoring and also currently works in automation, this this kind of thing comes up really frequently,
whether it be prior authorization, automation or this use case.
They're very similar.
Right.
And I coming from a health care provider lens, because I work for a health system, I don't
know that it's feasible for us to automate care specific requirements because they're

(52:12):
always changing on us.
Right.
And it's constantly evolving.
I don't want to throw a blanket on this really important opportunity that you've identified,
though.
I think if we can me personally, we can flip the narrative like telehealth.
To borrow from the ATA telehealth is health.
Right.
And so if you have a value based payment model, it makes sense to invest in these programs.

(52:36):
Right.
If you're on a fee for service model, then you got to deal with that administrative overhead
of trying to navigate the billing.
But in a way, the industry is sort of incenting itself to go engage in value based reimbursement
models.
If they're going to stand up telehealth programs.
Right.
Because they're proven to help patients be healthier.

(52:59):
Right.
And it's just one more tool in the toolbox.
When you think about population health.
Yeah.
Thank you for that answer, too, because I realized as you were saying that this is very
much I can understand the frustration of people who are on the startups and tech where doctors
are like, well, this is what we need.
And they're like, yeah, that's it's actually hard to build that.
So I appreciate that aspect.
But yeah, if we had, like you said, the value based here, then this wouldn't be a problem.

(53:23):
You can bundle this and people could just do it much more easily.
Radical idea.
I got a radical idea.
Yeah, it's totally brand new.
You have a radical idea.
I have a radical idea.
Oh, I love it.
What if we regulated insurance providers to require them to publish APIs that are kept
up to date of their billing requirements that EMRs could plug into and provide that information

(53:50):
back?
Dude, you should quit your job and just like make that happen.
Yeah.
Can we get that?
That's a brilliant idea.
I have no idea.
Can we?
I don't know.
I don't know.
I think it's a good idea.
Yeah, but they have the money.
They have the money.
So but make it on their side.
Do they have the incentive?
They certainly have the money.
Yeah, no.

(54:10):
This is it's like impossible to talk about telehealth without getting political because
we you know what I mean?
And it's not it's not partisan politics, as you know.
Yeah, but it's incredibly there's a lot of opportunity from a policy standpoint to make
this easier for patients and providers.
Yeah.

(54:31):
100%.
I think it's hard to talk about health care in general without getting right now as you
sit comfortably in France.
Yes.
I love their health system and I get it.
So one one question to to wrap up this awesome conversation, Aditi, as we've kind of talked

(54:52):
throughout this discussion, telemedicine isn't just about technology, right?
As you know, it's about people.
So what are some of the biggest human factors from your experience that can make or break
a virtual care experience for providers and patients?
Yeah, I love this question, because when it goes back to the whole thing that if you want

(55:13):
this to work, it's really about the patients and clinicians and those two arms of it.
So I'll start with the patient side of it.
I think some of the stories that I have of seeing telemedicine patients is really the
fact that often there was a couple of times that the patients thought it was a scam because
they don't really understand.
They didn't really know that this was a real medical encounter.

(55:34):
So the first thing I say is stress making it very clear that that's the case, right?
So that it's this is this is medicine.
This is like health care.
This is your doctor.
You're going to be seeing them.
I think we've come a long way from that idea.
People now recognize it as such.
But I do think we're in this very interesting time.
Let's take this.
We could talk about this again for an hour is that telemedicine has really become capitalized

(55:57):
just with all of these new startups to basically give out prescriptions for the GLP ones.
And I get that the medications work, but the way that telehealth is being used for it,
I find it's a little bit problematic.
And I'm a little bit afraid of the danger that it could be to patients.
And so it really needs to be very clear what is being done.

(56:18):
And it has to adhere to a certain set of criteria.
And the patients need to feel safe that when they go to that person, they actually know
what is part of their health care.
So that's part of it.
Just like that safe, that safety, that trust that's in there.
And if that doesn't happen, we're going to we're going to lose out all of the advances
we made in telemedicine.
And then from the clinician standpoint, it is in line with that.

(56:39):
But most of the time, it really has to be that they don't feel like they're being taken
advantage of.
Right.
I think that's more of a reimbursement point, because again, it is work.
It is a medical encounter.
So they have to feel like they're getting reimbursed for their time.
And then they have to, of course, have all of the necessary things that make it real
for them.
It has to be quality, it has to be efficient, it has to be convenient.

(57:00):
It should not make their work more.
It shouldn't be more work for them.
But I think lastly, and this is most important, and I learned more as a leader of teams of
clinicians, well, physicians mostly, but clinicians, is that it has to they have to understand
that you know what they're talking about.
I feel like the advantage that I had was that I was either I was working with them on this,

(57:21):
like I knew the clinical pathways, I knew the clinical processes.
So they didn't feel like they're working for me.
They were working with me.
And so all the problems we have really fix them together because I needed their input
and I wanted to make sure that they felt safe delivering that type of care.
And so I think we're still in the same boat.
Those are still the same issues we have.
We're just in a different space.
And these are what I would just say, you got to make sure that you have these conversations

(57:44):
very openly and transparently with both groups.
I love that you mentioned, you know, working with the clinicians to design the model, to
design the workflow, to design.
I'm curious, did you also do that with patients?
We did a couple of sprints with patients to see what their input was.

(58:05):
At Jefferson specifically, we had a lot of patient surveys to try to see how we could
improve our care.
And so, yes, we did take that input in there.
I would say that in the beginning, there weren't as many patients as there never were.
So we had a lot more opportunity to take that feedback and use it.
I use this quote a lot, but it's very interesting to me that in the beginning when we were at

(58:25):
this is at Jefferson, they, you know, we found that patients didn't really care where their
doctor was because they enjoyed the convenience of telemedicine.
But a couple of months in, once they realized that, oh, this is something that's here to
stay and that Jefferson is offering it, it actually mattered to them that we were Jefferson
doctors and that we could refer them to a primary care at Jefferson or a surgeon at

(58:47):
Jefferson.
It became important to them because they're like, oh, well, this is now health care.
So I'm going to want the same things that I'm always going to want in a health system.
So that was great to hear, but it just reinforces that people really want the same things in
any type of health care.
They want safety, they want trust, they want efficacy, and they don't want it to cost a
lot.
They want to be able to have practical things they can do as part of their health and their

(59:09):
life.
Okay, that was quotable.
Yeah, I was just typing it out.
I'm like, see minute 37 for an awesome quote.
This has been super fun.
The best way to end a really busy week for me, just chatting with two brilliant minds

(59:30):
about a topic we all care very deeply about.
So thank you so much for joining us, Aditi, and keep doing this really important work
worldwide.
Wish you all the best.
Yeah, thank you.
Where can people find you?
If they're looking to find you online and hear and read what you have to say, where
can they find you?

(59:50):
Yeah, thank you for having me.
It was such a pleasure.
It's the easiest place to find me is LinkedIn.
I'm most active on LinkedIn.
I do have a website and I also have a blog for anyone interested.
You can find that all on LinkedIn.
Well, thank you, Aditi.
We really appreciate it.
So stick around listeners.
We'll be right back.
Done.
That was really fun, guys.
Yeah.
Welcome back listeners.

(01:00:16):
So great to have...
Welcome back listeners to Tech It To The Limit.
So glad to have you here.
That was a great conversation with Dr. Joshi.
Glad to have her on.
She's got great energy.
Really enjoyed that conversation.
But now it's got me a little hankering for a taste of a plate of some Golden Wise Nuggets

(01:00:42):
from Maj.
Golden Wise Nuggets.
Some wisdom nuggets.
Sarah, did you have anything prepped that you heated up in the microwave for us?
You know, I don't do microwave.
It's got to be the toaster oven.
And yes, I had it preheated during the last foam commercial.
They just came out of the toaster oven and they're sizzly and golden and wise.

(01:01:05):
Nice steamy.
Can't wait to taste them.
So, you know, to follow traditional misogynistic practices, which are coming back into style
these days, I think we should have ladies go first.
Yeah, I think that's right.
Oh, I think that's right.
You go first.
It's misogyny.
It's retro.
Yes!
Misogyny is cool again.
All right.

(01:01:25):
At least for certain segments of the population.
All right, so my first nugget.
Telemedicine is easier if you know what you're doing in person.
I love that quote.
Thank you, Dr. Joshi.
Like totally snackable like a nugget, like a perfect little nugget.
It definitely, you know, as we kind of talked about in the interview, it reminds me of our

(01:01:46):
conversation with Bonnie Clipper around how to recruit the ideal candidates and train
the ideal candidates for your future virtual nursing workforce.
You know, it truly is a balanced skill set and that sets health systems over and above
your average startup that's trying to just quickly get into the telehealth space and

(01:02:09):
be a disruptor because they don't have that institutional knowledge.
They don't have that culture of evidence-based care and that camaraderie that comes with
a health system among physicians and advanced practice providers.
So really love that nugget.
And I'm keeping it tight here tonight.
Already had a huge meal, so I just need a tiny little midnight snack before I go beddy

(01:02:33):
bye.
I love Dr. Joshi's insight about letting strategy be your guide.
Let the problems you're facing or the opportunities you're confronting, however you want to frame
that, feel like a positive reframe, let's say opportunities, OK, let that be your guide
and then decide, OK, based on these problems we need to solve today and where we want to

(01:02:55):
be tomorrow, what kind of tools, resources, capabilities do we need to get there?
Is telemedicine one of them, right?
But it may be, but it may not be the only tool you need to solve a specific problem
and it may not be a tool that applies to every problem, right?
So I mean, pretty obvious to when you step back and think about it, but we often get

(01:03:17):
really excited as innovation is advancing at a rapid pace, technology, and we just forget
kind of our core principles.
So I appreciate that you reminded us to go back to basics.
Virtual care is not a strategy, it's a tactic.
Yeah, not a strategy in its own right.
Yeah, absolutely.
I couldn't agree.
I was snacking on a few myself throughout the conversation.

(01:03:40):
Mine are both in keeping with our prices right theme from the episode earlier.
Nice.
And I think Bob Barker is cheering you on.
She had a lot of really great insights.
One of the ones that kind of stuck out to me in both of them, both of the insights that
I took away were related to the bottom line, right, for hospital systems.

(01:04:02):
So the first one is around patient loyalty, right?
The findings that she had with Jefferson at the beginning of the telemedicine program,
right, where it was really just about increasing access, get access in, but what it ended up
turning out to be when patients started to trust in the technology and trust in the process
and see it as healthcare and not something unusual, then they started to seek out the

(01:04:28):
same from the health system, not just any doctor over telemedicine.
I want to see Jefferson's doctor over telemedicine, right?
And it turned into a loyalty tool that I think through the evolution of consumerism of healthcare
and specifically around telemedicine, we have seen that born out.
And I thought it was really interesting that she saw that happen in real time.

(01:04:49):
And I thought that was kind of cool.
Yeah, that is wicked.
The second bigger nugget, I think more important nugget, and it goes back to the destruction
of our industry is what she would wave her magic wand to do, which was to make the telemedicine
waivers permanent.

(01:05:11):
She talked about these constant renewal cycles that we're going through, right?
We're constantly kicking the can down the road on extending these telemedicine capabilities
for hospital systems and providers.
But every time we come up to that telehealth cliff, we stand at the precipice of it and
we make the sidewalk go out a little further and a little further and a little further.

(01:05:35):
Well, hospital systems can't operate in that level of uncertainty.
Tele can operate in that level of uncertainty.
And they have to go back and figure out their exit plans every single cycle, which is a
giant waste of time and money, ironically, right?
We're trying to save money by evaluating whether telemedicine is worthwhile or not.

(01:05:58):
And this uncertainty causes us to spend time and money.
Right.
It's just driving administrative waste for an organization.
And the cycles are accelerating, right?
The cycles are accelerating.
Two years.
Now we're down to three months.
We have until next month before these capabilities go away.

(01:06:19):
So we're in this countdown right now until we reach that telehealth cliff.
And I got to tell you, given what we're seeing from the federal space right now, I have very
little hope that we're not going to just jump right off it.
Yeah.
So on that happy note.
Right.
I'm feeling kind of sad all of a sudden.

(01:06:41):
Yeah.
On that happy note, please vote and please write to your lawmakers.
It's an issue that has bipartisan support and it only serves to help patients that we
all want to serve there.
Get involved with the American Telemedicine Association and their policy advocacy.
Yeah.
Yeah.
Look them up.
On that note, thanks in advance for following us on LinkedIn, leaving us a five-star review

(01:07:04):
wherever you pod, telling your friend, telling your neighbor, telling your kid's school teacher,
telling your least favorite political pundit.
Anyone, just tell someone that your favorite podcast is Tech It to the Limit.
And if you have to, just jam a boombox in their face and say, listen to this.
That's really effective.

(01:07:26):
Send them a mixtape of your favorite Tech It to the Limit quotes.
Oh my God.
I would rather have that than diamonds.
Just saying, just saying if you were planning anything special for my birthday.
Anyway, Elliot, will you please send us off into a blissful, dreamy state with the latest
HealthTech haiku?

(01:07:47):
I would be delighted.
I just want to say that this is good practice for your sonnet that you're going to be reading
live on the air on LinkedIn, broadcasting to a balcony near you.
Network spans the seas, healing hands across borders.

(01:08:11):
World unites in care.
That was beautiful.
Telemedicine.
That was really a beautiful performance.
I appreciated the interpretive dance that you just did for our listeners who can't see
you.
I assure you, it was gorgeous.
It was my pleasure on this famously visual medium.
Well, listeners, thank you so much.
We'll see you next time on Tech It to the Limit.

(01:08:32):
Au revoir.
Au revoir.
Au revoir.
Okay, let's go get some fromales.
Tech It to the Limit is produced by Sarah Harper and Elliot Wilson in consultation with
Chat GPT because they are masochists and also don't have any sponsors.

(01:08:53):
Yet.
Music was composed by the world famous court minstrel, Evan O'Donovan.
To consume more hilarious and informative content by digital transformation and healthcare,
visit us online at TechItToTheLimit.Fun.
And don't forget to follow us on LinkedIn, Twitter, Instagram, and across the event horizon.
See you next time on Tech It to the Limit.