JMIR Publications

ABSTRACT

Background:

Lockdowns and shelter-in-place orders during the COVID-19 pandemic have accelerated the adoption of remote and virtual care (RVC) models, which may include telehealth, telemedicine, internet-based electronic doctor visits (e-visits) for remote consultation, diagnosis, and care. However, this sudden shift in favor of RVC has left small healthcare businesses, such as clinics, physician offices, and pharmacies, struggling to align resources and operations to the new RVC realities. Insights into the current perceptions of small healthcare businesses towards remote care, particularly concerning their perceptions of whether RVC adoption will synergistically improve their business’s sustainability, will provide insight to policymakers regarding the pros and cons of rapidly adopting RVC technology.

Objective:

The study’s objective is to gauge small healthcare business owners’ perception of RVC’s impact on their business’s sustainability during and after the COVID-19 pandemic. Specifically, it measures their current adoption of and satisfaction with RVC models, how well this aligns with their current business practices (SCBS), and whether these perceptions influence their view about their own business’s long-term sustainability (SUST). Three groups of small healthcare businesses (i.e., Clinics, Physician Offices, and Pharmacies) are randomly sampled across Colorado.

Methods:

We randomly sampled small clinics, physician offices, and pharmacies across Colorado and collected survey data via the assistance of a consulting firm in July 2020. An ordinary least square regression, controlling for demographical characteristics of the business owners, was used for analysis. The focal estimated effects of the study were compared across the three groups of small businesses to draw several insights. The total sample size was 270 respondents, consisting of 82 Clinic, 99 Small Physician Office, and 89 Pharmacy owners across the state of Colorado.

Results:

The estimation results suggest that the direct effects of SRVC and SCBS on SUST are significant and positive. The goal of the paper, however, is measured via the interaction effect between SRVC and SCBC, which measures whether the adoption of RVC aligns with their current business model and whether this interaction impacts their perception of their business’s sustainability. We find differing effects across the three groups. The interaction term SRVC × SCBS is significant and positive for the Clinics sample (p = 0.015), significant and negative for the Physician Offices sample (p = 0.052), and not significant for the Pharmacy owners’ sample. These variations explain that while RVC integration with current business practices is perceived positively by clinics, the opposite is true for small physician offices.

Conclusions:

As the COVID-19 global pandemic continues to grow, and efforts for remote and virtual care are progressing at a rapid speed, it is critical to understand its impact on small healthcare businesses and their perceptions of long-term survival. This study finds that small physician practices are not able to take advantage of or even keep up with the rapid remote and virtual care developments, in contrast to clinics. If small healthcare firms are unable to compete with RVC (or synergistically integrate RVC platforms into their current business practices) and eventually go out of business, the damage thus inflicted to traditional healthcare services may be severe, particularly in the area of critical care delivery and other important services that RVC cannot effectively replace. This paper hence has implications for public policy decisions such as incentive-aligned models, policy-initiated incentives, and payer-based strategies for improved alignment between RVC and existing models.