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Less than a third of healthcare organizations conduct quality assurance (QA) on virtual visits more than once per month, a new survey from AI-enhanced clinical operations company Verbal found.

The survey, which queried leaders at 30 major healthcare companies, found that many organizations do no virtual care QA audits whatsoever, and those organizations that do conduct QA audits do so infrequently, with the majority of respondents saying they do QA once per month or less.

Additionally, the vast majority of virtual care QA reviews mimic traditional chart reviews and are based primarily on call notes, not full call transcripts or audio recordings, which may yield an incomplete or inaccurate picture of care quality and patient experience.

Verbal surveyed leaders across telehealth, virtual mental health, care navigation, substance disorder treatment and more about how and how often their teams conduct QA.

Key findings include:

  • Many organizations do no QA at all: 18% of respondents said they have no QA program in place.
  • The majority of organizations do QA once per month or less: 49% of respondents said they conduct monthly QA audits, while another 3% only do QA audits only once per quarter.
  • Less than a third of organizations do QA more than once per month: Only around 30% of respondents said they conduct QA audits multiple times per week (18% of total respondents), weekly (7% of total respondents) or bi-monthly (5% of total respondents).
  • Few organizations review call audio: Only around 4% of respondents have a QA program that covers both traditional call notes and audio recordings.

These results show a wide variance in the frequency and depth of virtual care QA and highlight potential gaps in industry practices. A lack of QA is particularly significant in the context of value-based care (VBC) models and for companies offering employer-sponsored health programs, as revenues are directly tied to care quality and patient outcomes and experience.

Considering the continued demand for virtual care, healthcare staffing shortages, and the potential impact of infrequent QA on patient experience and outcomes, virtual care leaders should consider how best to adapt traditional QA practices to the digital space.

The challenge of comprehensive QA

Spurred by the COVID-19 pandemic in 2020, virtual care has evolved from a niche form of care delivery to a staple of modern healthcare, with demand for telehealth stabilizing at levels 38 times higher than before the pandemic.

This surge in virtual care usage has clearly been a win for patient access, with surveys showing patients view telehealth visits as more convenient and easier to book than in-person appointments. Meanwhile, the majority of physicians say telehealth enables more comprehensive quality care.

However, as seen in the survey, few virtual care organizations have implemented comprehensive QA practices, with most conducting QA once per month or less and only reviewing chart notes, not full transcripts or audio recordings (two valuable resources of information typically only available in the context of virtual care).

Even those organizations that can manage monthly chart reviews are likely missing out on key information needed to assess virtual care quality. Without reviewing full transcripts or audio recordings, teams risk overlooking nuances like tone and patient sentiment and comprehension, all key to assessing the overall patient experience and ensuring providers address patient concerns effectively.

In many cases, such limited QA stems from resourcing challenges, namely a severe shortage of clinicians and clinical support staff. For example, an analysis in Health Affairs found that the number of registered nurses had dropped by over 100,000 from 2020 to 2021 – “the largest drop than ever observed over the past four decades.” Meanwhile, data from the American Association of Colleges of Nursing (AACN) shows that the U.S. will need more than 200,000 new nurses each year until 2026 simply to fill new positions.

Though nearly all virtual care leaders surveyed expressed an appreciation for the value of timely, comprehensive QA on virtual care calls, many simply struggle to fit regular audits into their workflows.

Along with requiring managers or QA teams to manually review hundreds of calls and information spread across transcripts, notes and call recordings, traditional QA practices depend on auditors noticing trends, providing feedback to individual staff members and following up to ensure improvements are made and standards maintained over time.

Plus, a lack of industry benchmarks means there may be no clear consensus on what constitutes comprehensive QA or even a high-quality virtual visit.

Toward virtual-care-specific QA practices

The survey’s findings shed light on the pressing need for QA practices tailored specifically to the virtual care context. With 50% of organizations conducting QA only once a month and a mere 30% doing so more than once a month, it’s evident that traditional QA practices might not be adequately serving virtual care teams.

The limited use of valuable resources like full transcripts and audio recordings further accentuates this gap. To address these challenges and move towards a more robust virtual care QA system, next steps may include:

  • Establishing consistent benchmarks: The absence of clear benchmarks in virtual care, as the survey suggests, can lead to varied and potentially inadequate QA practices. Standardized guidelines can set a foundational quality level, ensuring a consistent patient experience across the board.
  • Emphasizing comprehensive reviews: The data indicates a heavy reliance on chart notes, with only 4% of organizations reviewing both notes and audio recordings. Teams should be encouraged to adopt a more holistic review process, incorporating full transcripts and audio to capture the entirety of patient interactions, even if they remain unable to QA the majority of calls.
  • Investing in advanced QA technologies: Given the evident challenges of manual reviews, tools like automated call notes and AI-driven analytics can enhance QA efficiency and thoroughness.
  • Regular training and feedback: Training can help mitigate the risks of resource-limited QA by keeping staff updated on best practices. Leaning into opportunities for individual coaching and feedback can also lead to continuous improvement and a better patient experience if comprehensive QA is impractical.

The promise of AI in virtual care QA

The digital nature of virtual care offers a unique advantage for teams focused on care quality and patient experience: the ability to easily capture 100% of interactions and leverage technology to enhance QA practices.

AI tools in particular show promise in allowing virtual care teams to QA calls at an unprecedented depth and scale.

These tools can analyze large volumes of calls quickly, pinpointing areas of concern or highlighting best practices worth emulating across the organization. Organizations can train an AI on their best practices and generate quality scores for every interaction, allowing managers to easily spot trends and offer their teams the timely, specific feedback needed for a consistently high-quality experience.

Generative AI tools can also give providers in-the-moment feedback on their webside manner or offer suggestions on how to project empathy and concern for patients, proactively driving a better patient experience.

Bottom line

While this survey showcases potential gaps in virtual care QA and areas for improvement, the data also presents an opportunity. By understanding these practices and trends, stakeholders can collaboratively work towards forging a more robust, reliable, and patient-centric virtual care environment.

Waleed Mohsen

Author Waleed Mohsen

Waleed Mohsen is the CEO and founder of Verbal. He has been named a UCSF Rosenman Innovator and has over 10 years of experience working with leaders of hospitals and medical institutions in his business development roles at Siemens and Cisco

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