Don’t rely solely on “brick-and-mortar” locations to deliver quality care to your patients.
Don’t rely solely on “brick-and-mortar” locations to deliver quality care to your patients.
New Orleans, August 2005. Atlantic City, October 2012. Boston, winter of 2015. COVID, 2020. Each of these four catastrophic events taught the healthcare community two important lessons. First, interoperability of your electronic health record (EHR) isn’t just a fancy Medicare phrase. Second, don’t rely solely on “brick-and-mortar” locations to deliver quality care to your patients.
The past few months have motivated many practices to explore the option of telemedicine to address the needs of their patients when the “office” is unavailable, but a disruption in your workflow isn’t new or limited to the coronavirus (COVID-19). Telemedicine is a patient-focused service line that may be the one constant of your practice during any circumstance.
"There can be value in observing the patient's living environment and then adapting an exercise program to one that fits the living space."
There are considerations, such as treatment and care options, patient acceptance, delivery platform, and reimbursement. There are benefits, such as reduced exposure between patients and staff, increased patient compliance and satisfaction, and expanded access to remote patients.
The obvious limits to telehealth visits for a hands-on specialty such as chiropractic should not discourage a provider from revising how care has always been delivered. An initial assessment or explanation of treatment options may be performed as easily via a secure video conference. Discussing imaging results and assessing the patient’s progress may not require a face-to-face visit. There can be value in observing the patient’s living environment and then adapting an exercise program to one that fits the living space. The patient’s understanding of a fall-risk could benefit from your literal viewpoint. Access to their provider from the comfort of their home may encourage patients to reach out sooner and be more committed to their treatment plan. A virtual visit will never completely replace the face-to-face encounter in any specialty. However, with the upcoming patient-base being more comfortable with technology and the unpredictable access to a brick-andmortar location, the practice will benefit from having a complementary delivery method in place.
Back in the 1970s, a famous Life cereal TV commercial featured two brothers who were skeptical about a new cereal and waited until their younger brother tested the product— “He likes it! Hey, Mikey!” A well-thought-out implementation plan for televisits may strike the same surprising result with your patients. The October 2019 issue of Medical Economics featured an article titled, “How Patient Satisfaction Scores Are Changing Medicine.” It reminded readers that the majority of patient complaints (96%) are related to bad customer service, with long wait times and poor communication as examples. Is that a perception or a reality? The patient is typically in pain when scheduling an appointment with a chiropractor. That pain may continue until they can be seen, and then they must drive a variable distance to the office. They may also decide they don’t feel well enough to come in and either cancel or don’t show up. If a patient does arrive at the practice, they are already uncomfortable and probably annoyed at something that happened en route. Even a short wait in an uncomfortable waiting room (sorry, nothing will match their overstuffed recliner at home) can seem like an eternity and add to a patient’s annoyance. The person next to them may cough, sneeze, or wear a painful-looking brace, and your patient’s anxiety just increased. A poor score isn’t about a patient’s individual experience with the practice but rather the collective experience of the entire event.
Replay that same patient’s experience when scheduled for a televisit. They remain in their comfortable overstuffed recliner until the provider is ready to start the visit. Within their environment, the patient is relaxed and can focus on describing their condition or progress instead of being focused on the office environment. When the initial evaluation is a virtual meeting, the patient also has the chance to become comfortable with the provider, so the first face-to-face visit when they start treatment isn’t a hesitant, new experience. Like Mikey, they like it. A recent survey noted that 72% of the 1,000 respondents had their first virtual care visit during the pandemic, with over 75% saying they were very satisfied with the experience.1
Will Brady, senior advisor to HHS Secretary Alex Azar, has said, “Telehealth is now the preferred method. People want this as the first site of care. We are seeing a demand from consumers. ”2
If there is hesitancy within the team about telemedicine for your practice or your current patients, ease into this service by creating a positive experience with the patient portal. An integrated patient portal is an essential component of a successful televisit. When the patient is making payments and requesting appointments from the comfort of their home, it will be second nature to participate in a visit from home. Each staff member will play a significant role in helping the patient adapt to a virtual office. Clinical staff can remind the patient about requesting medication refills online or accessing educational materials through the portal. When the patient is already reaching out via the messaging system, it will be easier for them to reach out via televisit.
Consider reaching out to the patient virtually when responding to more in-depth phone calls or questions. When appointments are scheduled for nontreatment visits (consultations, reevaluations, etc.), the front desk can offer the televisit to save the patient time. The automatic response, “You’ll need to schedule an appointment,” can be updated to, “Would you like to discuss that with the provider via a televisit?” Improved communications between the practice and patient will naturally strengthen the relationship and loyalty of your patients. The cheapest marketing is a positive referral from an existing patient.
Select a vendor that is able to integrate telemedicine, including the video aspect, within the EHR module.
It can be tempting to implement a telemedicine workflow that uses the video features of Skype, FaceTime, or other social media. Those are convenient but not compliant. Zoom recently drew the attention of the federal government with multiple reports of video sessions being “Zoom bombed.” Select a vendor that is able to integrate telemedicine, including the video aspect, within the EHR module. The Office of the National Coordinator for Health Information Technology (ONC) certification will ensure that all aspects of the televisit are secure from data encryption, user authentication, and patient verification. There is efficiency in being able to document patient care during the encounter.
There is a saying in academic medicine—leading edge/bleeding edge. Insurance payers don’t embrace technology, procedure, or process as rapidly as the medical community. However, COVID-19 has definitely impacted payer policy. Many payers quickly relaxed copayment rules or expanded coverage for telehealth services “temporarily” during the pandemic. Now they see it may be very difficult to put the genie back in the bottle. The same survey referenced earlier also noted that almost 75% of the respondents wanted virtual care to be a standard part of care moving forward. Half of the respondents noted they would consider switching providers for the offering. Public demand drives healthcare policy, which includes reimbursement policy.
The Centers for Medicare and Medicaid’s (CMS) 2020 proposed rules for outpatient prospective payment systems (OPPS) are slated for release in July 2020, and they will contain key information about future reimbursement for telehealth services, at least for Medicare patients. The upside is that many know “so goes Medicare, so goes the world of reimbursement.” Emily Yoder, a CMS analyst in the division of practitioner services, offered advice to participants in the American Telemedicine Association’s virtual conference on June 23. She said, “Practitioners and stakeholders should look at the proposals that we’re making and provide comments. Tell us your experiences to help us decide on the flexibilities that we implemented that we want to see made permanent.”
The formal comments and responses from practicing providers are vital to the outcome of those proposed changes. There is a small window of opportunity for those responses before the rules are finalized and released toward the end of November.
The practice and delivery of health care continues to respond to the needs of the community. Do the homework. Check state regulations, especially if the practice and patient cross state lines. Ensure your risk-management policy covers additional services. It is worth the investment of time to determine the best way telemedicine can augment the quality of care you provide.
References
1. https: www. kyruus. com patientperspectives-on-virtual-care
2. https: //www. fiercehealthcare. com practices cms-upcomingm e die are-pay merit-rule-toincl ude-proposals-to-expandtelehealth '0
Karna Morrow, CPC, RCC, CCS-P, is an implementation manager. She has spent nearly three decades in the industry leading electronic health record (EHR) implementations and providing consulting and training for a variety of healthcare organizations. Morrow is a frequent contributor to highly regarded industry publications and national conferences, providing insights on practice management, coding, billing and other industry-related topics.
