The Journey Through: Changes in Practice
Allie Clark | 10 min read | October 28, 2020
The lingering uncertainty of the pandemic in America is causing consumers and practitioners to adjust and re-adjust expectations for healthcare delivery. Regulators are changing their stance on privacy and coverage requirements and then changing again. The market is being tossed around by the twin forces of consumer expectations and provider and practice resources – not to mention that what is possible in the current reimbursement landscape is a continuously revolving door. And while policy and procedural guidelines are still murky and fraught with more questions than answers —
How long can an “emergency rule” remain in practice?
When will we know if the pandemic allowances will be permanent?
Are we ever going to get paid this easily for telehealth again?
— it can seem harder, in the face of all that, to plan out what to do on a day-to-day basis. All the words on a page, codes released, and arguments on the Senate floor aren’t going to change the fact that patients still need care, doctors still go to work every day, and practices still have to keep their doors open. The changes in how we practice medicine have been as profound, if not more so, than the changes in the policy governing it – and it isn’t showing signs of letting up.
At SimpleVisit, our mission is to help doctors. Everything we do is in service to one goal – to relieve medical groups of the burden of telemedicine workflows and technology so doctors can get back to caring for their patients whenever, wherever, and however they need it. To help you navigate those waters, we have collected a list of challenges the pandemic has created in the daily practice of medicine, what can be expected to change, and how you can prepare.
A New Arrangement
As the chaos calms and the dust settles, there is one challenge from this time of blow-out telemedicine adoption that still plagues medical offices. In our society, supply is always driven by demand – the same is true in the healthcare space, from single-provider practices to large healthcare systems. During this time, practices are facing a unique challenge: the demand is split. When the steps were taken to reopen our country and, therefore, our medical offices, we realized quickly that many patients liked the convenience and safety of virtual visits when appropriate. However, it’s widely acknowledged that there are some applications in healthcare where telemedicine is not appropriate – procedures and physicals, for example – and those types of necessary care had been put off for long enough through the height of the shut-down. A new arrangement has grown out of that challenge – the blended schedule. What this looks like varies for each practice, but the big picture is this: telemedicine is no longer limited to a last-ditch, once-every-so-often, band-aid solution. It has the potential to share the appointment load equally with in-office appointments, and is doing so with increasing frequency. The question becomes how, then, do you adjust the way you practice medicine to accommodate that? We’re going to address some key elements of this shift in the importance and volume of virtual care. We will cover Triaging Appointments, Office Management, and Future Success.
When is telemedicine necessary, preferred, or superfluous?
The first thing a provider or practice must do is figure out how they will determine whether a particular medical need can be addressed over telemedicine, and if it can, whether it should be.
Patient Desire and Access
Does your patient want to do telemedicine? If so, do they have a device they can use? Depending on which telemedicine service your office uses, the patient may be required to have a desktop or laptop computer. Some require an application download and have limited support for the patient if they aren’t inherently tech-savvy. SimpleVisit’s unique managed telemedicine service offers full live patient support, any-to-any video calling app functionality, and calls can be completed on any device. Have transportation difficulties led to no-shows in the past? Are you in a rural area where the travel distance is great? These are all questions to ask when considering the patient’s need for telemedicine.
Covered in more depth below, the scheduling requirements of the patient or provider will come into this decision as well. Is the provider working from home? Is there a specific provider the patient needs to see or can it be anyone within the group? Does the patient only have a short window of availability? How long and complex will this appointment be?
Is telemedicine appropriate medically? Are there vitals or other physical health metrics that need to be gathered? If so, does (or can) your office have the equipment to do so remotely? Some examples are bluetooth scales, cloud-connected blood pressure cuffs, pulse oximeters, thermometers, and holter heart monitors. Is it safe for the patient to come into the office? If they are experiencing COVID-like symptoms, it might be a great use of telemedicine to triage and advise them at home. Appointments that are mainly consultations, counseling, or those likely to end in a referral, diagnostic test order or prescription are great opportunities for telehealth application. Your providers are best equipped to determine whether a concern can be addressed virtually or needs to be in person.
Depending on your payment model, whether an appointment can be taken care of virtually may be determined by the patient’s insurance or personal funds. Thankfully, the current reimbursement landscape is more favorable for telemedicine than it has ever been, and there are very few payers who will not cover some form of telemedicine. Does the patient’s insurance cover the type of telemedicine needed to complete the appointment? If not, is the patient willing to to pay out-of-pocket for the convenience of virtual service delivery? These are two very important pieces to the triage process.
Balancing your schedule and designing effective workflows
One of the areas of your practice that may be affected the most is your office workflow and how you manage your providers’ calendars. At SimpleVisit, we have designed our solution to create minimal disruption to your current workflow. In terms of schedules, here are some ideas we have seen:
- Office only open three days a week for in-office – reducing medical staff on other days to only what is needed for telemedicine
- Providers at half-days for in-office and half-days for virtual
- A set number of telemedicine appointment slots per day, as you would with any other appointment type with limitations around time or complexity
- With medical groups who have multiple locations, considering “telehealth” as another location that their providers are on a rotating schedule for staffing
- Mandatory virtual first-contact with patients to determine if they are safe in office (specifically for locations and specialities with high COVID rates)
Having a plan before you start scheduling telemedicine for how you will schedule telemedicine with your in-office appointments is extremely important. For workflow planning, analyze your current workflows. Take a look at what you are already doing – who is involved, what are the processes, what’s done simultaneously and what’s dependent on a trigger. After that is done, consider who and what you have available:
- Do you have staff who are able to help patients and providers with virtual platform set-up and technical guidance? Do you want to pay them to do that on top of the work they already do?
- Do you have providers that can handle managing their virtual connections on their own or will they need help?
- Do you have an EMR with a built-in telemedicine option? Will they provide troubleshooting or call reconnection if something goes wrong?
- Has your practice already purchased existing hardware that is able to be used for telemedicine or will you have to invest in and learn how to use new equipment as well?
- Are your providers going to be doing telemedicine appointments only from the office, or from their home as well? (Any service you choose would need to be able to be used somewhere without protected access to your EMR or any on-site technology.)
- What workflow steps would you like to be handled by your telemedicine vendor? Some examples: patient appointment confirmation, patient appointment request initiation, scheduling management, or patient satisfaction surveys. If it is a new workflow step, the more the telemedicine vendor can handle it, the better.
Make sure you get input on workflows from all members of your team, in a variety of departments or roles. Draft and then redraft. These steps are particularly important to plan out for telemedicine appointments:
- Completing intake procedures and forms
- Obtaining legal consent
- Getting vitals or preliminary information about the primary medical concern/reason for the appointment (usually done with a nurse in the room before the provider comes in)
- Transferring the call to the provider (if there is a handoff from an MA or nurse desired)
- Documentation, organization, processing and storage of encounter notes
- Notifying patients of appointments, follow-ups, orders after a virtual visit
- Collecting patient experience and compliance data to improve your program
A special point to keep in mind: many of these processes affect your coding and billing procedures, and whether the appointments will be reimbursed. When designing workflows, determining scheduling guidelines, or even when you are triaging your appointments, think about what kind of appointments in terms of coding descriptions will or can be done virtually and when. Specifically, this applies to whether a doctor-patient relationship was established in a prior office visit, the amount of time spent in face-to-face contact, whether it’s a new problem, a follow-up, or continued treatment of a previous issue, and the complexity of medical decision making that the issue is likely to require.
Ensuring sustainability and scalability
As mentioned earlier, policies surrounding telemedicine at every level are favorable but uncertain – how long they will last and how they will change is anyone’s guess. Choosing the right telemedicine service, taking the time to design workflows, and planning out the structure of your calendar – these will all contribute to how successful your mixed-schedule telemedicine program is of weathering those changes. Some tips:
- Choose a vendor that is HIPAA compliant. Right now, the Office for Civil Rights (OCR) has leeway in whether they enforce HIPAA privacy rules or not during the national public health emergency – there are no guidelines as to when that will change and they could start enforcing them again any time they choose, without warning. Make sure you are protected.
- Keep up-to-date on policy changes. For a list of resources, take a look at the first article in the series. Don’t be caught unaware by legislative and regulatory changes that might impact your program.
- Design your workflows with all variables in mind. Try to consider all the situations your office and providers have come up against that could affect the business of running a medical practice smoothly – provider illness, flu season, building or network failure, financial crises, county-wide shut-down – and plan accordingly.
- Incorporate the most ease-of-use possible. Just because a telemedicine solution is convenient (eg., included in your EMR package) doesn’t mean it will work for your office. The solutions that have the most steps, have clunky and hard-to-navigate technology, have a heavy burden of execution on the user, and aren’t accessible remotely have the least chance of succeeding long term. Think about your telemedicine service as being something your providers get to use, rather than what they have to use. In the world of telemedicine, convenience is everything.
While sustainability is important, there is one more piece to the puzzle of ensuring future success: scalability. Telemedicine is what everyone is talking about. It’s what patients want and providers need. It’s always been competitive and innovative, but it’s also now mandatory for a practice to stay afloat. If done well, a practice may not only see their bottom line protected from the economic impact of this pandemic, but they could see the very thing keeping them out of the red turn into a major selling point for new patients. Make sure your telemedicine program is able to grow with you. When planning, think of the opportunities for new business and how you can structure your schedule and practice around this new addition to your service offerings to accommodate it. Could you start remote consultations with some of your specialized MDs? Could you treat your patients while in a facility or on vacation? Could you deliver in-home behavioral services or guide a family member in wound care? There are truly so many use cases for telemedicine – the only limit is your imagination. Start dreaming now so you avoid the mistake of creating a program for this season that cannot handle the “more” you could attract or create out of this.
The age of telemedicine is here – and it is truly the silver lining of this difficult and terrible time for our world. Being proactive with your planning and diligent with your strategizing is the key to riding this wave through this current crisis and into the future. To find out how SimpleVisit can help relieve your practice of the burden of telemedicine workflows and technology by providing the most user-friendly solution and only managed service on the market, complete our Buyers Guide today!
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