Taking Patient Care from the Exam Room to the Living Room
By Gerard Johnson, M.S. May 05, 2020
Covid-19 has changed the way in which patients access healthcare forever. The medical industry has fought a valiant fight against the Neflixization of patient care but we are now at a crossroads. My practice, like many others, were forced to deal with the question of how we bring the best care possible for our patients to the comfort and safety of their homes. We knew this was something we had to meet head on much sooner than we had planned or hoped. The slow and deliberate implementation of telehealth we envisioned for our practice was turned into a sprint to meet our patients needs while adhering to CDC, CMS, and HIPAA guidelines. We quickly realized our need to implement telehealth into our practice would require a dual tracked approach that balanced our immediate needs with our long-term goals for growth.
My practice chose Amwell Telehealth as our long-term solution. We had been looking at telehealth options before Covid-19, but the outbreak of the pandemic greatly sped up the process. We agreed to move forward Amwell Telehealth rather quickly. It gives us a stable and secure audio/visual feed while also being relatively easy to use for patients and staff. Amwell also offers the ability to integrate seamlessly into our already existing EHR and patient portals. We can also have the flexibility as the practice grows. The ability of Amwell to integrate into of existing software also meant that going live would be massive undertaking that could not be nor should be rushed. Therefore, we proceeded with original Pre-Covid-19 plan of a more deliberate roll out for this software and we looked for an inexpensive temporary solution in the short-term.
Our practice weighed multiple temporary options such as phone visits, the use of apps and websites like Zoom, WhatsApp, FaceTime, and Skype for Business, and Doxy.me to meet our virtual visit needs. Phone only visits are simple use for our patients and staff but the inability to see each other limits the patient and provider experience. Zoom and WhatsApp were video conference apps that are quick and easy to use but they both had glaring security holes. FaceTime was easy to use and secure, but a large swath of our patients does not own IPhone or Apple products. Skype for Business and Doxy.me are simple to use, secure, and accessible on virtually all phones, tablets, and computers. They both offered the ability to email patients video conference links to start the virtual visit with the click of a button. However, Doxy.me proved to be the best fit for our practice workflow because it was designed specifically for telehealth use and offers virtual waiting room allowing us to track when a patient is ready to be seen.
Once a temporary telehealth option was selected, we needed to ensure the practice would be reimbursed for the virtual visits. Before Covid-19, most insurers treated telehealth visits different from a traditional face-to-face visit. Reimbursements were at times lower and patients had different co-pays and deductibles. Fortunately, most insurance companies were proactive and removed many of these barriers to care, but it is still best practice to confirm telehealth benefits prior to seeing the patient. Next to the confirmation of benefits documentation is most important aspect to ensure that your practice is properly reimbursed for its work. You need to document the patient consent to the telehealth visit and their understanding that the visit will be billed to their insurance as if it were a face-to-face visit. You also need to document the means in which the virtual visit is carried out. Is it a phone visit with just audio or an audio/ visual video visit through a website or app? A small note to remember is that phone visits are still reimbursed at disproportionately lower rate than virtual visits with both audio and video components. Finally, you need to document the total time of the visit as some insurance companies adjust reimbursements based on the length of the virtual visit.
We must never forget that technology can be a useful tool for connecting people, but people are still responsible for truly connecting. Taking patient care from the office to the patient home remotely will be the new normal whether you like it or not. Telemedicine will not only be an intricate part of practice growth but ultimately survival in this new era.
The only question is will your practice be Netflix or Blockbuster?