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So, You Implemented Telemedicine. Now What?

With the U.S. Centers for Disease Control (CDC), American Medical Association (AMA), and other medical specialties recommending a halt on non-essential medical encounters, the adoption of telemedicine has shifted into over-drive. According to research from Frost and Sullivan, March telehealth visits surged 50 percent amid the pandemic. Analysts now expect general medical care visits to top 200 million this year, up sharply from their original expectation of 36 million visits for all of 2020.

The need for virtual services is a necessity for patients trying to stay safe amid the COVID-19 pandemic but also for provider organizations seeking to extend quality care to patients outside the four walls of the hospital. An effective and sustainable telemedicine approach can help keep potentially infected patients out of the hospital, provide routine care for patients with chronic diseases who are at high risk if exposed to COVID-19, and protect healthcare workers on the frontlines. The quick adoption of telemedicine is a positive method of care delivery for patients and healthcare providers, however organizations that rapidly implemented are learning the unique challenges it provides.

In partnership with Sonder Health, Avaap is providing a three-part series for organizations that rapidly moved to implement a telehealth solution at the onset of COVID-19 and have dealt with a surge of virtual visits during that time. Our series will focus on topics to ensure you are thinking strategically about your telemedicine program while decisively moving forward with providing services.

Part I – Weathering the storm: Simple guidelines for using telemedicine

At the beginning of the COVID-19 pandemic, many hospitals and physician practices were not equipped to deliver care through telemedicine. As a result, these organizations have been racing to implement and scale up capabilities. Despite the need to move quickly to provide virtual services, health organizations need to think critically about how to properly provide virtual care, maintaining core telemedicine principles while also taking advantage of relaxed federal regulations enacted during the public health crisis.

To enable quick adoption of telemedicine during the pandemic, the federal government eased many regulatory requirements to help organizations provide services quickly. With CMS relaxing many barriers to entry for telemedicine such as the ability to provide care across state lines, expanded HIPAA-compliant platforms, and expanded Medicare coverage for telehealth visits, it has created a Wild West atmosphere for delivering virtual care. The need to scale quickly amid relaxed regulations should be counter-balanced by following best practices in the delivery of virtual care.

While it is uncertain when regulations will return to former requirements, and to what extent, one thing that is certain is that preparation is key to making the transition to telemedicine as seamless as possible. What should you focus on to remain relevant and compliant during the current coronavirus crisis, and more easily transition to a sustained program in the future?

Staffing for virtual visits

Increasing capacity for telemedicine requires having providers to perform virtual visits. With reduced volume of scheduled and inpatient visits, the existing care team can help support increased telemedicine volume. If that isn’t enough however, the Health and Human Services Department issued regulation to allow doctors and medical professionals to practice across state lines during the COVID-19 public health emergency. The ruling does not eliminate interstate licensing entirely, yet many governors have relaxed licensure requirements to allow physicians to work in another state.

Even still, credentialing, licensing, and privileging is resource-intensive for all physician practices and hospitals, and telemedicine is no exception. Virtually all states require physicians providing telemedicine services to be licensed in the state of the patient receiving care, and while some states are taking steps to increase the portability of clinical licenses, the guidelines are evolving. In addition to cross-state licensing, prescribing laws, the definition of what constitutes a patient-physician relationship, and how patient confidentiality and privacy work with virtual doctor visits varies state to state.

The relaxed licensure guidelines create a great opportunity for organizations to both expand their reach and more easily bring on support, but will require strong governance to keep track of states that have altered their telemedicine license policies now, and in the future, to reduce potential errors.

Marketing to patients

While 2020 saw an unprecedented leap forward in patient adoption of telemedicine amid COVID-19 concerns, making patients aware of telemedicine services is critical as is delivering benefit-focused service-line content. Helping patients understand their options, including the range of solutions based on their health needs, can help them understand when telemedicine is the right fit versus urgent care or emergency care. As consumers get increasingly comfortable with telemedicine, it is important to understand the needs, wants, and priorities of patients and then meet those demands. Market how the service will deliver improved patient convenience, reduced costs, shorter wait times, reduced readmissions, and time and money saved by eliminating travel, childcare, time off from work, and more. Establishing strong brand recognition and gaining patient’s trust now will serve organizations well as they expand services in the future.

Develop a standard workflow model

At the beginning of a telemedicine program, especially one quickly conceived, there may be some trial and error in determining how to best deliver care and capture the appropriate information. It is important for telemedicine to include integrated clinical workflows to improve the coordination of care between care settings and providers and reduce administration burden. It is also important to define success metrics for the program, so you know where and when to adjust workflows that are not meeting the desired goals. Analysis of workflow will allow an understanding of current processes and new opportunities for successfully introducing telemedicine solutions. For example, using the technology to prep the patient, including collection of patient demographic information, insurance information, and consents for treatment, and having it flow to the EHR.

Clinical site workflows need to make sense with room accommodations allowing for telemedicine to be mainstreamed into the clinical care process. Look at the whole process from scheduling to final communication and billing. Workflows done right can achieve greater efficiency and outcomes.

Telehealth etiquette

Carrying the trust and empathy patients expect from physicians through the screen requires planning and attention to detail. Start with good quality technology, create a professional space, and look the part. Cameras should be set at eye level for better eye contact with patients. Prior to the first visit, check what is in the patient’s field of vision and make sure the space is free from distractions, and so patients feel privacy is protected.

Communication is also important. When documenting, physicians should let the patient know they are still listening but taking notes. Internet connectivity is also prone to lag time. Adding a two-second pause before speaking can ensure patient’s last words come through.

Staff and patients need similar etiquette coaching. Provide staff with guidance on how to support physicians without being disruptive and that encounters need to be treated with the same privacy considerations as if the visit were in clinic. Ensure patients have a pleasant experience by encouraging them to be in a quiet area where they have privacy to discuss their cares and concerns.

Defining the new normal

As COVID-19 threatens to overwhelm the U.S. healthcare system and supply chains, telemedicine can prevent overcrowding and human exposures while facilitating high quality care. Hospitals and physician practices should revisit policies to incorporate telemedicine to address some of the unique challenges posed by infectious disease outbreaks and enhance the patient experience. Our next post will discuss what you’ll need to think about after the surge of telemedicine visits and as you work towards the new normal.

Subscribe to the Avaap blog for alerts or come back next week for part two, Picking Up the Pieces: Shifting to the “New Normal” and Maximizing Compensation and part three, Looking Ahead: Sustaining and Scaling Your Telehealth Program.