First and foremost, we would like to sincerely thank all the healthcare workers on the frontlines fighting the Coronavirus pandemic. We recognize the immense sacrifice that you are making for all of us during this unprecedented and stressful time. We know how difficult it has been because you are our colleagues, our friends, and our families. Thank you.
For all healthcare professionals, the Coronavirus pandemic has utterly and completely upended our daily routine. Unlike other industries, healthcare is usually not known for rapid changes. In fact, we often take pride in our meticulous analysis and careful consideration of all possibilities before implementing new treatments, or changes in practice. Afterall, we are scientists at the core, and our strongest, most reliable tool is high quality evidence. The Coronavirus and COVID-19 changed all that.
Within days, medical practices across the United States were forced to cope with unimaginable changes. For example, in our practice of orthopaedic surgery, all elective surgeries were cancelled to prevent the waste of personal protective equipment (PPE) and also for disease mitigation. Furthermore, as the spread of the Coronavirus continued, non-urgent office appointments were curtailed for the safety of our staff and our patients. These presented challenges from both a healthcare administration perspective as well as a business perspective.
With patients sheltering in place, there has been a major surge in the use of video conferencing technology within medicine. Whereas before the pandemic, telemedicine was offered mostly to patients who otherwise had no other easy means of physical access to medical care, now telemedicine has become the primary modality for evaluation and treatment of patients nationwide.
During the pandemic, prior regulations regarding reimbursement for these telemedicine visits have been relaxed or completely waived. This has significantly lowered the threshold of entry such that clinical practices that were merely considering telemedicine before are now seeing almost exclusively telemedicine patients. However, the implementation and initiation of telemedicine does require some thoughtful preparation.
There are several excellent guides with regards to implementation of Telemedicine. Here is one written by the American Society for Surgery of the Hand. In general, there are several different categories of issues to consider:
- Patient population. Do you treat patients that would be amenable to telemedicine? If you speak to your patients, the answer may surprise you. The smartphone is almost ubiquitous in our society and video conferencing is nearly as prevalent. Video conferencing no longer means you have to have a computer or even laptop, your smartphone is all you need. Socioeconomic and age-related barriers have largely been resolved by cheaper smartphones and more intuitive interfaces, however those working in underserved areas should keep in mind that telemedicine may not always serve your patients well. For those patients, consider simple telephone visits.
- The platform. There are a variety of different platforms to choose from, but they have more similarities than differences. One of the major regulations that changed with regards to platforms during the COVID-19 crisis was the waiving of prior HIPAA compliance mandates. This means even Facetime is acceptable. However, it may be wise to consider several other aspects of other platforms before simply using Facetime. For example, video conferencing tools like Microsoft Teams, Zoom, or Skype can provide more stable connections with patients, but what would your workflow be? Will the provider be calling patients? What if they don’t answer? What if their equipment is not setup? Do they need to download an app or program first? Finally, there are some integrated solutions that may be built-in to your EMR. These systems are likely in place if you work at large healtcare institutions. Exploring those options first may be reasonable, although if it is not already in place it may take too long to setup. These are the real-world considerations that must be carefully weighed.
- Workflow. As mentioned before, developing a Telemedicine workflow that can scale with your practice is important in the beginning. Should every patient be offered a telemedicine appointment? Or should you develop criteria that your telephone answering service can abide by? Depending on the size of your practice, variety of your practice specialties, and nuances of your medical practice, the appropriate workflow can vary widely. Take for example, a medium-sized practice of 30 doctors with multiple specialties, because developing a cogent algorithm for the call center is difficult, if not impossible, it likely is best to have all patients be screened first with Telemedicine. This reduces unnecessary in-person visits, at the risk of a higher volume of Telemedicine visits.
- Coding. Educating staff — everyone from physicians to billers/coders — is an important part of implementing Telemedicine. There are many resources online to provide guidance, however keep in mind these rules are evolving by the minute. For example, by the time this post was completed, CMS was already starting to consider allowing telephone (audio only) visits to be billed at Telemedicine rates.
We hope this article provides some fundamental knowledge regarding Telemedicine, and helps spur those who are considering it to incorporate it into their practice.