Renee Dowling is a compliance auditor at Sansum Clinic, LLC, in Santa Barbara, California.

 Are there any changes to the telehealth billing in 2023?

 For CY 2023, Medicare is finalizing a number of policies related to services, including making several services that are temporarily available as telehealth services for the Public Health Emergency (PHE) available at least through CY 2023. This allows additional time for the collection of data to help in determining whether or not Medicare will include service(s) as permanent additions to the Medicare Telehealth Services List. Centers for Medicare and Medicaid Services (CMS) has finalized their proposal to extend the duration of time that services are temporarily included on the telehealth services list during the PHE for at least a period of 151 days following the end of the PHE.

This confirms CMS' intention to implement the telehealth provisions to ensure a smooth transition after the end of the PHE. These policies, such as allowing telehealth services to be furnished in any geographic area and in any originating site setting (including the beneficiary’s home); allowing certain services to be furnished via audio-only telecommunications systems; and allowing physical therapists, occupational therapists, speech-language pathologists, and audiologists to furnish telehealth services, will remain in place during the PHE for 151 days after the PHE ends.

As a reminder, under this final provision, they will allow physicians and practitioners to continue to bill with the place of service (POS) indicator that would have been reported had the service been furnished in-person.These claims will continue to require the modifier 95 (Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System) to identify them as services furnished as telehealth services. Claims can continue to be billed with the place of service code that would be used if the telehealth service had been furnished in-person through the later of the end of CY 2023 or end of the year in which the PHE ends.

The Telehealth Originating Site Facility Fee has been updated for CY 2023, which can be found with the list of Medicare Telehealth List of Services at the following website:

https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

You can also find the listing of the telehealth services included in this ruling at:

List of Telehealth Services for Calendar Year 2023 (ZIP)

Articles

Any billing changes won't come for a while.

Telehealth services billing unchanged at least through 2023

 is the Chief Medical Officer at Qualtrics and a Staff Neurologist and former Chief Experience Officer at the Cleveland Clinic. A 

 and healthcare industry pioneer, Dr. Boissy advocates for empathy operationalized to design systems that deliver human centered care. An internationally renowned speaker and author, she has also been featured in the Washington Post, the Atlantic, and many more. She publishes extensively on the future of experience design, communication skills, workplace violence, and metrics that matter in humane experiences of health.

A long spanning debate about when someone becomes a “patient” has raged. Every so often we revisit whether we should find a new name, like “member” or “customer.” However, they are first and always a person - a mother, pianist, employee, and much more. In fact, being a “patient” is just a small part of life and goes far beyond the exam room.

In 2008, Verghese cautioned against the practice of patients 

, or iPatient, and not a real, live, multidimensional human. “

Pedagogically, what is tragic about tending to the iPatient is that it can't begin to compare with the joy, excitement, intellectual pleasure, pride, disappointment, and lessons in humility that [we] might experience by learning from the real patient's body examined at the bedside.

” As such, the purpose of having an electronic health record (EHR) is to better collect, manage, and care for patients. To house the insights in a way that enables clinicians to show up at the bedside knowing the clinical details and ready for 

what only the patient themselves could teach.

In 2022, there are 224 million Google results for patient-centered care. To provide this care, clinicians must understand a patient’s values, preferences, goals, and what they are looking to get out of their care, and their life. For example, is this person working towards going back to school, or are they a caregiver to someone? Hospitals do amazing things when they know this information - host weddings, present the American flag to veterans, and take gurneys out to the water’s edge for the last time.

We lose something magical if we make that extraordinary effort and then next time, no one knows any of that emotional or life context, and we start again from scratch. Having data at the first touchpoint and throughout the healthcare journey can uncover these insights, and provide clinicians with the opportunity to evolve their conversations and care plans. Understanding patient preferences, including preferred language and modes of communication, is necessary for high quality, high value care for both the patient and provider, as research shows 

 of patients will leave a provider after a poor experience with communication.

The EHR collects preferences, an overwhelming amount of detail on every test, written word or note, and a full array of medical opinions. Hospitals have become better at capturing surveys about bodily functions and mood (which are occasionally reviewed and used), and even social determinants of health. One insight we know from the EHR is that clinicians are spending 

two hours of EHR time for every hour of patient care 

- when they should be home engaging with their loved ones.

What is not included in many health records is the narrative of who people are and who they love. What we haven’t acted on at scale is how employees engage in the EHR and how we create more meaning and efficiency for them. Healthcare is just beginning to think about how to analyze emotional content and feedback, surface key drivers of patient satisfaction, proactively find hotspots in the patient experience to fix broken journeys, monitor employee engagement, and uncover coaching opportunities to boost team effectiveness.

The resulting problem, therefore, is the sheer volume of data that does not yet inform a meaningful view of human beings.

To overcome this data dilemma, healthcare leaders must commit to strategically 

understand the findings, and act. Emotions and subsequent behaviors can be combined with operational and financial data to understand their relationships and driving forces. Then - and only then - is when we shape the human experience at scale. Change can be as simple as an automated quick response to available data or feedback. Ideas can be crowdsourced on pain points and improvement efforts. Patients and employees themselves can be included in the new design of programs and resources to solve the issues right in front of us. Alternatively, we might find creative ways to use resources we already have.

Burnout and attrition are two hot button issues plaguing healthcare, with 75% of 

 anticipated to leave the profession by 2025. Data and improved workflows can help clinicians work at the top of their license, enhancing patient-centric care, improving career satisfaction, and mitigating burnout. There is evidence that patients are exhausted and overwhelmed too - whether due to mental well-being, or financial pressures - resulting in 

The term “dark data” is occasionally used to describe data that is collected and not used - seen, but not heard. The healthcare business is ultimately about people caring for people. To not harness data about people’s pain and joy in a meaningful way in today’s environment, is to pretend healthcare is a business without heart that sells a product to avatars. To get closer to a people first strategy, we must lift the voice and emotional insights we have today, at our fingertips. To honor the emotional rollercoaster that people are on and to bring holistic solutions forward that feel thoughtful, different, and impactful - we must bring that which is dark into the light.

Getting closer to a people always strategy: Unlocking empathy at scale

Jonathan Friedman, MBA, is CEO of PRN Advisors.

In 30 years of running revenue management the usual suspects come up in a Key Performance Indicator (KPI) Dashboard such as Charges, Payments, Adjustments, Net Collection, Gross Collection, Days in AR, AR over 90 Days and Bad Debt. Then you have the breakouts for each category by payer, CPT Code, Location, or ICD Code.

There are 3 other KPIs that I track that may not be traditional KPIs, but they have a significant impact on collections and cash flow.

You probably notice the C codes related to denials such as CO 11 – Diagnosis Inconsistent with Procedure, CO 22 – Coordination of Benefits, CO 167 – Diagnosis is Not Covered, etc.

I take the time to program a listing of denial codes that make sense to the practice. The C Codes are very generic and can only go so far to alert you of denial patterns and potential issues. I always ensure I have a listing of denial codes that correlate with the C codes and provide more pertinent information. For example, if I receive a denial of CO11 I would have several categories such as Need additional medical information from physician, diagnosis not covered with procedure, need additional modifier. 

Getting the denial and correcting the issue for that claim is not enough. Many times, I notice repeated instances of correcting the same issue on multiple claims. Once you identify the denial, seek to place a rule in your billing system that would correct this denial before the claim is sent out. The goal is to prevent the denial from ever happening.

I seek to quickly capture trends in the denials before they result in a bulge of denials that become difficult to manage and get paid due to volume. Payers may have different denials for specific procedures and diagnosis in accordance with their policies or your contract. Weekly I review any denials to ascertain if there is a trend or an accumulation of denials before it becomes an acute issue.

Always remember, the goal is not to correct the denial quickly but to prevent it from ever happening.

The Number of Touches indicates the number of times a specific claim has been worked. The claim may have been resubmitted, identified as still in process, in appeals, additional information being submitted, etc.... I will look for claims that have been touched multiple times, usually more than 3 and then I drill down. It is not infrequent to see claims that have been touched 15-20 times. The objective when working the Accounts Receivable is to get the outstanding claims resolved, not to solely perform an action that may perpetuate the unpaid claim. Sometimes incentives are misaligned and incentive the number of accounts worked as opposed to number of accounts paid. I am always looking for a claim to get paid within 3 touches. 

When it gets beyond the 3 touches, I tell my team not to hesitate about ringing it up the ladder. Sometimes if claims are denied by a payer, it could indicate there is an underlying issue such as the status of the provider, a failure to update a new policy, a contract not being uploaded or a glitch in the system. Creating a culture of rewarding the right outcomes and encouraging communication when there is an issue is imperative in running an effective revenue management department.

I have weekly meetings with my revenue management team. Usually these take about 30 minutes. To the outsider it may seem simple and common sense. However, I find this practice vital. Establishing the amount each month you are expected to bill out and collect and comparing to actual charges and collections is a quick gauge of how collections and charges are doing throughout the month. You will be able to quickly identify any issues with this simple review. My teams found trend in denials, issues with the payment cycle of a payer or missing charges from this simple review. It is not uncommon to find organizations where their Accounts Receivable and financials are in disarray because they have not implemented a forecast even in its simplest form.

I utilize a Waterfall analysis in estimating the amount of collections in any month. A Waterfall analysis is a report that indicates the percentage of collections contributed by each month. For example, if you are running a Waterfall analysis in June you may find 20% of the collections come from charges in that month, 35% come from charges entered in May, 20% come from charges entered in April, etc.... I find this along with modifications made for specific events such as seasonal differences or temporary closure of a location provides a decent estimation of collections.

Incorporating these 3 KPIs into your analysis will help you identify issues in a timely manner and improve collections and cash flow.

These non-traditional KPIs have a significant impact on collections and cashflow.

3 Revenue management KPIs people don’t talk about

Jeffrey Bendix is the senior editor of Medical Economics.

Despite its challenges, value-based care has shown great promise in improving health outcomes and access to care, particularly among traditionally underserved or high-risk patient populations.

That was the view of participants in the panel discission, “The Risky Business of Value-Based Care" at the 2022 HLTH conference in Las Vegas. Panel moderator Sara Pinto, a partner in the venture investment firm Emerson Collective, began by pointing out that currently only about 20% of Medicare reimbursements are value-based. But given the flaws in fee-for-service medicine, “in a lot of ways we need value-based care to work, and we all hope it will.”

Panelist Corbin Petro, co-founder and CEO of Eleanor Health, a company that provides mental health and substance abuse services, said that 90% of the population they serve are not connected to primary care. “We know we can engage with this population and improve the health, but we can only do it by taking on financial risk,” she said. “I think that’s the promise of value-based care, especially for populations that the health care system traditionally has left behind.”

Her view was echoed by Ali Khan, MD, MPP, chief medical officer for Chicago-based Oak Street Health, a network of primary care providers. “To me, the importance of value-based care is its ability to provide primary care where it didn’t exist,” he says, noting that Oak Street is the only health system to serve Chicago’s largely impoverished west side.

The same was true for many of the communities served by Khan’s previous employer, Iora Health. “These are places the medical-industrial complex has largely failed,” Khan said. “So if nothing else, value-based care has incentivized companies like ours to go into places that otherwise haven’t been touched by the health care system.”

Aaron Friedkin, MD, chief business officer for Homeward, a provider of health caree services to people in rural areas, says that by enabling his company to take on risk for large patient populations, “we can make investments to expand access to care deploying technologies and care models that may not be reimbursed under fee-for-service but that allow us to overcome many of the structural barriers to care found in many rural areas.”

Panelists also stressed that without the time constraints of fee-for-service medicine, their providers can take the time to get to know patients and build the trusting relationships necessary to provide high-quality care.

“You have to understand what’s top of mind for a community, and that’s not always health care,” Friedkin noted. “It could be ‘how do I pay my bills’ or ‘how do I get where I need to go?’ Knowing those kinds of things requires understanding not just the health needs of a community but everything that’s going on in their lives. If we show we can help with those issues is how we earn trust and the right to care for them.”

Panelists highlight care options unavailable under fee-for-service model.

HLTH 2022: Value-based care's potential

Ram joined Valant in 2020 as an experienced technology executive to lead the organization through its next stage of growth. His passion for listening to the customer and building strong teams, coupled with his demonstrated ability to drive scalability, provide a solid foundation for Valant to grow as it finds new ways to serve the behavioral healthcare market. Ram’s robust experience began at GE where he graduated through the Informational Management Leadership Program and went on to lead the Global Radiology and Services business units. After nearly 15 years at GE, he went on to lead multiple SaaS businesses through critical phases of growth.

Billing is one of the most critical parts of running a behavioral health practice. This is especially true for large practices, as maximizing efficiency at scale significantly affects their revenue cycle. It’s important to set realistic expectations about the mental health billing process, which isn’t easy to integrate into regular workflows.

To take on practice billing, clinicians must devote time to learning and accommodating new processes. This includes creating clean claims and monitoring them after submission, correcting and resubmitting rejected claims, negotiating denials, collecting payments from patients, and reconciling bank statements. If any of these steps are skipped, clinicians risk losing some of the reimbursement that is due.

Expecting too much too quickly can lead to disappointment and possibly burnout, neither of which are conducive to competent practice management. Behavioral healthcare billing can be challenging at first, but plenty of clinicians and practices have mastered it with the right tools and guidelines. This includes:

Clinicians should use billing best practices to their advantage to maximize reimbursement for services. However, they should be patient with the process. It takes time to hone in on service coding skills and become adept at negotiating with payers. These changes will increase a practice’s revenue, but it won’t happen overnight.

To understand a practice’s revenue cycle, clinicians should set up reporting, whether they do that independently or use billing software. A system with advanced reporting features can help clinicians understand exactly what is happening in the revenue cycle. Billing software should provide an overview of aging claims and show how many days each claim has been waiting. This tracking helps with cash flow and allows practices to fix mistakes and denials more quickly.

Payment breakdown reports show which payments have been received from insurance and which from patients so they can be reconciled with bank statements. Productivity reports for providers, while not directly related to billing, nevertheless help make practices more profitable. Also, provider efficiency can be reviewed and reminders can be sent about submitting bills on time.

Behavioral health practices should compose a written process for billing procedures that every staff member will follow. This guide should include every step from creating and coding the bill, to submitting it, tracking it, following up on rejections/denials, and receiving payment. This is the best way to stay organized and prevent any oversights.

It is important to document what information to gather from new patients when to perform insurance eligibility checks, and how claims are generated once services are complete.

Practices should keep a schedule for submitting claims, track them, investigate aging claims, and respond to rejections and denials.

Additionally, insurance coverage for existing patients should be periodically checked. Some practices run the insurance information for every patient before each appointment because a patient’s insurance status may change at any time, while other practices find this checking frequency too burdensome and instead schedule specific days to update insurance information.

The cadence of these tasks will differ depending on the size of the practice and the number of individuals devoted to the billing process. For individual therapists, it’s best to check documentation regularly and claims submissions throughout the week, designating time to review any rejected and unpaid claims.

Larger practices with a dedicated biller on staff should visit the revenue cycle every day. Staff should routinely submit each day’s claims, work on a portion of claims that require follow-up, check bank statements, and collect patient payments. If a practice is large enough to have one or more billers on staff, the billing workload is heavy enough to require constant and thorough attention. All providers and practices should aim to review their list of aging claims at least every 30 days.

Creating a discipline of regularly managing the revenue cycle is vital for practices today or work will backlog quickly and revenue could be lost. This includes making time to carefully check each claim, running reports on a regular basis, and filing claims promptly after treatment.

Behavioral health practices must be adept at medical billing to survive. Whether they opt to bill in-house or vet and partner with a competent third party to manage the process, it is essential to have a meticulous billing process in place in order to truly flourish.

Ram joined Valant in 2020 as an experienced technology executive to lead the organization through its next stage of growth. His passion for listening to the customer and building strong teams, coupled with his demonstrated ability to drive scalability, provide a solid foundation for Valant to grow as it finds new ways to serve the behavioral healthcare market.

It’s important to set realistic expectations about the billing process, which isn’t easy to integrate into regular workflows.

Achieving best-in-class billing for behavioral health practices

practiced as a nurse and nurse practitioner for over 20 years.

With all the useful information available on Physicians Practice, it is easy to become overwhelmed.

With this in mind, the tip of the week is a chance to reflect on some of the wisdom found all across the site. In a February 2021 story on five reasons why doctors should become wound care specialists, Gayle Morris, BSN, MSN writes the following:

“Senior populations are growing rapidly and will need increased quality medical care. Along with this growth comes an increased need for quality medical care, especially in areas such as wound care and pressure ulcers. Becoming certified in wound care can help doctors in many ways. Here are just five:

 - understanding how to treat wounds and pressure ulcers expands a doctor’s knowledge base in a way that is increasingly needed.

 - pressure ulcers have recently attracted the attention of the medicolegal community. Some courts regard pressure ulcers as evidence of elder abuse, and following this precedent, in 2008 the Center for Medicare and Medicaid Services instituted a policy to withhold reimbursement to acute-care hospitals for the costs of treating pressure ulcers.

 - The National Library of Medicine recognizes pressure ulcers as a relevant contributor to hospital stays. They write, “Pressure ulcers make a significant independent contribution to excess length of hospitalization beyond what might be expected based on admission diagnosis.”

 - Compared to patients who do not develop pressure ulcers, patients who develop pressure ulcers are more likely to develop nosocomial infections and other hospital complications.

 - As patients with many medical conditions may be at higher risk for pressure ulcers, it is important that physicians recognize that even in the ambulatory care environment appropriate prevention and detection strategies are needed.

Your weekly dose of wisdom from the Physicians Practice experts.

Practice tip of the week: Five reasons why doctors should become wound care specialists

Therasa Bell is Co-founder, President, and Chief Technology Officer at Kno2 (Boise). 

Combining her passion for healthcare and extensive technical expertise, Ms. Bell created Kno2 as market forces began to drive more effective, lighter-weight healthcare solutions. She is known for three things: her focus on driving interoperability, her ability to simplify the complexities of patient document exchange and clinical workflows, and her commitment to serve that infuses her interactions with everyone and powers the company’s purpose to democratize healthcare communication for all, enabling the secure, effortless, and maximized exchange of patient information. A true inventor at heart, Ms. Bell is responsible for Kno2’s innovation, vision, and engineering, and holds six patents for patient information exchange.

Dr. Peter Schoch, Senior VP of Population Health, Advent Health System & President of the Florida Hospital Physicians Network

A St. Louis native, Dr. Schoch attended medical school at the University of Missouri – Columbia. He spent the first 20 years of his career practicing as a board-certified internist before stepping into an administrative role with SSM Health. He has served in various capacities as a physician leader at SSM Health, including Regional VP of Value Based Care and Payment and Chief Medical Officer, transforming the health system into a population health management company. He directed EHR optimization, transformation of critical processes and clinical workflow, developing an integrated delivery network focusing on quality, safety and patient centeredness achieving a new care delivery model (PCMH, ACO, CIO) that embodies the triple aim. Dr. Schoch made the move to Florida in 2018 as their SVP of Population Health leading the population health initiatives and transformation of the care delivery model. Regardless of position, Dr. Peter Schoch champions a coordinated approach to care, including the development of interoperability to simplify data sharing between providers throughout the care continuum.

6 Steps You Can Take Now as a Provider to Address Health Inequities

Inequities in healthcare have importantly moved to the forefront, but many clinicians are left asking––what’s next? Addressing the seemingly endless array of obstacles that prevent equal health outcomes for everyone sometimes feels impossible. Social determinants of health, how people live, work and play affect their overall wellness and account for about half of the equation to a person’s ultimate healthcare outcomes, much more than the clinical treatment they receive.

If a person’s zip code has more bearing on their wellness than their genetic code, how are healthcare providers supposed to address inequitable outcomes? Often, healthcare providers spend only a few minutes with each patient. This doesn’t give them much insight into their lives to see what is happening.

There is one specialty within the medical industry that 

 get the opportunity to spend extended time with patients, often in a familiar environment or even their own homes. The post-acute space is uniquely suited to dive deep into social factors and solutions that work. 

With this in mind, we spoke with experts in the field to compile a list of action items that providers can realistically take on how to make an impact on the overall picture of health equity.

Slideshows

If a person’s zip code has more bearing on their wellness than their genetic code, how are healthcare providers supposed to address inequitable outcomes?

6 Steps you can take now as a provider to address health inequities

 advises clients on compliance, transactions, government administrative actions, and litigation involving healthcare, cybersecurity, corporate and securities law, as well as False Claims Act and Dodd-Frank whistleblower cases. She also teaches bioethics at Baylor College of Medicine in Houston. Rachel can be reached through her website, 

In November 2022, Senator Mark R. Warner released an important policy paper entitled, 

. As an attorney with federal government experience, as well as focusing my practice on healthcare, cybersecurity, securities law, Dodd Frank, and False Claims Act compliance, transactions, litigation, and representing individuals on certain matters before government agencies post-reportable cybersecurity incidents, there are a couple of important items that stood out to me as already being available.

 The critical question is why persons are not reading what is out there and utilizing the National Institute of Standards and Technology (“NIST”)’s general framework for approaching cybersecurity, which I have distilled from five (5) words to three (3) words: prevention, detection, and correction

In my experience handling these issues from different vantage pointsfor over a decade, persons either ignore the risks and costs of non-compliance with 

Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and related Rules and laws

, gamble on not having a government action brought against them either organically by a government agency or through the False Claims Act’s 

 provision, and/or view the monetary fines as a cost of doing business.

In order to address some of the items in the 

 in particular on certain cybercriminals overt statements about targeting hospitals and the healthcare system in order to put pressure on the hospitals to pay the ransom demand because of the threat of adverse patient outcomes, including a patient death;

Appreciating what has been in the HIPAA Security Rule since its effective date in 2005 – the fundamental purpose of the security rule is to protect 

 by ensuring that the confidentiality, integrity, and availability of the data remain intact. Hence, privacy and security go hand in hand;

Understanding that there are already laws in place, including the Cybersecurity Act of 2015 and the subsequent efforts under §405(d) which leveraged a public-private partnership to provide resources that now available through 

Evaluating compliance with recognized security practices (i.e., NIST standards, §405(d) guidelines and best practices, and HIPAA Security Rule) as expressed in 

HR 7898 (Pub. L. 116-321 (Jan. 5, 2021)),

 which are factors the government will consider when assessing fines and conducting an investigation; and

Ensuring that False Claims Act liability is mitigated using the new 

Anti-Kickback Statute’s safe harbors and Stark Law exceptions, most of which became effective on January 19, 2021

. In particular, those that relate to cybersecurity.

Incentives or “carrots” are important. Equally as important is the appreciation that where there are incentives, there are also those who allegedly will exploit or attempt to exploit a government incentive program or government procurement contract. In other words, commit fraud by not following the laws. One example is the 

U.S. Department of Justice’s first False Claims Act settlement

 under its Civil Division Cyber-Fraud Initiative. Another follows a line of cases and settlements stemming back at least five (5) years – electronic health record companies both falsifying their own compliance with HIPAA and the HITECH Act under the Meaningful Use and Interoperability Program, which providers detrimentally relied upon and placed their patients and systems at risk, as well as the illegal payment of kickbacks and the causing of false claims to be submitted. A 

recent example is Modernizing Medicine agreeing to pay $45 million to resolve these types of allegations.

In order to cultivate a culture of compliance organizations need to take a “patient safety first” approach, whether the person is a covered entity, business associate, or subcontractor because of the connectivity between these different entities. Coordination between government agencies ia always beneficial. I would argue that HIPAA is not outdated. To the contrary, it has continued to evolve since its inception. The question is whether persons utilize the resources and refer to the laws, which have been available for years.

In order to cultivate a culture of compliance organizations need to take a “patient safety first” approach to cybersecurity.

Cybersecurity is patient safety

After a 15-month fight with Long COVID, author Lucien W. Roberts, III, MHA, FACMPE, retired in February 2022 on the advice of his primary care doctor and his wife…perhaps not in that order.In retirement, he spends a few hours a week at a freestanding infusion center he co-owns, writes the occasional article, and tries not to drive his wife too crazy.He may be reached at 

This is an article about the future battle between telehealth and telewealth. Telehealth - the version of telemedicine most of you practiced during the pandemic - will be pitted against telewealth, the Amazonization of healthcare in which patient care becomes a commodity. Your success or lack thereof will rest upon 

. That bears repeating: your success or lack thereof will rest upon patient loyalty.Please permit me to explain.

Amazon, CVS, United Healthcare, and other conglomerates are investing serious resources (aka telewealth) into taking away your core business: patient care. I imagine artificial intelligence and treatment algorithms will be part of their strategy, yet the main strategy will be convenience: healthcare when a patient wants it, where a patient wants it.

Think about it: so many of us want to support local business, but time after time we succumb to Amazon’s advances. In the absence of a personal relationship with a retailer, convenience trumps loyalty time and time again.You cannot compete with the convenience of 24/7/365, but you can compete – and win - on loyalty. I believe it is the key.

6 Tips to boost your telehealth patients' loyalty

Your success or lack thereof will rest upon patient loyalty.



Randall Curnow Jr., MD, MBA, FACP, FACHE, FACPE currently serves as Medical Director of Cadence, a health technology company pioneering remote patient intervention for people managing chronic conditions. Cadence’s clinically led, technology-enabled platform personalizes patient care, predicts clinical risk, and intervenes as necessary, all outside the four walls of the hospital.

Stop me if you’ve heard this: To care for an average number of patients according to national recommendation guidelines, primary care physicians need to work 26.7 hours a day.

It sounds like the punchline to a joke, but that is the unfortunate reality for physicians according to recent 

 conducted by the University of Chicago, Johns Hopkins University, and Imperial College London. How is it possible to meet national guidelines for patient care if physicians must dedicate 14.1 hours a day for preventive care, 7.2 hours a day for chronic disease care, 2.2 hours a day for acute care, and 3.2 hours a day for documentation and inbox management?

It’s not possible, and as many physicians know all too well, we are still struggling with the aftershocks of the global pandemic, which only worsened already oversize patient panels, practice staff labor shortages and the increasing level of patient communications demands—phone calls, texting and emails. Along with our nurses and office staff, many of us are facing overwhelming demand from increasingly complex patients while also dealing with burnout issues. So, where do we turn?

Mentioning technology-based solutions to physicians can be conversation-limiting. Burned by electronic medical record implementation, documentation requirements and prior authorization technology that are still remnants of a bygone era, we are rightly suspicious of those who suggest technology can make our lives easier.

On the surface, remote patient monitoring offers some hope for a respite, but like many other solutions intended to help both patients and physicians, many RPM solutions end up adding to the work burden for physicians and their office staff. That’s because RPM devices monitor and alert physicians to changes in the condition of patients suffering from chronic conditions, but they leave it up to the physician to do the work of getting patients stabilized and on a better track with their health. Physicians in private practice simply don’t have the bandwidth.
But what if RPM technology gets paired with a novel type of clinical support provided for patients as an extension of the physician? In addition to RPM technology, providing a level of clinical oversight to help doctors better manage their patients with hypertension, heart failure, diabetes and COPD is the real game changer.

So, how does this work? Instead of relying on a patient’s primary care physician to triage and analyze all the reported health information, a dedicated clinical team not only monitors the patient’s daily vital information but also intervenes as soon as there is any escalation and provides the patient with virtual clinical support. Using this model, we’ve found only 1% of our interactions with patients escalate to the primary physician. Couple that with better patient compliance and satisfaction (90% of our patients use their daily devices), and you can successfully reduce avoidable hospitalizations, trips to the physician’s office and improve patients’ overall health. This innovative solution to managing patients with chronic conditions provides practice physicians more time to expand their panels, reduces their patient phone messages and email, and allows them to better focus on the patients in front of them.

Another important aspect to this innovative solution is that all of the clinical interventions and patient engagement are seamlessly fed into the EHR so physicians can review them at their convenience. This is critical, considering that over the past few decades, many technologies with the best of intentions have failed to deliver true value to physicians because of their lack of integration into physicians’ EHR. Indeed, in prior iterations of RPM, physicians would be left to review faxed results — which needed to be scanned into a computer­— or to log, review, download and transfer documents into their EHR from a separate site. In order for RPM technology to be truly helpful and reduce burden on physicians, it must be seamlessly integrated into the EHR.

But will RPM take care of patients better than me?

Any primary care physician knows patients with chronic conditions are difficult to manage. To stay out of the hospital, they need much more attention on an ongoing basis than regular office visits can provide.

But despite their overwhelming workload, some physicians worry about remote patient monitoring further distancing them from their patients. They wonder whether they’ll ultimately lose control of their patients.

In my experience, nothing could be further from the truth. Most of the patients we work with see us as an extension of their physician’s office — they’re happier because they’re getting the attention they need to manage their condition and their health improves. So not only are these patients healthier, but also, they are happier with the care they’re getting from the practice because our clinical staff is perceived as a vital part of services the local practice provides. Just as importantly, they’re staying out of the ER and the hospital, a critical concern given the high likelihood of admission and readmission for people with chronic conditions, and the potential financial penalties that can result.

It’s about improving health, preventing hospital stays

Ultimately, physicians are concerned with providing excellent care to their patients. However, given all the demands on their time, many physicians will admit providing exceptional quality care that meets guidelines can seem impossible. The vast majority of patients receive excellent healthcare 

 physician support tools, not because of them. Using the advances described here, we are turning tools into true resources to improve patient lives and physicians’ quality of practice.In practice, with overstretched clinical and office staff and burnout concerns rampant, remote patient monitoring with clinical intervention can help provide a respite so practices can focus on other important issues.

And while an eight-hour workday still might be a bridge too far, when looking at remote patient monitoring partners, physicians should choose one that extends their practice, not one that just gives them more to do.

Many physicians are facing overwhelming demand from increasingly complex patients while also dealing with burnout issues. So, where do we turn?