Eric Haden

Due to the Coronavirus pandemic, telehealth for both patients and providers has quickly become a necessity rather than an option. On February 20, 2020, the Federal Government 

 of the HIPAA regulations associated with using a secure HIPAA telehealth platform for virtual care. Many states have also enacted similar measures as well. One thing they all have in common is that they are a TEMPORARY response related to steps taken during the Coronavirus Pandemic. As many states begin to lift other non-medical COVID-19 orders such as social distancing and closures of businesses and schools, it is expected that these emergency telehealth orders will expire soon. Thus, what was enacted during the emergency, will probably not remain in place after the COVID-19 has come to a solution. For example, in the 

 and telehealth are set to expire on June 19, 2020. Even with the lifting of these restrictions, it would be naÃ¯ve for providers to assume that demand by patients for telemedicine will dissipate with the lifting of these emergency orders. PCPs and other healthcare providers should be looking now to understand how they can continue to utilize the implementation of telehealth into their practices. This article will provide suggestions for selecting a secure, HIPAA compliant vendor for a primary care practice.

For those PCPs that have opted to conduct consults over the phone, Skype, FaceTime, and other non-HIPAA Compliant forms for virtual care during the COVID-19 crisis should be planning now on adopting telemedicine into their practices. Patients and providers alike have overcome the most common barrier to telemedicine adoption; they have had a chance to use it and discovered its utility to both providers and to patients. And if the 

 as reported by Fair Health in March, 2019 coupled with the favorable patient satisfaction results reported in October of 2019 by 

 that were being demonstrated pre-Covid-19 should make a strong argument that PCPs should be looking at telemedicine as the “new normal”, rather than the exception in how they communicate with their patients.

HHS Stimulus: Practices may not be eligible to retain funds

The two major questions that need to be answered

What does the practice hope to achieve by integrating telemedicine into their practices?

Who are your patients, and how can they benefit from telemedicine?

These questions require answering or considering before selecting a vendor. A provider cannot expect to select a telemedicine platform and expect it to work "right out of the box." But a practice that takes a time to thoroughly consider these two vital questions will establish the critical foundation of building a successful telemedicine solution that meets the needs of both the provider and the patient.

Self-employed PCPs must think carefully about offering telemedicine, as they generally lack the resources to go the trial and error approach and the finances to survive a failed project. PCPs should not look to replicate the programs used by multi-specialty groups and large health systems; instead, they should look at their patient populations, pick a platform that can be easily moved online (such as non-acute primary care, follow-up visits or medication refills), and match the technology to the needs and wants of both patients and PCPs.

In developing the Care Services Plan, you should consider the needs identified in the previous step, determine which services will be offered, and how they will be delivered using telemedicine. In this step, you must consider the source of medical services, how those services will be delivered, the location of the providers, the location of the patients, and the guidelines and procedures for delivering these services. This step also includes consideration of telemedicine technology features used in delivering the services, such as the quality of audio and video transmission, special equipment required to view the patient or the equipment to measure certain physiologic parameters such as blood pressure and glucose monitoring and even ultrasound imaging.

In this step, references to technology should be in terms of general features and designs, and not in terms of specific vendors or equipment models. For example, you might state that your practice has a high incidence of patients with congestive heart failure, which indicates the need to measure blood pressure, pulse rate, and body weight in their homes. This will need to be followed by developing protocols that include the referral of the patient by the PCP, the scheduling of the telemedicine examination, communication with the staff at the remote site, and the examination between the patient and the specialist. (Is this what you mean?)

Identify Your Patients Who Benefit from Telemedicine

Most PCPs know their patients' needs, but what about healthier patients in your practice who might only require maintenance medication for high blood pressure that is controlled with medication? Is your prescribing pattern to issue a prescription to these patients for months at a time due to the time restraints of the patient? It is common for a provider to want to reduce the inconvenience of their patient from having to take a day off of work or get someone to watch their children so that mom can go to the doctor for a routine medication office follow-up. The result is sporadic office visits at best that are spread out over a period of months between seeing their physician. With telemedicine, the patient can now schedule a time and place to receive their healthcare that is convenient for them. It can be accomplished over their smartphones on their tablet or personal computer, and even in the privacy of their vehicle. This means that those 3-6-month routine office visits can now be conducted monthly by the PCP, and the result is improved patient engagement and, of course, the apparent increase in practice revenue.

Telemedicine is currently a viable option and fills an unmet need for most practicing PCPs-- especially during the COVID-19 pandemic. Patients are going to expect to be able to have a virtual visit with their primary care physicians. Failure to offer this method of communication will result in patients leaving a practice to find PCPs who are able to communicate using telemedicine.

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The pandemic has made telemedicine a necessity, rather than an option.

Finding a telemedicine vendor

According to a news release by the American Medical Association, results from a 

 that analyzed insurance claims filed for alternative settings of care indicates telehealth services rocketed up 53 percent from 2016 to 2017. 

, in October 2019, found that patients who use Telehealth for their alternative care reported high satisfaction levels with their experience-nearly half out of a total of 1,000 surveyed patients scored telehealth services 900 points or more. 

“These customer satisfaction scores are among the highest of the healthcare industry,” says J.D. Power in their official release.

, as a whole, with Provider-to-Patient in green.

A 2020 asset protection checklist for physicians

There are hundreds of different types of Integrated Care Models, such as Patient-Centered Medical Homes (PCMH), Integrated Primary Behavioral Care (IPBC), or the many VBP models, to name a few. These reports on increasing patient satisfaction and utilization growth by providers should be raising red flags across the board. According to the 

 (PCC), PCMH models "have grown over the past decade, with nearly 500 public and private sector PCMH initiatives tracked across the

Telehealth Reports Reveal Patients Are Not Going To PCMH, Integrated Care, or VBP Programs

 also reported that, among the fastest-growing segments of healthcare, Telehealth is experiencing greater applications in 

urgent care (14 percent) and retail clinics (9 percent).

Initially, when the Centers for Medicare & Medicaid Services was designing what are now hundreds of different PCMH, Integrated Care, and VBP programs, they were either focused on primary care, mental health, or a combination of both. Thus, all PCMHs have two goals in mind:

Design different payment options that allow clinicians to choose based on their practice needs and, at the same time, improve better patient care.

The surge of Telehealth for healthcare services in urgent care and retail clinics essentially means that both the PCP and Behavior Health organizations are seeing their patients opting to see providers not affiliated with their system. Similarly, the JD Power reports reveal that their patients are extremely satisfied to seek healthcare with other providers.

Many in healthcare do not recognize the value and broad ways that telehealth improves PCMH, Integrated, or VBP-based programs. For relatively little cost, telehealth provides dramatically positive results. One of the greatest examples of Telehealth’s ability to enhance a program's effectiveness is it’s application to an Integrated Care program treating substance abuse illness (specifically opioid treatment). 

Medication-Assisted Treatment (MAT) for those suffering from Opioid addiction involves multiple types of organizations to achieve success.

With Telehealth, all of the providers types listed in Figure 2 can use telehealth services to deliver healthcare to the patient. Examples of how Telehealth could be utilized include:

 – Provider is located at their office/facility and patient at home

 – Provider Consultations with another Provider

 in an Inpatient/Facility setting – Provider treats the patient that is in an inpatient/outpatient setting.

To further demonstrate how many providers can supplement the delivery of care to their patients with telemedicine, figure 3 only includes situations where the provider is onsite and interacting with the patient (red icons). 

Every provider category highlighted in blue can see a patient for many services while at their office and the patient is located home.

Beyond the vast number and variety of providers that are part of the continuum of care for addiction treatment, retail clinics, or Urgent Care are not do not provide such treatment. Yes, one could validly point out that Urgent Care and Retail Clinic utilization helps to reduce emergency room visits, but the treatment of a chronic condition like substance abuse requires high touch services and engagement with the patient. A lot of the patient engagement can be supplemented with a Telehealth program. Also, referring back to the 

 on consumer satisfaction with Telehealth, it could facilitate patient satisfaction as well.

, LLC. He is a healthcare executive with a successful career background in developing and executing strategic plans focused on increasing the Integrated Care delivery systems.

Programs risk losing patients to organizations offering telehealth services.

Author | Eric Haden

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