Role of Telemedicine in COVID-19

Build relationship with Patients by using Telemedicine

The US Federal government took a number of significant steps to increase the availability and use of Telemedicine during the Covid-19 pandemic. Although these measures are temporary and subject to revision in future, the widespread use of Telemedicine as a useful tool to fight the constraints of the pandemic is expected to help establish its viability as a mainstream healthcare service.

The US department of Health and Human services (HHS) introduced flexibility in allowing consumer communications applications such as FaceTime, Zoom, Skype etc. without any risk of penalties imposed for HIPAA violations. However. it also encourages providers that seek additional privacy protections to use technology vendors that provide HIPAA compliant platforms. Vivadox.life has been built incorporating advanced encryption technologies to ensure privacy protections.

The Centers for Medicare and Medicaid services (CMS) made it easy for enrolled patients to use Telemedicine from their homes. To encourage providers to offer the Telemedicine option, CMS will be reimbursing telemedicine virtual appointments at par with many in-person appointments and has significantly expanded the list of services eligible for Telemedicine. Providers are also allowed to offer their Telemedicine services across state lines subject to any specific requirements set by states for the duration of the Covid-19 Public Health Emergency. Providers are allowed to see new patients via Telemedicine and not just established patients.

More details can be accessed here

Family doctor online.Parents and a child consult a doctor using a laptop at home.

All major private payers including UnitedHealthCare, Cigna, Aetna and Anthem have announced significant telehealth coverage options including parity with in-person visits, waiver of patient cost sharing for in-network providers as well as originating site restrictions.

More details can be accessed here as well as directly with the private payers.

When Telemedicine made difference – Success Stories

Telemedicine Success Stories

Assessing the benefits of telemedicine and telehealth overall and using them to enhance existing courses of treatments can make a huge difference. Telemedicine allows you to continue monitoring your patients even when they are out of your reach.

A great example of how telehealth can make a huge difference in the patient outcome is Harris County Public Health that has implemented telehealth tools to help tuberculosis patients stay on track with their treatment. Tuberculosis can be spread though air via coughs or sneezes. In 2017, when Hurricane Harvey hit Texas badly, they were able to provide continuous treatment and support to the patients. Patients would record themselves taking their therapy for the staff to review at a later time. In addition, patients had a way of reaching their case manager quickly in case they faced any issues. As a result, not only that the 97% of the patients took their treatment as instructed, but the disease was also not spread in the community.

Family doctor online.Parents and a child consult a doctor using a laptop at home.

Similarly, New York Presbyterian specialists used telemedicine to help treat the victims of Hurricane Maria in Puerto Rico as a part of emergency response. On-site team helped set up telemedicine equipment that enabled the communications with the specialists in New York. In this scenario, telemedicine was used for consultation – the New York specialists consulted local specialists on patient treatment, while also being able to see and hear the patients. This set up helped establish trust between both the providers and the patient.

These are examples of how telemedicine helped when traditional medicine was out of reach. We are still to see how powerful impact of telemedicine can truly be.

Tips for successful adoption of Telemedicine

Medical technology concept. Doctor working with mobile phone and stethoscope and digital tablet laptop
Family doctor online.Parents and a child consult a doctor using a laptop at home.
After the implementation, the work is not done. In order to assess any gaps and improve, it is important to continuously monitor and reevaluate the telemedicine platform and your workflow.

Start a conversation

Telemedicine is new to you, your team, and your patients. Ask your colleagues about their experience with telemedicine so far. They may have some concerns or questions, but they may not be comfortable starting the conversation about it. Or they may have some suggestions on how to make telemedicine even a bigger success for your practice. Seek feedback from your patients as well. You may get some valuable insights and learn about things you can improve in your processes to make your patients’ virtual visits better.

Introduce your patients to telemedicine

Spend time talking to your patients about the telemedicine option you are offering. If appropriate for their case, offer them to try it for their next appointment. Provide them with sufficient information on what telemedicine is and how it works and be prepared to answer any additional questions they may have.

Use telemedicine capabilities to the fullest potential

Understand how to get the most out of the chosen telemedicine platform. Learn about features that you maybe did not initially considered, but that may help you make your processes more efficient and improve patient care. Communicate your feedback and any new requirements to the chosen telemedicine platform vendor to get improvements that will allow you to provide even better care with telemedicine.

Find ways to measure the impact of Telemedicine

As a practice that is just starting to use telemedicine, it is important that you have a way of telling if and how telemedicine has impacted your practice – both in the context of patient care and revenue. Metrics will help you understand where you are comparing to where you want to be. Some of the metrics you can easily gather and analyze are:

  • How many telemedicine appointments have you conducted as a practice (or per provider)? This metric can tell you if your patient is comfortable using telemedicine practice as well as if your investment in such telemedicine platform is justified. Have in mind that it will take some time for both you and your patient to get used to the idea and become more comfortable booking telemedicine visits.
  • How many patients were satisfied versus unsatisfied with this form of interaction? If the platform you are using allows for the patient to rate how satisfied they are with their telemedicine experience you can use this information to see if your patients find this service valuable.
  • How many patients did cancel their scheduled appointment or never showed up? This information can indicate whether or not your patients are confident in using telemedicine. This parameter can be a good indicator if you need to educate your patients more on what telemedicine is and how it works, as well as to reassess if you are picking the right type of patients for these visits (and right type of conditions).

Designing an optimal workflow with Telemedicine

Build relationship with Patients by using Telemedicine
Build relationship with Patients by using Telemedicine
In order to best utilize telemedicine tools and capabilities, you need to make sure they are adapted to and implemented successfully with your current ways of working internally and with your patients to help achieve improved patient outcomes and operational efficiency.
The key to getting the most out of Telemedicine implementation is to have a well-planned out workflow that addresses your entire virtual care process. Make sure that you incorporate compliance to privacy laws and security standards that address any regulatory risk and liability. Your flow should include any actions that you need to take before, during, and after the telemedicine appointment with your patient. It is important to make sure that you consider any adjustments your existing workflow and practices might require to the new telemedicine setting. Try simulating the workflow and patient interaction with your colleagues to assess any gaps and become comfortable with the process.

Prior to the visit:

Scheduling

It is important to understand where in your schedule you are booking telemedicine visits. Are they going to be in-between regular appointments, or do you have a certain time frame blocked off in your schedule just for telemedicine appointments? How will your patients book telemedicine appointments? Make sure that you include the booked time in the existing scheduling system you use. Share any appointment details and information on how to join in for the appointment with the patient ahead of time.

Patient Education

In this part of the workflow include activities such as educating patient on telemedicine and what they should expect from their visit. It could be as simple as forwarding a “patient flyer” detailing the steps to join virtual appointments before their first telemedicine appointment. Check if they have any one of the supported devices for the virtual appointment, as well as if they understand the steps, they need to take to connect with you. Patients might have different levels of comfort with technology and some things that may seem straight forward and easy to you might not be easy for them. Ask questions like “Do you understand how to access the link in the text and join for the appointment?”; “Do you have a device that has access to the internet?” ;“Do you have stable internet connection at home/place you are planning to use when attending the appointment?”

Regulatory Compliance

Make sure you understand the telemedicine policies and regulations governing patient under private or public payer systems. If patients are across state lines, additional considerations with respect to state laws need to be made. Practitioners may only provide care in the states they are licensed to practice. In addition, ensure that telemedicine is covered in the liability insurance of the practitioners that will be performing the virtual appointments.

During the visit:

Connecting and troubleshooting potential issues

To begin telemedicine appointment, connect with the patient and make sure that they can see and hear you. Have a plan of action in case either side experiences technical difficulties with their devices or internet connectivity. Do you have necessary information to troubleshoot the issues? Will you switch to a phone call or will you reschedule?

Conduct the appointment

Start the appointment by validating patient information and making sure that the patient is comfortable with the set up. Interact with the patient and take notes that you will use to update their EHR records and to create a follow up care plan.

After the visit – The Follow-Up:

Codes and Billing

Be familiar with the CPT codes that are used for telehealth interaction to provide complete information for the billing processing.

Patient Follow-Up

Share any follow up care plans, issuing prescriptions, regimen to follow, or information on the condition with the patient.

Reference for this section: Telehealth Implementation Playbook, American Medical Association

Getting reimbursed for telemedicine appointments

The reimbursement policies governing telemedicine visits vary based on the type of the insurance the patient has and the state regulations. Due to COVID-19, many existing guidelines have been changed and coverage expanded.

Centers for Medicare & Medicaid Services (CMS) has been regularly making changes to their guidelines to reduce the need of patient visits or hospital stays post procedures with the goal to minimize COVID-19 infections. In addition, they introduced parity for Telehealth services allowing using the same POS code for Telehealth and in-person visits. They also included remote patient monitoring, remote supervision, hospice care and nursing homes in their scope.

Guidelines vary from state to state. Some states allow only the specific patient setting for telemedicine appointments (like home, schools, or schools-based health center), while some have specific reimbursement criteria covering only specific types of providers. In addition, states have different parity laws, which can significantly impact the costs and reimbursements. This is why it is crucial to understand applicable laws and procedures in the states you are practicing telemedicine.

Private insurance covers the largest segment of health insurance coverage. The adoption of telehealth in private insurance plans was relatively low until COVID-19 but has been significantly increased since.

Assessing your needs and choosing the correct Telemedicine platform

Regulations Governing Telemedicine
Build relationship with Patients by using Telemedicine

There are many synchronous and asynchronous telemedicine solutions available. It is important to correctly identify and assess your needs as well as understanding your options before starting telemedicine practice.

When choosing a telemedicine platform consider the following questions:

Do you have the hardware and connectivity needed for telemedicine software?

Check if your practice has sufficient devices that are up to date with the latest version of applicable browsers & operating systems. In addition, consider whether practitioners will use their personal devices to conduct telemedicine appointments. Check the connectivity requirements needed for the selected telemedicine software and ensure any system prerequisites such as a specific browser etc. are also taken care of.

Do you need a telemedicine solution that will allow you to monitor your patients’ biometrics data coming in from their wearable devices?

If the answer is yes, seek out telemedicine solutions that include or integrate with remote patient monitoring systems. Check which systems and type of devices they support, and if those devices are in line with the ones your patients are using. If none of the telemedicine solutions currently support the preferred integrations, it is important to look for telemedicine solutions and vendors who provide a path to adding those functionalities in the future.

Will your patients benefit from you offering telemedicine?

There are a number of ways your patients benefit from Telemedicine such as easy follow-ups, timely adjustments to their treatment plans, medication prescription renewals, and better management of chronic diseases and conditions. It is important for you have a program to educate your patients on the benefits of Telemedicine and help them transition into an integrated in-person and virtual care model.

Does the telemedicine solution you are considering offer free trial to try it out before committing?

It is beneficial that you do a trial run on the telemedicine solution before deciding to use it. Check if the telemedicine solution you are considering offers free trials.

Is the telemedicine platform easy and quick to use for your patients who might not be tech savvy?

Choose a telemedicine platform that is intuitive and does not involve too many complicated steps to execute a virtual appointment. The telemedicine platform should be simple enough such that any first-time user of any age and having minimal experience in using computer or mobile applications can use it with no additional guidelines and handholding.

Can you and your patients conveniently use this telemedicine platform from different devices like mobile phones or tablets?

Gather information on the devices and browsers that the platform supports. Some patients may want to join via tablet, a MacBook, a smartphone, or a PC. Some of them might involve downloading the app or additional software while others might just work on existing browsers on your devices. The more diverse set of devices and browsers the selected telemedicine platform supports the better it is with regards to convenience and flexibility.

Does the telemedicine platform you are considering offer you a plan that fits your ways of working? Does it allow requests for enhancements and customization based on your needs?

Every practice has different needs. Before choosing a telemedicine platform, look into the plans it offers and asses how each of them ranks against your needs. Additionally, make sure that they respond to customer feedback by discussing and delivering the requested features that will add value to you and other users of the platform.

Is the telemedicine platform compliant with HIPAA, PHI, and PCI regulations? Are they following the best security practices?

One of the key hurdles practitioners face for telemedicine is the security concerns involving privacy and data. This is why it is important that you seek a telemedicine platform that describes in detail how it assures security and compliance with respect to applicable regulations. Attention should be paid in particular to HIPAA compliant hosting architecture on enterprise level hardware or Cloud systems, architecture with separate web and database environments, password encryption, encrypted link between a server and a client at all times, amongst many others.

Does the telemedicine platform you are considering offer online or in-person training for your team?

Selecting and implementing a telemedicine platform is the most important step in the process of embarking on a telemedicine program. However, if you and your team do not know how to use the tools to its full extent, you will not benefit from telemedicine. You and your team receiving adequate training is very important step in running a successful telemedicine practice. Make sure that the telemedicine platform you are selecting offers the training that fits your needs and preferences. Most common practices for training can consist of online tutorials and documentation, scheduled online sessions with an expert, or in-person workshop. However, in-person support is the most preferred and helpful mode of training and implementation assistance.

Does the telemedicine platform you are considering have extensive online tutorials and resources to help you get started easily?

In addition to training, it is good to have access to online resources that can help you quickly get the information you need. Video tutorials covering different modules can assist you while you are getting started with the telemedicine platform or when you simply want to learn more about a feature of the telemedicine platform. In addition, frequently asked questions can be a great resource when you need to clarify something or when you are facing an issue.

Does the telemedicine platform offer tutorials and help content for your patients as well?

As patients will be joining for their appointments from their homes, you may not always be able to assist them if any issues arise. Additionally, patients may be accessing the telemedicine system from a different kind of device than yours. Hence, it is necessary that the telemedicine platform has resources for the patients, instructing them how to join from different devices or browsers that the telemedicine platform supports. In addition, an easily accessed FAQ (Frequently Asked Questions) section for patients and the ability to contact application support for help can improve patient adoption of telemedicine.

Does the telemedicine platform you are considering offer easily accessible support and maintenance for both you and your patients?

It is important that the telemedicine platform you are choosing is offering accessible support for both you and your patients. If you are experiencing any issues with the telemedicine platform, there should be resources that you can look into including frequently asked questions and tutorials, as well as a support email and/or a phone number you can contact for assistance.

Is Telemedicine expensive?

Telemedicine Success Stories

Telemedicine used to be onerous and expensive earlier and restricted to specific scenarios of treatment when it was not possible for the patient to be seen in-person. The patient also needed to be in certain approved locations for the Telemedicine session to be recognized by payers. However, with the widespread availability and affordability of digital connectivity and devices, Telemedicine becomes a very affordable technology for healthcare providers to introduce as a convenient option for their patients.

Vivadox.life has “zero” startup costs for healthcare providers and competitive pricing plans to help them implement a successful Telemedicine program. With continuous progress in both coverage and payment parity made across all payers, Telemedicine is an attractive way for healthcare providers to expand their revenue opportunities.

Family doctor online.Parents and a child consult a doctor using a laptop at home.

For patients, Telemedicine does not cost them any more than an in-person visit. It saves them time and money by avoiding the commute. It is also less disruptive to their personal and professional work schedules resulting in greater patient engagement. Telemedicine is also safer for patients minimizing any chances for cross infections from other patients in the waiting rooms.

What are the regulations governing Telemedicine

Regulations Governing Telemedicine

Telemedicine requires following the same protocols and standards as defined in HIPAA for any in-person visit. For Telemedicine to be functionally equivalent to in-person medical visits, it may involve transmission of patient data hence requiring all protocols of privacy and security to be rigorously applied. While some of these regulations have been relaxed due to Covid, it would be prudent for providers to choose technologies built for Telemedicine that use advanced levels of security processes including data encryption rather than consumer apps. Given that both provider and patient can be in-home or office settings, adequate diligence should be employed to ensure conversation privacy.

Telemedicine benefits

Telemedicine and Medicare

Since March 2020, CMS has been regularly making changes to its Telehealth Services guidelines expanding the use of Telemedicine to 80 plus services to reduce the need of patients to visit or stay in hospital/clinical premises post procedures to minimize Covid infections. CMS introduced parity for Telehealth services allowing using the same POS code for Telehealth previously used for in-person visits. Virtual check-ins are allowed for new patients. CMS also expanded scope of Telemedicine to include new providers, remote patient monitoring, remote supervision, hospice care and nursing homes.

For more details visit Telehealth guidance section of CMS Covid 19 webpage

Telemedicine and Medicaid

Telemedicine guidelines for Medicaid is dependent on state policy and hence vary from state to state. Some key highlights regarding Medicaid coverage for Telemedicine,

  • 29 states do not specify patient setting, while 12 states recognize home as an originating site while 12 other states recognize schools and schools-based health centers as originating sites
  • 29 states and Washington DC cover Telemedicine through store and forward technology while one-third of the states in US qualify live synchronous Telemedicine applications only for reimbursement
  • 26 states do not specify the type of provider as a reimbursement criteria while the rest allow specific types of providers only
  • 21 states and Washington DC have coverage parity while 28 states also have payment parity policies. Medicaid parity policies have continued to make progress in the last few years

Private Insurance?

Private insurance covers the largest segment (67%) of health insurance coverage out of which 55% is through Employer plans. Employers continue to encourage favorable Telemedicine policies in their plans due to the ease of access and less disruptive nature of Telemedicine for their employees. For private payers, 36 states have coverage parity policies, 16 states have payment parity policies while 12 states have no identified parity policies. The adoption of Telehealth in large employer health plans until 2018 was relatively low (2.4%). However, with the unfortunate constraints of Covid 19, the adoption of Telemedicine has seen a significant uptick.

Vivadox.life has “zero” startup costs for healthcare providers and competitive pricing plans to help them implement a successful Telemedicine program. With continuous progress in both coverage and payment parity made across all payers, Telemedicine is an attractive way for healthcare providers to expand their revenue opportunities.

For more details by state, we recommend State of the States report by American Telemedicine Organization