Telehealth for Providers

Still, many providers were not ingrained in telehealth until COVID-19 hit. “By now, most of us have experienced telehealth in one way or another, whether by phone or video, because of Covid,” says Jack Higgins, MD, president and chief medical officer, Global Telehealth Network (GTN), Los Altos, Calif., and president of RotaCare Bay Area Free Medical Clinics.

Telehealth usage soared in 2020, with 22% of consumers and 80% of physicians having virtual visits, up from 8% and 22% in 2019, according to telehealth provider Amwell’s annual Physician and Consumer Survey. Results indicate that telehealth will increase after the pandemic, with adoption and acceptance of virtual visits continuing to steer more patients toward telemedicine.

“Before the pandemic, we were 100-percent in person,” says Jonathan Chin, MD, Excelsior Pain Management, Austin, Texas. “We moved initial visits and follow-ups to telemedicine, and now we are 60% telehealth and 40% in person. I feel like telehealth is here to stay and it’s really only going to take off in the next 10 years.”

For providers, the key is to integrate telehealth practices and implement telehealth technology to deliver effective telemedicine visits. This telehealth for providers resource will help you navigate tech tools and understand best practices.

Integrating Telehealth Practices

First, providers need an understanding of what telehealth is and how it is delivered today. According to the American Medical Association (AMA), telemedicine includes communication tools and platforms so clinicians can connect with each other and with their patients. This includes text and photo exchanges through patient portals, health system apps and website chat features. It also includes synchronous (live) video and audio appointments through telehealth platforms, apps or customized technologies providers use.

As the AMA explains in its Telehealth Implementation Playbook, telehealth is widely used for follow-up care, behavioral health services, and to connect those in rural or underserved areas to specialists.

Key areas to address when implementing telehealth practices include:

• Identifying the need / problem that telehealth will solve for providers and patients.
• Setting goals and defining what you hope to achieve with telehealth.
• Forming a team that will quarterback telehealth implementation.
• Evaluating telehealth vendors to find the right technology.
• Preparing the care team and identifying what must change in the workflow for telehealth to be successful.
• Partnering with patients so they understand how and when to use telehealth.
• Scaling telehealth to meet the demand for services.
• Evaluating success and tweaking to constantly improve telehealth delivery.

Identifying the Need and Setting Goals for Telehealth

More consumers are interested in using telehealth now, according to the Amwell survey. In 2020, 42% of consumers reported having a virtual visit with a specialist they already knew and 13% had virtual visits with a new specialist. The survey indicated that specialists’ use of telehealth increased, doubling for specialities including radiology, cardiology and surgery. To successfully implement telehealth, providers first must determine how patients would benefit and what services could be delivered by video, audio or use of asynchronous communications like text messaging, photo and video sharing via a secure portal.

In Dr. Chin’s pain management practice, he identified that a portion of his practice could be shifted to telehealth. “In person, we do a lot of procedures and injections, and that portion of my practice could not change, but initial visits and follow-ups could be moved to telemedicine,” he says, noting that patients who live farther away from his office preferred the telehealth visits. So for his practice, he sees a need for telehealth among those who want to save themselves the trip into the office and an opportunity to geographically expand by extending virtual visits to patients who do not require in-office procedures.

Dr. Higgins has a different experience concerning defining the need for telehealth. He began using video conferencing in 1992 for emergency department care on Mondays when a nurse practitioner was not on site and only an ambulance driver was available. “It worked out really well, and this told us we could popularize the concept of telehealth,” he says, relating that the military had been using telehealth for decades but back then, it was untouched by primary care practices like his.

He identified a need for telehealth to deliver care to those living in underserved areas and rural regions, nationally and globally. RotaCare Bay Area operates 10 free clinics staffed by volunteer doctors and nurses. Also, the Global Telehealth Network has six pilot projects in Kenya and Uganda hospitals, clinics and schools in partnership with the Institute of Electrical and Electronics Engineers (IEEE), which uses its Smart Village project to set up solar power systems to enable broadband used for telehealth.

“My focus is on underserved populations, and the barrier has been that it’s hard to get to where they are, but with telehealth we can do that,” Dr. Higgins says.

Forming a Telehealth Team

Who will implement telehealth in the practice? The answer depends on the type of practice and size. AMA recommends identifying how each part of the practice will be impacted by telehealth, from scheduling to billing and care delivery. Different viewpoints from stakeholders will help identify possible barriers and gain buy-in across the organization. Most successful telehealth implementations are typically led by a “clinical champion”, a respected member of the practice who provides consistent project leadership and endorsement across the organization. Having that person as part of the team can make or break the project..

Addressing Telehealth Barriers: HIPAA, Interstate Licensure and Payment

Patient privacy and HIPAA guidelines are a concern for some providers when they enter the telehealth space, and for good reason. There are rules and regulations from Medicare, the Drug Enforcement Administration (DEA), state medical boards and medical boards for your practice area.

The AMA notes that telehealth rules and regulations vary from state to state. Guidelines include reimbursement policies and clinician licensure. Some telehealth vendors have geolocation features that let you know if a patient is out-of-state. The Federation of State Medical Boards in February 2021 issued a listing of the 41 states with waivers for using out-of-state physicians in response to COVID-19.

As for HIPAA, the U.S. Department of Health and Human Services Office for Civil Rights issued guidance allowing HIPAA-covered providers to provide telehealth during the pandemic by using apps like FaceTime, Facebook Messenger, Google Hangouts, Zoom and Skype.

The Centers for Medicare & Medicaid Services (CMS) responded quickly to the pandemic by issuing new  telehealth reimbursement guidelines that provide payment parity with in-person visits for providers delivering care via telemedicine for the duration of the public health emergency. “Unfortunately, medicine is still a business, for better or worse, and no one wants to do good work and find out on the back end they will not get paid,” Dr. Chin says. “When CMS stated because of the pandemic there were stipulations allowing us to do telehealth and get reimbursed, that was a reasonable policy move, so we all gravitated toward it.”

According to CMS: “Currently, Medicare patients may use telecommunication technology for office, hospital visits and other services that generally occur in-person.” Telehealth visits beginning March 6, 2020 through the Public Health Emergency are considered the same as in-person visits and paid at the same rate. CMS released updated telehealth services covered and billing codes, updated January 2021.

How to Find a Telehealth Vendor

Before identifying a telehealth vendor, understand the scope of telehealth services that patients can access. For example, will telehealth involve a secure portal for your practice that has features allowing individuals to securely send messages, download lab results and launch video virtual visits?

Your practice type will also dictate how you use telehealth. For instance, behavioral health providers will have different telehealth needs than a cardiologist or primary care physician. A psychologist who’s seeing a patient for anxiety and depression could use audio and video telehealth tools, alone. A doctor who is conducting follow-up visits for patients with diabetes will need to collect and review vital signs remotely.

The point is, providers’ telehealth scope can vary greatly. Simple app-based solutions and a video platform might be enough for your practice, or you could require advanced tools that allow you to assist remote rural facilities with surgeries.

When selecting a telehealth platform, be sure it is HIPAA compliant and can integrate with other software you have in place, as the telehealth consulting agency Boost Medical suggests. Electronic Health Record (EHR) vendors can provide telehealth technologies that align with the system you have in place.

When selecting a telehealth vendor, the AMA recommends evaluating these six key areas:

• Business: What expertise can the vendor provide to your operation? Do they have knowledge of federal and private payer requirements?
• Information technology: Will the system integrate with your existing IT platform? What will it take to integrate the technology and what support can you access?
• Security: Does the vendor adhere to HIPAA rules, including willingness to sign a Business Association Agreement (BAA). What third-party audits does the vendor receive (SOC 2, HITRUST), and does its offering comply with local and state medical boards?
• Usability: How easy is it to navigate and use the telehealth platform?
• Customer Service: What support is available? Will the vendor provide training for staff and/or patient education resources?
• Clinical validation: What outcomes does the vendor deliver?

There are additional considerations when choosing a telehealth vendor for your medical practice. Teladoc Health, one of the most widely used telemedicine platforms, suggests considering the platform design. Spend time navigating the tools as if you were the patient and see how quickly you can complete processes like logging on to a video appointment or sending a secure message. Consider any specific language requirements that are common among your patient population, and does the vendor support those needs. Also, specialists should look for a vendor that is focused on specialty care practices. Customization can also be important based on the type of telehealth delivery methods you plan to use. Finally, data analytics can help you learn more about your practice, patient interactions and even problems using the technology.

The Best Telehealth Technology Options

When Dr. Chin first began conducting virtual visits in his practice, he relied on basic tools like Zoom and Skype. But, he found that the learning curve for the older patient population he serves was a barrier to participating in appointments. “Some couldn’t operate the apps and a 30-minute visit would take much longer because I was spending time on the phone with them teaching them to log on,” he says, advising that practices that do not have a deep administrative or support staff keep it simple.

While tools like Skype, Google Meets and Zoom are approved for use as telehealth video platforms and were transition technologies for many practitioners that quickly shifted to telehealth in March 2020 with COVID-19, “now telemedicine is more established,” Dr. Chin says of the array of telehealth apps and technologies. Since his older patient population tended to struggle with logins and passwords, Zoom waiting rooms and downloading apps like Skype, he moved to Doxy.me, a free telemedicine app. “You send a text to the patient, they click on it and can enter the video call,” he describes.

Dr. Chin also relies on Doximity, an app with the same functionality as Doxy.me. It allows providers to call patients’ phone numbers or send a text (from a no-reply number) to initiate a video call. The patient clicks on the link and is connected.

There are layers of telehealth technology, from these simple solutions Dr. Chin uses in his pain management practice to robust EMR systems like those Epic provides for top hospitals across the United States.

According to the American Academy of Family Physicians (AAFP), and its toolkit for telemedicine, there are two basic technology approaches. You can choose stand-alone products that are not connected to patient charts but are more cost-effective and easier to implement. Or, you can opt for Electronic Health Record (EHR)-integrated applications that seamlessly connect with charts and house telehealth tools in a secure portal that is accessed by patients and physicians.

Following are additional technologies used to deliver telehealth:

Broadband internet: The speed and quality of your internet connection factor into video quality. The American Academy of Allergy, Asthma and Immunology (AAAI) advises at least 50 to 100 megabits per second for a basic business.

Patient portal: A secure, online portal allows providers to communicate with patients by sending messages. There are also built-in tools that allow patients to request prescription refills, review visit summaries and test results, and schedule appointments.

Remote monitoring devices: Web-based or mobile apps can allow patients to upload data like blood glucose readings. Cellular-enabled weight scales and blood pressure monitors can also wirelessly send information to a patient portal or directly to a doctor’s office. There are also wearable devices that automatically record information like heart rate or sleep patterns and transmit data to providers.

Video platforms: From apps designed for the healthcare industry like Doximity and Doxy.me to mainline tools like Zoom, Google Hangouts and Skype, video allows providers to connect virtually in real-time with patients.

Smart devices: As telemedicine evolves, technologies are entering the marketplace that make it possible to deliver a range of services. For example, smart glasses and augmented reality allow doctors to see vitals, provide feedback during surgery, and train other physicians. 

Telehealth Resources for Providers

As you navigate telehealth and put systems in place to deliver telemedicine to your patient population, there are a range of ready resources to help you create a digital journey, from selecting telehealth vendors to integrating telehealth practices. Here are some helpful guides from respected professional industry associations and key industry players.

American Telemedicine Association, QuickStart Guide to Telehealth

When providers were forced to quickly shift to telehealth after COVID-19 hit, the American Telemedicine Association (ATA) released this QuickStart Guide to Telehealth to help caregivers quickly establish a virtual practice. ATA is focused on accelerating telehealth adoption and offers an array of videos, case studies and informational guides.

ATA Guide to Telehealth Vendors

Selecting a telehealth vendor involves vetting a fast-growing market of technology and software providers that deliver products for your telehealth practice. What should you look for in a vendor? What vendors are associated with ATA? This guide will help you get a handle on the telehealth vendor universe.

HLTH Foundation

Aside from annual events that bring together providers to discuss access and equity in delivering healthcare, HLTH provides webinars and digital content, including insights on telehealth practices.

American Medical Association Physician Innovation Network

The American Medical Association (AMA) Physician Innovation Network (PIN) connects the healthcare and technology innovation worlds. That includes matching physicians with peers to share best practices, healthcare delivery and efficiency. Members can access educational content and participate in panel discussions.

American Academy of Family Physicians Telehealth Toolkit

The American Academy of Family Physicians (AAFP) offers this toolkit for developing a sustainable telehealth practice. The comprehensive guide addresses factors including: licensing and legal requirements, vendor selection, digital journey, workflow, and billing and coding.

American College of Physicians, Telemedicine: A Practical Guide for Incorporation into Your Practice

Through its online learning center, the American College of Physicians (ACP) offers interactive modules to help practitioners integrate telehealth into their practices.

The National Consortium of Telehealth Resource Centers (NCTRC)
NTRC is a government sponsored collaborative of 12 regional and 2 national Telehealth Resource Centers (TRCs), committed to expanding access to care through telehealth. Each Telehealth Resource Center has a regional uniqueness, allowing them to provide a wide range of assistance targeting local community needs. They provide free technical assistance, education, and resources on various telehealth topics.

Telemedicine Resources for Allergy & Immunology Physicians

The American Academy of Allergy, Asthma and Immunology (AAAI) offers a library of resources for allergy and immunology physicians who are integrating telehealth. That includes a wrap-up of technology requirements you’ll need to deliver care virtually.

Experts

These experts offered insight into telemedicine for providers:

Jack Higgins, MD, president and chief medical officer, Global Telehealth Network (GTN), Los Altos, Calif., and president of RotaCare Bay Area Free Medical Clinics

Jonathan Chin, MD, Excelsior Pain Management, Austin, Texas