How Telehealth Will Change Your Workflow Forever
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Across the industry, experts conclusively agree that telehealth services changed the landscape of healthcare amid the public health emergency. This is a care model that has only begun to truly take shape in the last year and a half. This means there is a lot of information we don’t have or truly understand in the long term, and there’s still much work to be done in the way of research and policy and the ways we will need to adjust in our organization in terms of workflow.
There are two pieces of proposed legislation in Congress centered around Telehealth, the “Connect for Health Act” and the “Protecting Access to Post-Covid-19 Telehealth Act of 2021.”
The Protecting Access to Post-Covid-19 Telehealth Act of 2021
The Protecting Access to Post-Covid-19 Telehealth Act of 2021 has four main provisions; these provisions highlight the potential future of telehealth.
Eliminate Geographic Site Restrictions: Eliminate most geographic and originating site restrictions on the use of telehealth in Medicare and establish the patient’s home as an eligible distant site.
Reimbursement Changes: CMS made changes to the reimbursement for telehealth services. The 2nd provision of this act authorizes the Centers for Medicare and Medicaid Service to continue reimbursement for telehealth for 90 days beyond the end of the public health emergency.
Disaster Waiver Authority: Make permanent the disaster waiver authority, enabling Health and Human Service to expand telehealth in Medicare during all future emergencies and disasters.
Telehealth Study: Require a study on the use of telehealth during COVID, including its costs, uptake rates, measurable health outcomes, and racial and geographic disparities.
While neither bill has made much progress, this proposed legislation implies that this care model is here to stay. So the industry needs to take action right now. Policymakers, care providers, and payers need to focus on developing guidelines, regulations, and research the effectiveness of telehealth as a permanent platform for healthcare delivery. The heart of these proposed bills is taking necessary, crucial steps to shape the telehealthcare model apart from the PHE.
Impact on Workflow
Telehealth services require a completely different workflow than in-person visits. When we think about the flow of a regular in-person visit, it usually involves several people. Somebody checks the patient in, updates annual forms if necessary, confirms demographic data, gets updated insurance information, collects copays or even balances due, another person rooms the patients, takes basic vitals, asks screening questions, and then the provider sees the patients. Depending on the type of visit and the provider’s specialty, the patient may require confirmatory testing such as a UA or throat swab, X Rays, lab testing, EKGs, pulmonary testing, etc. After the appointment, somebody typically checks the patient out, schedules follow-up appointments, or collects the co-pay if it was not collected at check-in.
With telehealth services, the landscape of your typical appointment dramatically changes. The Dept of Health and Human Services and several other organizations and associations like the American Medical Association have published great information about workflow considerations relative to telehealth services. Many offices struggled with on-the-fly implementation when the PHE was first declared, but now we have to look at how that will evolve long-term.
The PHE was extended in July of this year for another 90 days (which is soon, so be on the look for updated information about the PHE), but even beyond the PHE, it’s looking like telehealth services will be a routine part of healthcare.
Like the revenue has a life cycle, telehealth has a life cycle and workflow that needs to be adjusted to accommodate it. For example:
Availability: What is your organization’s availability for telehealth appointments? How will your providers adjust their schedules for both in-person and telehealth visits? If some of the proposed changes are adopted permanently, providers could see patients from their homes. It then doesn’t make sense to scatter both in-person and telehealth visits on the same day. Maybe the provider does telehealth appointments from home on Mon-Wed and sees patients in the clinic on other days. Then we have to think about how this affects scheduling for in-office procedures or even surgeries.
Patient Scheduling: How can patients schedule appointments? Do you have online scheduling for both new and follow-up appointments, and does that system delineate in-person vs. telehealth visits, and how does that correlate to the provider’s schedule? If patients need to be seen in the office after a telehealth appt, who will make sure that appt gets scheduled? Is the patient responsible? Is the clinic reliable? Essential things to think about to ensure continuity of care. And then, we need to talk about telehealth services resulting in visits within seven days. How will that be monitored for proper billing?
Your Triage Protocols: Telehealth needs to be used for clinically relevant purposes and adhere to licensure, policy, and clinical treatment guidelines. How will clinical and scheduling teams be trained to distinguish an appropriate telehealth visit and what requires an in-person visit? And how is that accomplished if the patient is scheduling online? Not every issue is suitable for a telehealth visit. There are some circumstances where an in-person is necessary and is required; staff must be trained to understand when and what is appropriate.
Legal Compliance: How will you ensure that care is provided in a legally compliant way, adhering to all privacy standards? This involves system functionality and logistic considerations for both the patient and the clinic staff and provider.
Initiating the Appointments: Who will greet the patient, medical assistant, nurse, provider, etc.? If there are screening questions, who will ask the questions? If not the provider, then who? As a former practice manager, I understand how medical offices flow. Frequently, clinical staff juggles responsibilities and patients, and providers see multiple patients at once, which means staff is multi-tasking between patients. You can be late into a patient’s room if they are in person, but you can’t play phone tag with a medical appointment. How will schedules be adjusted, so the provider isn’t late to the telehealth appt?
Conducting the Appointments: Ensuring stable internet connection, what is the backup plan if your internet or the patient's internet drops? Do you have a quiet and private workspace? How will you support patients who need a translator or with disabilities such as hearing loss or visual impairment?
Immediate Medicare Care: If the patient needs primary medical care, how will that be coordinated? If the patient is in person and needs immediate medical attention, the provider is present to intervene. That is not the case in a telehealth visit.
Continuity of Care: How are specialty referrals going to be managed? Other considerations are lab work, prescription, and medical equipment needs.
Telehealth services have changed the landscape of healthcare. And it’s exciting to watch it take shape as research is conducted, legislation is created, and we transform our workflow to meet Telehealth needs.
Stay tuned for part 3 of this 4-Part series, “How Telehealth Impacts The Revenue Cycle.”
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