If you are like many healthcare providers, your methodical plans to introduce telemedicine in the next few years has suddenly been accelerated and upended by the COVID-19 pandemic. Some providers suddenly need to see ten times more patients remotely, if not all their patients. What is the best way to deal with such a radical disruption?
Telemedicine was already a growing trend before the pandemic, with tech-savvy patients expecting increased flexibility, and healthcare providers looking for modern solutions to increase the efficiency of their practices. When the pandemic hit, both patients and practitioners were forced to stay home in order to flatten the curve, so telemedicine became even more important—and sometimes mandatory. It is not temporary, however. Any work you put into a telemedicine plan today will have long-term consequences, because telemedicine is here to stay.
Whether you have dabbled in telemedicine before or the urgent need is entirely new, it is crucial to consider all the benefits, risks, and practical steps that you need to take in order to serve patients at home. This article will walk through a process for getting started quickly.
In 2018, almost one out of every four patients had a virtual visit with a doctor or nurse, and out of those who had not, more than half would be willing to give it a try (Deloitte Survey of US Physicians, 2018). The majority of physicians are also willing to try telemedicine, though many have not moved forward with it yet, perhaps due to technological barriers to adoption, or the lack of an urgent need until now. An exception is psychiatrists, of whom the vast majority are both willing and able to transition to telemedicine (American Well, 2019).
With adoption of telemedicine becoming widespread, it is also becoming clear that it may be as effective as traditional medicine in the right circumstances. For example, one before-and-after analysis of a behavioural health program delivered via telehealth demonstrated wider reach, high patient satisfaction, and significant reductions in symptoms of depression, anxiety, and stress (Dent et al., 2018).
Telemedicine was traditionally used to reach remote or rural patients, but with improving telecommunications technology, and now COVID-19, the use case for telemedicine has expanded, likely permanently.
Many providers will not be able to transition entirely to telemedicine overnight, especially if treatment requires physical contact or specialized equipment. However, portions of the process may be easily conducted remotely, such as intake interviews, check-ins, and follow-up assessments. Telemedicine is not an all-or-nothing proposition; consider which parts of your practice can most easily be transitioned, then introduce telemedicine where it is viable and valuable.
As you make this transition, perhaps at an accelerated pace, it is important to consider present and future challenges that may come up. Develop a plan that captures advantages and anticipates challenges, implement the first version of your plan, then iterate as the situation changes.
The rest of this guide will quickly review the main areas to consider when developing a telemedicine plan, with a particular emphasis on mental health care and the remote assessments that Creyos specializes in.
Why is telemedicine on the rise and here to stay? In short, providers are realizing that telemedicine results in benefits that have nothing to do with the short-term pressure from the pandemic. Start to shape your telemedicine strategic plan by identifying the main goals you are aiming to achieve.
The days of viewing telemedicine as a compromise are over.
Studies have found that telemedicine results in fewer admissions, better patient outcomes, no impediments to the doctor-patient relationship, no decrease in safety, and no decrease in patient satisfaction. Again, it is not all or nothing—parts of the patient flow may be perfect for telemedicine, improving the overall efficacy of the process. Many practitioners ease the transition from in-person care to everyday life via follow-ups that are actually better delivered via telemedicine, for example. With the low cost of telemedicine (see below), it is possible for follow-ups to be more frequent, or kept up for longer, which can ease patients into integrating the treatment in their everyday lives and ensure treatments have a long-term effect on patient health.
Remote patient monitoring is one key focus for many healthcare providers looking to improve patient care. Devices and software that remotely collect and send data to a healthcare provider can be used to adjust and enhance in-person treatments, and monitor for potential issues when a healthcare provider is not nearby. Creyos Health is an example of a digital product that can easily monitor a patient’s brain health from a distance.
Rural areas have historically been a target for telemedicine, but the concept of reaching additional patients who would not normally seek in-person treatment extends beyond remote locations. COVID-19 has emphasized the need to reach patients at home, but for many patients, the need already existed, and will continue to exist after lockdowns have lifted.
Patients with physical or mental disabilities that make travel difficult may be reachable with virtual care. A wider range of symptoms may also be treatable by providers who have implemented telemedicine. For example, patients with milder symptoms, or who would benefit from long-term preventative programs, may not have considered traditional treatment, but may reach out for a telemedicine consultation that requires less effort.
Additional services only deliverable by telemedicine can also reach new patients specifically seeking those services—see below for more on new services and revenue opportunities.
Many healthcare providers find that telemedicine reduces costs, especially long-term. There may be capital costs, such as new technology infrastructure, equipment, and training, but these often pay for themselves quickly in a well-managed telemedicine plan. In one recent survey, 69% of organizations surveyed realized cost savings from telemedicine services, and 29% of them generated savings of 20% or more.
Sources of reduced cost include fewer cancellations and readmissions, less of a need for expansion of physical space, and reduced need to hire new staff, even as the patient roster grows.
These cost savings for healthcare providers do not come at the expense of patients. Travel costs, parking, and even taking time off work can be major costs associated with travelling to an in-person visit, and may even prevent some patients from seeking treatment.
In addition to raw financial savings, telemedicine has potential to save physicians and patients time. By overcoming barriers associated with time and distance, a healthcare clinic’s resources can be used more efficiently.
Technology can replace tasks that would typically take up administrative time with self-service processes or automation. For example, a self-service online scheduling portal can ensure that appointments are easily initiated, modified, and tracked, with little need for manually juggling appointments (e.g., see OnCall). Remote follow-up assessments can also be automated—for example, Creyos Health can put patients on a series of scheduled assessments with only a few clicks from a practitioner or admin staff.
A hidden advantage of digital over physical, and deeper integration with technology in general, is that fewer mistakes are introduced by transcription errors, verbal misunderstandings, and other issues due to human error. With more automation and fewer faults to correct, the result is a more efficient practice overall.
Seeing more patients for the same or lower costs is enough financial incentive to consider telemedicine, but there is also potential for entirely new streams of revenue.
First, note that reimbursement for existing services is usually not a source of increased revenue for practices moving forward with telemedicine—rather, increases in new or retained patient volume tend to lead to financial benefits. New services that reach additional patients, or better serve existing patients, are one way to accomplish that.
Following up post-treatment is a potentially fruitful area to introduce new services. For example, sending automated cognitive assessments after a patient has been treated for depression can help demonstrate the efficacy of the treatment in the short term. Long term, the patient will keep your practice in mind, and the assessments will monitor for any signs of relapse that may require additional treatment, when appropriate. Some practitioners have introduced subscriptions, service bundles, or a concierge health model in order to keep in touch with patients on a regular basis, and telemedicine can help keep such a service from being too costly to maintain.
With telemedicine, patients can technically be almost anywhere.
All these benefits sound great, right? But it is not all sunshine and rainbows—there are reasons that some practitioners avoid telemedicine, aside from the healthcare habit of sticking with the status quo. Government and public health agencies are quickly easing restrictions to make the transition to telehealth less cumbersome, but there are still real and perceived barriers that can make implementing telemedicine a challenge. Consider possible challenges that may come up, and develop a plan that acknowledges them.
Receiving reimbursement for services provided remotely has been one barrier to implementing telemedicine for many practitioners. Billing can be a complex endeavour, with uncertainty about which codes to use and whether or not claims will be approved. The specifics vary by country and by state. Always check with your local payer before implementing your telemedicine plan, so that you can ensure your processes are designed to be eligible for reimbursement, and you can properly plan the return on your investment by outlining which services will lead to revenue and which will be a cost to absorb.
Depending on your profession, there may be a licensing body or medical board with its own requirements. Licensing is often state-specific, which makes treating patients in another state problematic, even if performed via telemedicine. COVID-19 has caused restrictions to be loosened, but consider your long-term telemedicine plan—will you want to build a long-term relationship with a patient in another state if it has to end after restrictions have been lifted? The same types of challenges come up when considering compliance with your state’s or country’s healthcare regulations and legislation. When building your plan, setting limits can be critical, especially when it comes to meeting the various requirements required in your profession.
If you are sold on the benefits and willing to navigate some of the complexities, then the next question is: where do you begin? Use this five-step guide to a strategic plan as a starting point, and be sure to follow relevant links to more detailed information to flesh out your plan and maximize your chances for success.
There are three main areas to consider under the category of compliance: licensing, insurance, and legal requirements.
Collect this information about compliance first, so that the following steps in developing your plan can be properly laid out, and work within limitations so your plan is not so ambitious as to run into compliance issues once you get started.
Modern telemedicine often focuses on synchronous communication—that is, real-time two-way communication. However, consider the technology needed for asynchronous communication as well, which allows you and your patients to respond when it is most convenient, and may make for more efficient use of time. Capabilities like the scheduling feature of Creyos Health automate communications on your side, while allowing patients flexibility to determine when to perform assessments, within a reasonable window.
Fortunately, an initial telemedicine plan can often be implemented using existing consumer technology, such as laptops, which often have integrated webcams and microphones, and can run any software required. Test existing equipment first to determine if it is up for the job. Pay attention to the quality of the screen, the speakers, and the microphone. Deficits may be overcome with an external webcam or a headset for voice communication.
Many tools are web-based, such as Creyos Health, or have a web-based option, like most videoconferencing platforms (e.g., Doxy.me). Using web-based services can further simplify treatment, for both practitioners and patients, as no new hardware is needed, and no software needs to be installed. Online platforms also update automatically, so that improvements or changes affecting compliance can be taken care of by the vendor, with little or no action needed by the practitioner.
Flexible web-based technology is also better able to integrate the devices already present in patients’ lives. Most patients today have a computer, tablet, or smartphone available for videoconferencing or remote assessments. Additional health technology may already be present in patients’ everyday lives as well. According to Deloitte, the majority of consumers are willing to share information collected via wearables, digital scales, and other home technologies with their doctor.
A telemedicine plan will require updates to the protocols, policies, and communication materials that make up the everyday flow of your practice.
Examine the patient journey, from intake to treatment to long-term follow-ups, and determine which parts of the workflow can be improved by telemedicine. Remember to consider areas such as:
The materials you use to communicate with patients and prospective patients will need to be updated to include telemedicine. Examples include:
Other written materials to update may include emergency and safety procedures, training documents, job descriptions, and reimbursement procedures. We will cover reimbursement in more detail next.
Receiving reimbursement from insurance and other assistance programs is a complex area that has a large effect on the financial situation of a health practice. Your telemedicine plan should include steps to determine the effect on reimbursement. Adjust your implementation to continue receiving reimbursement wherever possible, or integrate additional procedures that are eligible for reimbursement.
Luckily, the billing situation for telemedicine is improving rapidly. As of 2017, 48 state Medicaid programs provided reimbursement for synchronous telehealth services (source), and COVID-19 has jumpstarted federal and state guidelines to ease restrictions on what can be considered telemedicine. For example, some services that could previously only be delivered to remote rural locations can now be delivered to patients in any location, often at the same rate as an in-person visit.
Navigating reimbursement can still be quite complex, however. The Center for Connected Health Policy maintains a list of current state laws and reimbursement policies related to telemedicine, and Aetna has an updated list of approved behavioural health telemedicine services, including relevant codes. Check with telehealth vendors for additional guidance. Creyos Health provides a reimbursement guide for cognitive assessments, and we have outlined the expanded telehealth benefits due to COVID-19 in the U.S.
With the main areas of your telemedicine plan thought out, it’s time to set a schedule. Some key recommendations to consider when setting a timeline for your telemedicine rollout include:
There will be no going back when it comes to telemedicine. The widespread adoption of virtual healthcare will surely stick around long past 2021, and continue to grow. Your workflow will need to adapt as the healthcare landscape changes. Based on the success of your initial telemedicine strategic plan, consider how it can be improved and expanded upon to continue maintaining and improving the health of your patients.
Be sure to also check out our guide to The Top 30 Tools for Improving Your Telehealth Implementation.
Disclaimers: this guide is for informational purposes only. Creyos is not providing medical, legal, or financial advice, and this guide is not a substitute for the advice of a physician, attorney, or other financial or consulting professional. Reimbursement-related information provided here is for guidance purposes only—Creyos can not determine your eligibility for reimbursement and does not assume responsibility over the outcome of any claims. Please contact your local payer to determine whether you qualify for reimbursement, and if any coding and coverage guidelines exist.
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