HealthJune 25, 2020

Can your practice benefit from integrating telemedicine services?

By: Melissa Welby, MD

Telemedicine services provide patients with efficient ways to receive care. Here’s what you need to know if you’re deciding whether to offer them.

Telehealth started as a way to deliver care to patients in rural and remote locations; today, it's no longer only for the underserved. In a society accustomed to convenience, telemedicine services fit right in, providing patients with more efficient ways to receive care. But ease of obtaining treatment is not the only benefit, and many healthcare systems, physicians and patients have noticed.

U.S. hospitals have increasingly integrated telehealth into their workflows, up from 35% in 2010 to 76% in 2017, according to the American Hospital Association. And certain specialties have been early adopters: Radiology, psychiatry and dermatology are among the highest users as there's less need for complex technology and complicated logistics. States are also continually adopting telehealth laws that support parity in insurance coverage and loosen restrictions on delivery of healthcare, as the Center for Connected Health Policy notes.

Despite the benefits, private physicians have been slower to incorporate telehealth into their practices. Many doctors express confusion about what it is, its benefits and telemedicine best practices as reasons for not using it. With that in mind, here's an introduction to telemedicine to help you decide whether to offer these services.

What is telemedicine?

For physicians who weren't raised with cell phones and video chatting, the idea of having an appointment with a patient over the computer can be met with skepticism. Even the terminology is confusing. Simply put, telemedicine is a way to deliver healthcare services to patients who are not in your office. Physicians are no strangers to providing remote delivery of care, and many of us spend hours of unbillable time each day talking on the phone to patients or consulting with colleagues. Telemedicine has advanced our capabilities beyond phone calls and provides an opportunity to both improve the efficiency of care and capture reimbursement.

Telemedicine services can be broken down into three forms:

  1. Live (synchronous) videoconferencing involves talking on the phone to patients while incorporating video technology.
  2. Store-and-forward (asynchronous) videoconferencing records health information to be accessed by a physician later. This is often used in dermatology, where pictures can be sent and viewed at a different time, and in radiology, where studies can be transmitted and read by an off-site physician.
  3. Remote patient monitoring allows health and medical data to be recorded and remotely reviewed by a physician. An example of this is the transmission of data from an implanted cardiac device or a CPAP machine. This data allows earlier intervention and an accurate assessment of how a patient, especially one with a chronic condition, is doing day to day.

The advantages of telemedicine services

Telemedicine is a powerful tool that can enhance healthcare delivery while benefiting both the patient and physician. For one thing, it's convenient! Travel and wait times can take two (or more) hours for a 20-minute in-person appointment with a physician. This time burden disproportionately affects low-income and minority patients. In a study in JAMA Internal Medicine, the total time was 25% to 28% longer for racial/ethnic minorities and unemployed individuals. This excess time burden can be a disincentive to seeking care.

A study in the Journal of the American Academy of Orthopaedic Surgeons found that patients are just as satisfied with telemedicine services as they are with in-clinic consultations. Plus, telemedicine allows improved monitoring of patients' symptoms between office visits, which has been shown to decrease disease activity scores, improve adherence to treatment and reduce emergency room visits, according to GI & Hepatology News. And technology expands the reach of physicians, allowing patients at a distance to access specialists.

Finally, physicians can convert unbillable phone calls into billable time, instead of calling to discuss lab results and treatment options.

Determining whether to offer telemedicine services

If you're contemplating offering telemedicine services but aren't sure how and when to use them, consider the following questions.

  1. What services do you currently provide over the phone?
  2. What chronic conditions do you manage where follow-up doesn't need to be in person?
  3. Can a remote appointment be held for patients who are waiting to discuss study results and treatment options?
  4. Do follow-up medication management appointments need to be done in person?

Depending on your answers to these questions, you may be ready to take the next steps toward getting started with telemedicine.

5 telemedicine best practices

You can find guidelines on telemedicine best practices through specialty societies and associations like the American Medical Association. The Center for Connected Health Policy publishes current state laws and regulations and is a resource to stay up to date with the evolving requirements. Consider consulting with a lawyer who specializes in telemedicine to ensure you are in compliance. Although not legal advice, here's a quick overview of five key points to consider.

  1. Before starting, familiarize yourself with both state and federal telemedicine regulations. Some states don't allow you to establish a doctor-patient relationship without an in-person visit, and prescribing laws vary. Remember, when prescribing a controlled substance, you must also follow federal laws.
  2. Check that your malpractice carrier covers telemedicine appointments.
  3. Ensure that your patient is located in a state you're licensed.
  4. Because of privacy and security standards, HIPAA compliance requires you obtain a business associate agreement with the technology company you'll use for remote visits.
  5. Standards of care via telemedicine are the same as for in-person care. If you miss a diagnosis, being unable to do the needed assessment remotely isn't a valid excuse. During a telemedicine visit, if you realize a person needs an exam that can't be performed remotely, refer them for an in-person visit.

Telemedicine is a tool to provide individualized and flexible care that benefits both the doctor and the patient. When used correctly, it's an effective alternative to in-person appointments and can eliminate certain obstacles to accessing treatment. As technology and reimbursements continue to improve, this method will only get easier to integrate into the workflow. If you haven't started already, now is a great time to think about it.

Melissa Welby, MD
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