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Telemedicine

Pros and cons of telemedicine

While this is not an exhaustive list for prons and cons of telemedicine, it is good to be aware of some of these before you get started. If you truly think through these, they can help you decide if telemedicine is right for your practice or not.

While this is not an exhaustive list for prons and cons of telemedicine, it is good to be aware of some of these before you get started.

Benefit of televisits – Reduced emergency utilization

Such visits can be used – when appropriate – to reduce Emergency Department utilization. Additionally, they provide patients with a way of receiving some care without having to leave their home and at an affordable cost.

Benefit of televisits – Address specialist shortages

If one is uninsured or has a high-deductible, the cost for an e-visit is often around $45-55. There are also specialties providing these services. For example, telepsychiatry has grown and is continuing to grow and other specialties such as rheumatology have been experimenting with ways to leverage telemedicine to address their specialty’s shortage.

Benefit of televisits – Improved efficiencies for uncompensated encounters

Medical practices, specifically, can use e-visits in a few unique ways. If the practice is, for example, a surgical group where there are numerous uncompensated encounters post-op, if it is medically responsible, it may be more efficient for both the provider and the patient to receive some or all the post-op appointments via e-visits.

Such virtual visits can also be used by specialist providers to monitor new or changed medication regimens.

Both uses can allow a provider to more quickly see patients and, possibly, save a patient from having to drive or have a caregiver drive them into a practice that may -especially in rural areas – be a significant distance from their home and involve missing work.

Such a process will save the front desk staff check-in time and save the patient waiting room time; moreover, the provider will be able to see more patients since the logistics of having patients check-in and meeting with a medical assistant or nurse is removed.

Benefit of televisits – Reducing no-shows and improving office workflow

Primary care practices can also benefit from e-visits.

Providers have had success with using telemedicine for routine follow-up visits such as those for depression or ADHD medications. Some have also used them for hypertension follow-up to assess how a patient uses their home blood pressure cuff.

Visits that might lead to a loss of revenue because the patient is diverted to an urgent care after hours can be captured by the primary care practice which might provide uncompensated on-call care prior to diverting to an urgent care.

If a practice has a relatively high cancellation rate, e-visits can be used to augment a practice’s income as well. Pediatric practices, likewise, can increase patient satisfaction and encourage a stronger continuity of care by providing telemedicine.

For example, pediatric groups could provider e-visits early in the morning – the provider can even be at home – to assess children for parents who are concerned that they may be too sick for school.

Also, as with adult primary care, there already exists significant uncompensated care or care that is diverted to Emergency Rooms or Urgent Cares that can be converted back into income for the pediatric practice.

Benefits of RPM – Reimbursements

CMS has already announced reimbursement policies and associated reimbursement codes for remote patient monitoring. According to mhealthintelligence,

“The final rule for the 2020 Physician Fee Schedule gives hospitals and health systems more opportunities to use remote patient monitoring and paves the way for new telehealth and mHealth programs.” 

The Centers for Medicare & Medicaid Services (CMS) updated their CPT codes and now, CPT code 99453 pays $19 on average, CPT code 99454 pays about $64, CPT code 99457 pays around $51 for non-facility and $32 for facility and CPT code 99091 pays about $58.

There is much more clarity on RPM reimbursements, CPT codes and a clear path to additional revenues in exchange for taking on this additional burden.

Benefits of RPM – Higher patient engagement

There are several studies like this one done by NIH that speaks volumes about the increased patient engagement due to remote patient monitoring. There’s another brilliant article written by becker’s hospital review here, that is based on the “nudge theory”. This is the same theory that we use in our patient contact center / medical call center as well. Nudging patients / reminding patients seems to keep them engaged to our customers.

Benefits of RPM – Higher patient care adherence, easier value based care

As we move towards value based care and value based payments, care adherence becomes even more important when it comes to achieving the triple aim. Care adherence and preventive care allow providers to be better equipped to reduce acute/episodic care and demonstrate higher value based care.

Simply put, higher care adherence = higher patient engagement = lower acute episodes = demonstration of higher value based care.

Benefits of RPM – Higher patient satisfaction and reviews

This should have been expected but never was that guiding principle for adoption of remote patient monitoring. In general, it has been documented (see here) that 25% of survey respondents stated remote patient monitoring increased patient satisfaction.. Which inevitably leads to better patient reviews.

Benefit of econsults / store and forward – Easier access to specialists

Patient no shows rates are notoriously high – national average is around 30%. After spending years managing practices that deal with a certain patient population, we can easily attribute no-show rates to the patient’s social determinants of health.

Patients like the convenience of being able to get in and out of meeting with a provider within 30 mins. In metropolitan areas, having long waits at a specialist office almost always guarantees increasing no-show rates.

EConsults help reduce these long wait times for patients at specialty care offices. 

Benefit of econsults – reduced unnecessary referrals

Studies have shown that “About 52% of PCPs reported making unnecessary referrals” (read this). Being able to conduct econsults with specialty providers within your referral network allows referring providers to determine the medical necessity of such referrals. As an example – a PCP office could very easily send retinal scans of their diabetic patients to an ophthalmologist in their referral network to determine diabetic retinopathy and whether the patient should be sent to the specialist as a referral or not.

Benefit of econsult – lesser scheduling friction

Most administrative personnel will gladly tell you that coordinating “live” televisits between a patient at the PCP office and the specialist at a referring partner of choice can be a real nightmare. Conflicts arise with specialist availability. Electronic consults alleviate this friction due to the fact that the specialist can review a patient’s econsult request at a time that’s more convenient for them. This leads to higher fulfillment rates that is simply not possible with video / evisits.

Benefit of econsult – better care coordination

An additional benefit is that store-and-forward telemedicine strengthens the patient’s relationship with their primary care provider by keeping patients within their practice. It is a well known fact that closing a referral loop has never been a forte for most specialist offices that are already overburdened with treating cases of their own. 40% of patients that are referred out to a specialist office do not even make an appointment with the specialist provider. Coordination of care breaks down in such cases. When a PCP office has the ability to request e-consults with their referring partner, care coordination has been proven to trend higher.

Issues with telemedicine

It’s not all that rosy a picture. There are (were) several barriers to telemedicine. Some of them have been relaxed due to COVID, however, challenges still remain.

Reimbursements

State laws are complex and reimbursements are varied across payers. Make sure that you understand your reimbursements well enough before you get started.

At a minimum, you need to understand the parity laws for that state, the limitations of locations in your state, the types of telemedicine allowed in that state, the covered services, who the eligible providers are (whether your specialty can even use / offer these services), whether you can e-prescribe or not, whether you need patient consent or not (there are specific rules around patient consent).

Still not a complete exam

Doctors in specific specialties still will not feel 100% comfortable with telemedicine or televisits. Take ophthalmology as an example – tele refractions have been around for a while now, but still do not have a great deal of traction; primarily because of questionable reliability.

While it can solve problems, it is used essentially as some form of triaging. E.g. a patient might complain of bilateral itching and can be sent antihistamine drops. However, this also depends on whether the patient and provider state allows e-prescribing for these scenarios or not.

Meanwhile, if a patient presents with flashes, floaters, vision loss – this may need immediate in person evaluation.

In ophthalmology, as an example, most anterior segment conditions can have some amount of telemedicine evaluation.

This is not a problem with telemedicine as a concept in general. It’s a problem with perception – telemedicine cannot be thought of as a replacement to a full, comprehensive exam. In many provider groups, there will certainly be cases that cannot be diagnosed via telemedicine. In such cases, triaging is important and that in itself contributes to the success story of telemedicine.

Hopefully this gives you a general idea of the pros & cons involved with telemedicine. Let’s look at whether you should offer telemedicine services or not.


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