Virtually every hospital, healthcare provider, clinic and health services agency is using some form of telehealth today to manage remote health services and medical records. But in the age of COVID and beyond, it is the virtual clinical services of telemedicine that have captured the attention of primary care providers and patients alike.
While telemedicine has been operational since the 1950s, most implementations have focused on serving rural communities where patients don’t have access to the clinical services of specialists. Now, according to a Mordor Intelligence report, telemedicine is on the cusp of becoming a $66 billion industry.
Also, a Washington Post article estimates that telemedicine will be mainstream within a decade. So, if you’re not already offering telemedicine services, now may be the time to start.
And here’s the good news: Incorporating telemedicine into your practice may be easier than you think. To get you started, here are some of the issues you need to consider.
Why You May Want to Create a Hybrid Practice
As coronavirus began to spread, and businesses and many services shut down, physicians saw firsthand the benefits of working remotely and virtually. With broadband communications, hardware, software and a secure platform, telemedicine becomes an efficient and effective service that potentially can:
- Expand a physician’s clinical services to new communities—often without opening additional offices
- Allow both healthcare providers and patients to enjoy more flexible scheduling—including after-hours visits
- Save money by cutting overhead costs
- Provide a convenient way to see patients for preventive care and follow-up with post-operative patients
- Triage patients to determine whether or not an in-person visit is necessary
Consider that before the coronavirus, telemedicine accounted for about 2% of patient visits. But according to Statista, healthcare professionals predict telemedicine visits will account for an average of 61% of appointments during the pandemic and almost 20% of visits when COVID-19 is in the rearview mirror.
If you have an existing office or clinic, creating a hybrid practice of in-person and virtual services may be easier than you think. Here’s what you need to know.
Tackling the Operational Issues
Here are the issues you must address before moving forward with telemedicine:
- Think through the role that you want telemedicine to have in your family practice. How does telemedicine best serve your patients? When does it make sense to use remote clinical care? What services are best offered virtually? Are there underserved markets that you could be reaching remotely? Will you cut office hours? Offer after-hours appointments? Can you reduce overhead costs?
- Revise your consent forms and pre-visit paperwork to explain your telemedicine services and policies. You want to be very clear about the conditions you can diagnose and prescribe for via telemedicine.
- Consider what is necessary to get your patients to accept and use remote, virtual care. Will they need help accessing the system? Do they have technology?
- Determine whether you can train your staff to manage the telemedicine system. You’ll need to educate them about services you can provide remotely so they’ll know how to schedule patients.
- Find a knowledgeable service provider that can help you set up an easy-to-use, secure system. Stress that you want to work with your existing technology as much as possible and that you need a system your patients can understand and use.
Ensuring HIPAA-Compliance
Telemedicine must comply with the HIPAA guidelines on telemedicine. The critical elements are patient confidentiality and security of medical records and recordings of calls. This data falls under electronically protected health information (ePHI) regulations.
For this reason, setting up telemedicine services is not as easy as setting up a Skype, SMS or Facetime platform and notifying your patients. You cannot use any free videoconferencing connection. Nor is standard email acceptable; encryption is essential.
HIPAA-compliant communications require a secure teleconferencing platform that can be monitored, provide for remote deletion and include automatic log-off. And third-party data storage requires a Business Associate Agreement that specifies security protections and mechanisms, including regular audits.
Complying with State Laws
Be aware that you need to follow state laws for telemedicine, so it’s a good idea to check with your state medical board. For example, some states disallow treating a new patient’s first visit remotely. Others have restrictions on certain prescriptions—especially for controlled substances. Of course, you can only practice where your medical license allows.
Working with Insurance and Other Payers
First, it’s essential to know that all the major commercial payers cover telemedicine. Increasingly, states have been passing telemedicine parity legislation. This rule requires private payers in the state to reimburse for in-person and remote or virtual care equally. While Medicare pays for telemedicine, coverage tends to be limited. Medicaid, on the other hand, is very supportive of telemedicine—flexible about access and good about paying.
You’ll want to notify your malpractice insurance provider, but you’ll probably find them most receptive to your addition of telemedicine.
Finally, while you’ll find the billing codes largely unchanged, you will need to maintain a physical address. Again, as a hybrid practice, you’ll have your office for in-person visits, so this shouldn’t be a problem.
Finding the Right Telemedicine Platform
Although setting up a telemedicine system doesn’t have to be expensive, it does need to be done right—factoring in the equipment you already have, HIPAA compliance and patient needs.
As platforms become more streamlined, you may only need to add a webcam for videoconferencing, a secure communications portal and software that manages encryption of both the conversation and its recording.
Again, considering what’s best for your patients may help you to decide on the telemedicine model you want to install:
- Hub-and-Spoke: Requires a patient to receive a call from an “originating site,” such as a hospital, clinic, healthcare facility or participating doctor’s office. In this way, the patient does not require any technology, and there is always someone on staff to offer assistance.
- Direct-to-Consumer: Some states and payers allow patients to self-report on their condition and provide vitals as well as receive telemedicine services directly at home, without having any medical staff or facility oversight. While convenient, some of your patients will likely not have the technical skills necessary to participate.
As we’ve said before, we are witnessing a tectonic shift in medicine. Although telemedicine may not change everything, it certainly will have an impact on your practice. And now is the time to start thinking about how you and your patients can benefit.
