Telemedicine has been available now for a number of years. Despite being widely accessible, it still struggles to maintain a foothold in the minds of many traditional practitioners. There are many reasons for this, including gaps in knowledge related to billing and reimbursement for virtual visits, as well as varying levels of coverage by insurance providers. This is particularly cumbersome when it comes to Medicare patients, although there is hope that as of 2020 the range of benefits related to telehealth will be widely expanded for Medicare patients.
Above all others, I have found that the largest hurdle seems to be knowledge on the side of providers regarding how telemedicine can fit within the framework of their existing practices. Many physicians seem to consider telemedicine as an “all or nothing” proposition; that is to say, they have to decide between either continuing with a traditional practice or transitioning to a virtual one.
There are a number of telehealth companies that have evolved into the space successfully, functioning often in the areas of urgent care, promising the ability to see a doctor from the comfort of your home. Many of these companies will contract with physicians for their services for as little as a few hours per week, allowing physicians to create a little bit of side income doing what they do best. In this realm, the companies themselves own and operate the virtual clinics, and the physicians are essentially hired employees.
The reality, however, is that there is so much more you can do with telemedicine nowadays. There are a number or user-definable platforms which allow you to create a virtual office of your own, with additional services which may include EHR integration and even billing depending on the platform. A number of EHRs themselves may have add-on virtual medicine capabilities, often at an additional fee.
This can open up new possibilities for existing practices, and shift the paradigm from all or nothing to a natural extension of the practice itself. Non-physical exam based specialties such as behavioral health have been early adopters to embrace this new avenue for patient relationships. Ultimately, each provider would have to decide what their level of comfort is when evaluating patients without the ability to perform a physical exam, however, this allows for face-to-face interactions to occur, which can provide greater feedback and input from both patient and provider rather than a simple phone call. Additionally, there exists the ability to bill similar to traditional visits on many insurance plans.
How telemedicine can fit into your practice can be quite individually tailored. Whether utilized to see new consults for patients who may live some distance from your office, continue care for chronic patients who may be away such as students at school, or used as a method of communication to discuss laboratory and test results, the possibilities are many.
What if you have an abnormal CT scan result you would like to discuss with your patient in detail, but they are unavailable to come to the office? Abnormal results can be difficult to discuss over the phone without a face-to-face interaction. What about a busy primary care practice who could fill a block of time for patients to discuss medication refills, and all those patients would only need to invest 15 minutes of their time rather than the time needed for travel, waiting in the waiting room, etc.? Many practices already have blocked office hours late in the day to accommodate working patients. What if you instead market an evening virtual practice, where patients can log in after work without taking away time from their families or other responsibilities?
This can create better patient engagement, patient retention, and increase satisfaction. This may also open your practice to a new demographic of patients previously limited by geography. The same thought applies to both urban and rural patients: What difference does it make if you live far away from the practice and it takes time to travel, or if you live close to the practice but are in a large urban environment where traffic may make it take just as long to reach the office? Either way, your patient may appreciate the flexibility that the virtual visit may offer.
As telehealth continues to evolve, it may be time to consider incorporating it into your practice in some fashion. Before embarking on this venture, you may want to see if it is an available feature in your current EHR. You should research options available to you with various telemedicine platforms to see which best suits your particular needs, and make yourself aware of the very specific and sometimes different nuances in billing and reimbursement for telemedicine visits.
Stuart Akerman is a gastroenterologist and can be reached at his self-titled site, Stuart Akerman, MD.
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