Healthcare workers have been on the frontlines of the COVID-19 battle and in the media headlines for the past several months. One of the tools we’ve used in the fight against the pandemic has nothing to do with PPEs and everything to do with social distancing. From small practices to large healthcare networks, telemedicine has become the go-to technology to help keep our patients and providers safer.
According to Becker’s Hospital Review, 24% of U.S. healthcare providers had telemedicine service lines at the beginning of this year. In a turn of events perhaps as astonishing as the COVID-19 crisis, they now predict there will be more than one billion telehealth visits in 2020. With this benchmark comes the realization that the virtual visit, like working from home, or wearing a facemask, maybe the new normal in the years to come.
How will the new healthcare reality that is telemedicine change your practice this year?
Telehealth Services Benefit Public Health
Telehealth is a broad spectrum of services that encompasses:
- Virtual healthcare visits via video conference.
- Digital transmission of medical images or test results for a specialty consult.
- Remote patient monitoring of chronically ill patients who digitally transmit physical data from their homes to a distant healthcare facility.
- Physician-to-physician consults, including for ER specialist coverage.
- Mental and behavioral health counseling.
- Care coordination between quarantined patients, families, and clinicians.
- Post-surgical wound care.
- Immediate triage during a worker’s compensation incident.
These are just a few of the typical telemedicine services available. Today, a telehealth app is as close as your favorite digital device. How doctors and healthcare facilities use these tools varies, but the successful outcomes of these visits have been documented for several decades. Telemedicine can:
- Improve patient engagement.
- Improve health outcomes.
- Improve patient satisfaction.
- Lessen wait times to receive care.
- Improve access to patients in rural settings.
- Cut travel costs for patients.
- Reduce practice overhead.
- Improve practice revenue.
- Reduce patient no shows.
A Forrester report predicts that telehealth apps will be the go-to tool for care this year:
- 900 million virtual visits will screen COVID-19 related illnesses.
- 200 million general care visits will occur by video conference.
- 80 million mental health visits will be conducted via telehealth.
The benefits of telemedicine were well-established before COVID-19. The effectiveness of telehealth apps during a pandemic not only offers the same benefits we’ve seen for years; it brings the added benefits of applying social distancing techniques to slow the virus spread.
Today, telehealth is used to reduce the pressure on our overburdened ERs. Patients can see a clinician over a video chat, which helps triage cases that would have ended up in the ER. A virtual visit keeps contagious and slightly symptomatic patients in quarantine where they can receive advice and support from their doctor without infecting a practice or ER waiting room of people. Telemedicine services can also keep chronically ill patients at home while clinicians monitor vital signs, blood sugar, and more, while still keeping them safe from exposure to the coronavirus.
The benefits of telehealth are myriad. While it may have taken a global pandemic for widespread adoption of these tools to occur, the genie is now out of the bottle, and most predictions suggest that telemedicine will be the go-to tool for practices in the coming years. Here is what your practice can expect long after COVID-19 is over.
The State of Telemedicine
Fierce Healthcare says close to one-half of all U.S. doctors are now using telemedicine. Just two years ago, that number was only 18%. The Executive Vice President of Merritt Hawkins says, “The impact on physicians from COVID-19 is going to be transformative. The way patients access physicians and how and where physicians practice will fundamentally change.”
Part of the issue slowing adoption of virtual technology was barriers to telemedicine, including the requirement that the patient travel to an eligible originating site to receive care or reimbursement rates that were lower than for traditional in-person visits.
Not anymore. CMS recently smashed these barriers by expanding telehealth reimbursement during the COVID-19 pandemic. Now, providers can provide virtual care to patients in their homes and receive the same reimbursement as traditional visits. The cumulative effect of these changes, according to Healthcare Finance, was that “Even providers who previously didn’t offer telehealth services are scrambling to implement the technology is some form.” In addition to helping practices reinforce social distancing, telehealth is providing needed revenue at a time when many practices are delaying elective surgeries until the pandemic pans out.
Increasing Revenue with Telehealth
Self-quarantines for doctors and their patients, stay-at-home orders, and social distancing have all had a negative impact on the revenues of many practices. The Medical Group Management Association (MGMA) recently polled their member-practices to determine if they experienced a decline in patient volumes and revenue. The results were sobering:
- 97% of medical practice leaders say their organization has seen a patient volume drop since COVID-19.
- Multispecialty practices report a 50% decline in visits.
- Practices that rely heavily on elective surgery revenue have felt a 70 to 99% patient volume drop.
- Even primary care felt the pinch; one eight-doctor practice said they were at half their normal patient volume and still in decline.
Like restaurants and retail, medical practices across the nation have been forced to contemplate layoffs, furloughs, and even office closures. The U.S. Bureau of Labor Statistics shows 40,700 employees dropped from ambulatory healthcare payrolls between February to March 2020.
Struggling practices can offer a variety of virtual services to shore up declining patient volumes. Adding a telehealth app to your practice can increase the convenience and access to care for housebound patients while bringing in needed revenues. Practices considering telemedicine services have several billable options:
- Telephone consults are reimbursable, and they do not have to be COVID-19 related. Medicare permits reimbursement*, as do many payers, but practices should check with their individual providers. For example:
- A 10-minute phone consultation with a Medicare patient could be reported as a virtual check-in under HCPCS code G2012 (private payers use 99441 for telephone services).
- Longer calls (11-20 minutes) could be covered under CPT code 99442.
- For calls lasting 21-30 minutes, use CPT code 99443.
*Note that Medicare is currently also accepting 99441 – 99443 during the public health emergency.
- Telehealth virtual care can include Medicare annual wellness visits for patient check-ins and COVID-19 education. You can use telehealth for new and established patient visits (CMS waived requirements that telemedicine can only be conducted with existing patients.). Or, use it to monitor patients with chronic care issues (see below). Advanced care planning, smoking cessation, annual depression, or alcohol screenings—all can be conducted online and reimbursed.
- Remote patient monitoring gives clinicians a way to keep tabs on your customers without requiring an office visit. You can monitor weight, blood pressure, respiratory flow, vitals, and pulse oximetry online. Most telehealth apps work with remote sensors that allow patient data to flow to your practice. There are basically three CMS billable options for remote patient monitoring:
- Educate the patient on the setup and operation of the remote monitoring device. Bill: CPT 99453.
- Monitor patient recordings daily or any alerts. Bill: CPT 99454 each month.
- If the doctor or midlevel must consult with the patient, for example, about weight reduction strategies, you can also bill CPT 99457 for up to 20-minutes, and 99458 for each 20-minute increment afterward.
Self-measured blood pressure has a different set of codes, and they require a treatment plan.
While CMS has made a number of concessions to help during the COVID-19 crisis, always check with private payers to determine reimbursement requirements. Ask the payers these questions:
- Is telemedicine covered?
- What types of telemedicine are covered? (Telephone, video conferencing, other?)
- What services are covered?
- Can you treat new and existing patients with telehealth?
- What codes and modifiers should the practice use?
Your practice can recoup at least some COVID-19 revenue losses by considering a telemedicine service line. But if you go to the trouble of changing workflows and marketing telehealth to your patients, are these services that will resonate in the future, after COVID-19 is a memory?
Telehealth After COVID-19
MGMA says, “Virtual care is a change agent.” With the pandemic as an accelerator, telemedicine is expected to become a $66 billion industry in the next year. COVID-19 has changed how we interact, and a lingering impact from the virus is our collective level of comfort with the video conference format. While telehealth use has been growing steadily since the technology first became a billable service in 1997, the pandemic and the government support of these tools have pushed the technology into the mainstream for patients and providers.
What can we expect for practices and our use of telemedicine in the future? We know that rural communities were already feeling the effects of community hospital closures and a shortage of clinical providers. Telehealth has always been a way to extend care to vulnerable populations. But with hospitals and specialty providers feeling enormous financial strain due to the cancellation of elective surgeries, Healthcare Finance predicts Congress (and CMS) will continue their support of telehealth services:
“As long as CMS’s telehealth reimbursement waivers are in place, hospitals can lean on the technology to replace some of their lost income and open up new revenue streams. But the coronavirus’s reign will end one day, and
when that day comes, many hospitals – and patients – will want
remote care to remain a staple of U.S. healthcare.”
FierceHealthcare agrees, suggesting that once patients try telehealth, they will wonder why they ever really needed to see their doctor in the office. The convenience of telehealth will accelerate healthcare consumerism, with more patients seeking out virtual options as a speedier and more convenient method of care delivery.
In an article titled, “COVID-19 Gives Providers a Blueprint for New Telehealth Strategies,” mHealth Intelligence says: “As health systems and hospitals adjust their workflows to deal with the coronavirus pandemic, they’re learning some valuable lessons on how to best use connected health technology. With in-person care reduced to emergencies and an emphasis on keeping patients and providers separated, they’re using telemedicine platforms and mHealth devices – including the telephone – to deliver care. And they’re planning beyond the COVID-19 crisis, with telehealth front and center.”
We believe telemedicine will remain the new normal long after COVID-19. Some of the telehealth services that will linger are at the front and the backend of patient interaction. For example:
- Telehealth triage
Using a telehealth app as a triage tool allows a variety of interactions, from those middle-of-the-night childhood illnesses to screening flu or even coronavirus symptoms. The cost savings over the alternative of an ER visit are very high. But we’ve also seen our own telehealth app provide immediate triage for an on-site workplace injury that also cuts ER costs for businesses.
- Telemedicine check-ins
At the end of the patient care continuum lies the chronically ill patient requiring sometimes daily check-ins to monitor their care. Or, post-surgical wound checks for orthopedic patients no longer require an uncomfortable and time-consuming trip to an office. Could telemedicine prevent hospital readmissions? The studies show that technology can do this—and more.
It seems that telehealth is shifting the paradigm of patient care in the United States. In the past few months, we’ve seen a massive uptick in telehealth services, from a trickle to a flood of video visits to provide care. While telehealth is not appropriate for every clinical visit, providers and patients now see the benefits of these applications, their convenience, and that care delivery is still high quality.
It’s unfortunate and even tragic that it took a global pandemic for many healthcare providers and patients to see the value inherent in telemedicine service. But we are very grateful that the technology exists to keep patients and providers safer, offer high-quality care and caring, and provide necessary revenue to clinical practices across the country.
Michael Greiwe, M.D.
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