By now, telehealth is a well-established option for many patients and physicians. However, it has been out of reach for many private practice physicians who simply are not familiar with telehealth best practices. Clinicians who are using telemedicine and telehealth for the first time should educate themselves on some of the important issues associated with this kind of care.
The umbrella of telehealth includes the use of any electronic means to provide care for patients. This is not limited just to video calls, but also includes other electronic communications and even phone calls. As the National Conference of State Legislatures points out, telehealth does not mean that more healthcare is available, but instead, that providers have a broader reach and more efficient services.
When Telehealth Is Appropriate
A Becker's Hospital Review survey of more than 2,000 primary care physicians listed respondents' top uses for telehealth. Many of these uses, such as managing medications and behavioral health, are sometimes performed by gynecologists. Some of the top use cases pertain directly to gynecology practices, such as urgent care for minor illnesses, counseling for birth control and managing chronic conditions.
Not surprisingly, telehealth works well for patients who do not need a physical exam. In the setting of a video visit or phone call, patients are often able to take their own temperature and even measure their blood pressure from their own home. In a video encounter, the physician is able to observe the patient, monitor respiration, look at problems on the body's surface and better determine whether the patient should physically come to the office.
A phone or video consultation may be appropriate for patients who live at a great distance from their provider, such as patients who live in rural areas or require specialized care. Remote care is also valuable for patients who are not sure whether their issue necessitates a visit to the doctor's office and patients who have contagious conditions (or need to avoid others who are contagious).
Key Benefits of Telemedicine
One of the primary benefits that telemedicine offers is flexibility, both for the patient and the physician. A doctor can see patients from the office or even from home if needed, while the concerned, ill or injured patient is able to stay home. Both parties in this transaction save commuting time. The patient's overall cost is often reduced further by avoiding the need to take time off work.
Teleheath providers can now access their patient records and ultrasound results from outside the office using cloud-based image management systems, such as Trice. They can save, share and attach ultrasound images within the patient's record through secure uploads.
Practices offering telehealth are able to see more patients in less time, with the advantage of having fewer staff in the office. Some practices are already realizing the benefit of the boost in revenue from adding telehealth to their services.
Many physicians are using specialist consultations while the patient is physically in the room. Tele-consultations are often used to discern whether the patient should be referred to another physician, and they are particularly important when specialty care is not available in a patient's location. Additionally, gynecologists can be reimbursed for providing tele-consultations to other providers, saving the patient a trip to the practice, and again, reducing the number of patients physically present in the office.
In addition to seeing patients within a defined geographic catchment area, physicians can also be licensed to conduct televisits in multiple other states. Depending on the state in which a physician is licensed, they may be able to expedite licensure within other states through the Interstate Medical Licensure Compact. This way, they are able to expand their services in areas that might be underserved by gynecology providers.
Adopting Telehealth Best Practices
A transition to telehealth can be bumpy, but it is workable. Research published in NEJM Catalyst reviewed four primary care practices that upscaled telehealth services quickly in 2020 and found that they were able to successfully convert most of their patient visits to telehealth. Within one week, they were "seeing" 62 percent of their normal number of patients, and the overwhelming majority of these were virtual services. There are multiple reasons that the overall patient population could have gone down; it is important to note that not all patients are equipped for or amenable to receiving virtual services from their physicians.
Gynecologists who are looking to reduce the number of in-person visits and increase their telehealth services should talk with their patients about the availability of this service. This could be a short in-person conversation, perhaps to simply educate the patient about telehealth options for a follow-up, or even a conversation when the patient calls to schedule an appointment. While some patients will welcome the chance to see their physician from the comfort of home, others may be worried about privacy, or they may feel that a videoconference might not be adequate.
Physicians should be prepared to discuss limitations of telehealth, such as the inability to perform a pelvic exam. Further, depending on the assessment and the patient's condition, they might just need to come into the office after all. Physicians should also be prepared to discuss their privacy and security protocols and to explain which methods of communication are acceptable under federal regulations. Explain to patients that telehealth visits are billable and that they will be charged accordingly.
All methods of telemedicine or communication between a doctor and patient should be performed with HIPAA-compliant technology. Patient portals for email communication are an example of technology that needs to be compliant, as are cloud-based image management systems, which can be used to seamlessly share stored ultrasound images.
Any video calls, communications, records or images that are transferred virtually are required to be encrypted. Popular video technology such as FaceTime or Skype might be more familiar to some patients, but they are not secure and should not be used. In some instances, such as during national emergencies, HIPAA laws are not as stringent and some exceptions are allowed.
The Centers for Medicare and Medicaid Services (CMS) maintains a list of all reimbursable telehealth services, and other third-party payers generally follow CMS guidelines for reimbursement. Providers should skim the current list of 191 CPT codes to ensure they are capturing all possible charges appropriately. The 2020 list was updated to include some services that are not normally reimbursable, such as home visits for new patients during a public health crisis.
When deployed appropriately, telehealth can enhance patient care and possibly reach patients who would not otherwise seek care or return for a follow-up. It is both convenient and efficient in its ability to engage patients who are otherwise too busy or live at too great a distance to receive adequate care. Although the onus is on the provider to ensure that all telehealth transactions are appropriate, private and secure, the tools for implementation are available and ready for use.
