The experience of patients in America
June 15, 2020
The experience of patients in the American health system has been one of frustration and occasionally satisfaction to later infuriating. In days past, if you need medical care you would call the doctor's office during business hours to get an appointment anywhere from days to weeks in advance. You would take time off from work or school to go through traffic jams and find a parking spot hopefully not too far away. You have to arrive early enough to fill out paperwork, half of which is Greek to you. You hope the staff don’t blurt out the reason you’ve come to see the doctor accidently in the middle of the waiting room. Hoping to wait only fifteen minutes or less, you usually end up waiting an hour. You finally get to the exam room where you tell the assistant the whole story for why you are there and they ask you all sorts of questions not related to the reason for your visit. The doctor would finally come into the room and ask how you are doing, you start to answer and before you finish they have more questions. Within a few minutes your doctor has the answer to your problem hopefully and asks is there anything else, and hurriedly, you say no. You get your prescription, paperwork for labs, radiology, referrals, and or work notes at the check out desk and make your follow up appointment. By the time you get to your car it's been a couple of hours since you left work or school and you realize that you forgot to ask the other two questions and you’ve already forgotten half of your doctors plan to fix your original problem. But wait, your ordeal isn’t over yet, you still have to go to the pharmacy or lab or radiology department or worse to a specialist for further care. Your work day is almost over by then. Some time later, almost when the visit has become a distant memory, you get a bill which is not understandable. This country proudly says we have the best healthcare in the world with no rationing as in other countries, but people’s wallets or their insurance company denials of coverage replace rationing.
There are many telehealth platforms which provide online scheduling. Telehealth by its very nature allows for less disruption of your day. There is no traveling, parking or waiting. There are a few telehealth apps which provide for a virtual waiting room and an ability to create and maintain a personal health summary. Most telehealth platforms don’t have a function to transmit prescriptions, lab orders, radiology orders, or work notes between doctors and patients. Only a minority of telehealth platforms give you the option for recording the visit. Some telehealth platforms allow doctors to tailor educational videos for the patient’s health circumstances. A rare few of the telehealth options also allow remote patient monitoring and behavioral health integration capabilities. During the time of the covid-19 pandemic rules and regulations have been relaxed regarding HIPPA issues as well as billing requirements and the method of interaction such as telephone conversations being allowed instead of in person visits. As the new normal develops,some of these restrictions will return. Continuity of care is a hallmark of quality care and only telehealth platforms that promote and preserve the doctor patient relationship over time will deliver better outcomes. There are even telehealth platforms which are free to use, but only Telehealer’s platform incorporates all of these attributes into one solution.
I can see a time when a patient schedules a visit online within a few days or less. A few minutes before the visit they update/edit their health summary, input their vitals measurements and then enter the waiting room. After having a video chat with the doctor (whose attention is undivided as there is no computer entry), the patient can review the entire interaction and access any orders through the telehealth platform. They can return to their normal routine. The patient is better connected to their doctor with platforms that are capable of doing remote patient monitoring and behavioral health integration with immediate feedback based on their measurements. There are many disparities in our healthcare system. There are provider shortages in many areas. High cost spotty insurance coverage and less than optimal care if you can’t afford it. Most importantly late care availability. These disparities lead to inappropriate access to care in emergency rooms or worse unnecessary hospitalizations. While telehealth can’t fix all of these problems, it goes a long way towards decreasing frustration and improving healthcare in America.
Observations of a doctor
June 8, 2020
Being a 55-year-old family medicine doctor I have seen a lot! When I started practicing, we wrote on paper charts and would have to read each other's hieroglyphics. Our main concern at the time was hoping to write enough to justify our billing. We were constantly defending ourselves from a lawsuit because the refrain was “if it’s not written it wasn’t done”. Being a tech aficionado, I was a first adopter of EMR’s even though I would hunt and peck on the keyboard. This solved the problem of hieroglyphics but introduced a new problem of hunt and seek for key information regarding the visit amongst the fluff required by insurance companies to justify charges. The lawyers created a new refrain, “if it was copied it wasn’t done”. So 20 years ago I had a dream of being able to see patients while the entire interaction was recorded. Who knew it would be called telehealth. It took me 17 years to find a partner that was as much a tech guru as I was a doctor. In the meantime, society and the circumstances have changed from roadblocks such as concerns regarding the privacy of video visit recordings and the need to physically see the patient as well as rules and regulations regarding payment. The advent of social media created new social norms regarding video privacies. The laws and regulations were slowly reflecting the technical advances until the storm of COVID 19 came in. The Coronavirus phenomenon pushed medical care into the virtual world of telehealth and defined the specific conditions that truly required physical contact and the rules and regulations rapidly changed to reflect the needs of the current situation.
There have been many large Telehealth platforms established for years. They have had poor adoption from patients as well as doctors. The well-established platforms were lacking in reflecting established norms. Many platforms disregarded the doctor-patient relationship, continuity of care, accurate data measurements, and not mimicking current workflows in the healthcare system. The Telehealer platform that we created is structured to address each of these concerns. Telehealer reflects the current workflow of most doctor's offices. It has a scheduling system, a reminder system, a virtual waiting room, the ability of patients to measure key vitals that the doctor needs to make a more confident and accurate diagnosis and plan of care. It allows doctors the ability to order prescriptions, labs, radiology, write referrals, and even create work letters. Doctors and patients can share miscellaneous forms, as well as do screening questionnaires. They can also review the entire visit in case they forget what was discussed. Doctors can also provide educational videos customized to the patient’s healthcare needs. In today’s telehealth universe of platforms there are free of cost options that providers have initially adopted, but they are feature free also. Telehealer is feature rich and offers a plan to make it free when remote patient monitoring is adopted.
Unlike the established platforms, Telehealer is capable of allowing doctors offices to do remote patient monitoring and behavioral health integration. Both concepts are new to medical care. They are well documented to improve the doctor-patient relationship and outcomes so payors are ready to reimburse for them. The codes for remote patient monitoring services are 99453, 99454, 99457, and the code for behavioral health integration is 99484. For primary care doctors and specialists, these new programs represent not only the future of medicine but significant new sources of revenue. They are easy to implement and are performed mostly by support staff. Patients are also reminded to enter their data routinely and once they do they are given immediate feedback regarding the results. Patients appreciate a better connection to their provider’s office. Insurances also benefit from remote patient monitoring and behavioral health integration due to fewer hospitalizations and ER visits as the result of better control of chronic conditions.
I can see a future which is much brighter than in the past two decades. Telehealer improves patient care and their providers’ financial outlook. I can confidently say that COVID 19 has indirectly improved health care delivery in America. The hope we had for EMR technology to improve our lives will finally be realized through Telehealth apps such as Telehealer.
The Age of Telehealth is Upon Us
June 2, 2020
We’ve been through the dark ages of scribbling notes and keying into computers hoping to avoid lawsuits while trying to maintain our incomes. For years, we looked at telehealth platforms cautiously. We worried about reimbursement. Today, most of the states have adopted parity laws. These laws allow doctors to be reimbursed the same amount of money for telehealth visits as for office visits. We worried about maintaining quality of care. Now, smartphones allow us to gather important biometric vitals such as blood pressure, pulse, weight, temperature, blood sugar, even heart and lung sounds. We worried about brief but accurate documentation. With advances in voice recognition technology, your entire conversation with the patient can now be automatically transcribed into a PDF. We worried about continuity of care. There are a plethora of apps in telehealth which allow us to choose the mode of care we wish to participate in. Some doctors may choose the urgent care environment where they see patients they’ve never seen before and will possibly never see again. While other doctors may choose to see only patients with whom they have an established rapport. Other options allow you to pick shift care, nursing home care, gig care (flexible hours), direct pay care, and even managed care. So there are a multitude of options for all physicians on the table now.
Even if you choose not to do televisits, there are bold new developments in telemedicine that will make you reconsider. Medicare is now trying to promote telehealth by paying for non-face to face clinical care (the work your staff does for free now). Medicare has two new programs: remote patient monitoring (RPM) with codes 99453 (initiation of RPM one time payment of $21), 99454 (initiation of device monthly payment of $69), and 99457 (20 minutes of non face to face clinical care payment of $53 monthly) and behavioral health integration (BHI) with code 99484 (20 minutes of non face to face clinical work). Adopting these programs into your practice for just one hundred Medicare patients a month would result in over $150,000 of new revenue annually. More importantly, this will improve clinical care, patient experience, lower total healthcare costs, and even improve our work lives. Thus addressing the quadruple aim of improving our overall health system performance. I have instituted these programs in my practice with great acceptance. My patients have responded very favorably to these new services because they are more invested in their care when they do things actively and are routinely communicating with my staff. The programs have resulted in less ER visits and hospitalizations as well as better blood pressure and blood sugar management as we can respond more quickly to abnormal results. The RPM and BHI programs are much simpler to institute and perform than the chronic care management (CCM) program and the compensation is much greater. If you are interested in starting telehealth, contact me and I will give you step by step instructions to take to integrate telehealth into your practice.
Imagine having the ability to practice medicine confidently without having to vex over writing or typing. Imagine having time to be able to truly engage with your patients. Imagine the health system evolving to have professional coders reviewing videos of your care for reimbursement purposes. Imagine when no one can question the care that was delivered. Imagine parity of primary care with specialists. Imagine a time when you can see everyone that needs to be seen and have more time with your family. I hope, as John Lennon says, “I’m not the only one.”
Important points to understand about Telehealer/telehealth/RPM.
May 14, 2020
In the days of Coronavirus physicians and patients have adopted technology out of necessity. It is easy to choose options in the marketplace that are low cost and simple to use during the emergency. With a little extra effort and expense, patients and physicians will experience the benefits and convenience that more robust platforms provide. Doctors have decreased documentation time and increased revenue from offering remote patient monitoring. Telehealer provides continuity of care and less burnout because it is intuitive and convenient. The best in class platform provides confidence in the care provided to patients by giving physicians access to patients' vitals measurements while making it easier to meet MIPS requirements.
Medical care for the long haul requires continuity of care. In telehealth just a simple registration by the patient helps keep things in order. Options like Telehealer record the interaction so you can better document the encounter. If a picture is worth a thousand words, then a video should be worth a million. The video recording allows the patient to review their providers recommendations later and follow them better. A video recording can also show a consultant the reason why a patient is being referred to them.
Recorded encounters also save you a ton of time; as your EMR data entry is much simpler-just refer to the video and place your diagnosis codes and CPT codes and you’re done! You can see more patients and have more personal time to enjoy life. We also realize the need for flexibility as not all doctors or patients want the recordings. Telehealer offers the option to see the patient without recordings or transcriptions - this actually decreases the cost involved tremendously but still avails physicians the ability to use the app for remote patient monitoring. If physicians choose to commit to a year-long subscription they save 20%. When remote patient monitoring is used, telehealer telehealth visit costs can become free.
Most telehealth platforms don’t allow transmission of a patient’s current vitals. With Telehealer's ability to convey current vitals, providers can give better plans of care knowing the actual status of many chronic diseases. Patients can be more connected to the practice by transmitting vital measurements on a routine basis. The physicians and staff can incorporate vitals monitoring into their workflow easily as most of the process is automated and patient-driven. Physicians can set parameters for abnormal measurements and the automated response the patient receives. The devices patients need to measure their vitals are reasonably priced and simple to use.
Telehealer allows for customized patient education videos to be created or selected by physicians. The educational videos may be accessed at any time by the patient and should lead to better compliance with treatment plans and hopefully better outcomes. Patients and physicians can also access telehealer basic functionality on the web at their desktops, laptops, and tablets. The low priced other programs do not afford the practice to order prescriptions, labs, or radiology studies. They can’t even allow the physician to give the patient an excuse note or return to work correspondence.
The future is upon us as Medicare and many commercial insurances now cover remote patient monitoring. Patients, as well as insurances, see the value of monitoring. There are studies that show better outcomes and compliance with remote patient monitoring. With Telehealer, regular low tech devices that are FDA approved are compatible. Having more time, while improving the practice revenues and improving physician MIPS scores results in a trifecta. We will return to our routine practices soon enough with the grey cloud of coronavirus in our rearview mirrors but hopefully, we will have improved our practices with a silver lining of incorporating both telehealth and remote patient monitoring.