Patient Access

Using Telehealth to Benefit Patients and Your Bottom Line

Patient using telehealth

There’s no doubt that 2020 will go down in the books as the year telehealth officially arrived. It’s also been a year where the healthcare industry has taken more than its fair share of financial hits. The strain of coping with so many unknowns due to COVID-19 has meant finding creative ways to offer care, often at a steep price for both providers and patients.

While telehealth isn’t a new phenomenon, the pandemic has shown its transformative potential, now and in the future. Let’s take a closer look at the dual-purpose power of telehealth: not only does it address patient needs, but it also supports the financial recovery and stability that health systems and providers seek.

Telehealth 101

Telehealth is an umbrella term covering a variety of remote clinical and non-clinical information, services and technology designed to improve healthcare delivery. One of those services is telemedicine, in which clinical services such as doctor visits are conducted remotely.

Telehealth found niches in the post-WWII growth era. NASA used remote sensors to monitor animals in its test flights, then later to track the health of its astronauts. Its capabilities progressed to offering medical services in space.

Back on earth, those developments were extended to rural areas where physicians and medical facilities were in short supply, such as the Tohono O’odham Reservation in Arizona. X-rays, electrocardiographs and other medical information were transmitted via microwave technology to and from hospitals located hours away.

Compare these applications to today’s Fitbits, smart watches and other consumer-oriented devices, and you realize how far telehealth has progressed—primarily thanks to technological advances in computing and communications.

Telehealth Plays to the Consumerism of Healthcare

Anyone who watches TV is well aware of the volume of healthcare advertising now aimed directly at consumers. And many consumers are responding, because they want to control their healthcare in the same way they manage their finances or their travel. Their lives are based on interaction via technology (usually mobile), and revolve around “just in time” expectations.

When it comes to healthcare, consumers expect a lot:

  • A transparent search for a provider, including easy referrals from other patients, insights to make a good personal match with a provider, and online ability to view availability and schedule appointments.
  • Convenient access, with the ability to make appointments outside business hours, locations open for immediate care, same-day appointments, and a way to talk to their provider without traveling.
  • A positive encounter, with an easy-to-find office, appointments that begin on time, respectful treatment by the clinician, quick responsiveness to concerns and readily understood bills and payment systems.
  • A durable relationship, where the health system knows them and their unique needs, proactively supports them both clinically and non-clinically, and provides access to all their clinical information.

What’s in It for Patients and Providers?

Even before 2020, consumers began taking a more mindful approach to their health and were seeking exactly what telehealth provides: greater convenience, easier access to providers and shorter wait times.

With so many people working remotely, why shouldn’t they be able to see their practitioners that way? Now health systems and providers are seeing the value of telehealth as well, as they’ve had to pivot rapidly to address the “new normal.” Here are just some of the benefits of telehealth they can realize immediately:

  • Better patient outcomes due to easier access and care plan compliance
  • Faster responsiveness to patient care needs
  • Fewer appointment no-shows
  • Greater schedule flexibility and time savings
  • Improved safety by limiting in-person contact
  • Increased reimbursement/cost savings
  • Reduced administrative burden

The benefit of increased reimbursement and cost savings has always been elusive, but that situation was remedied earlier this year.

Relaxing the Rules Made All the Difference

Prior to the pandemic, providers had to jump over hurdles to provide telehealth services. For health systems or providers to be reimbursed for telehealth by the government or private insurers, patients had to actually be at an “originating” site at the time of service, which was either a county outside a Metropolitan Statistical Area, or a rural Health Professional Shortage Area in a rural census tract. Additionally, sites such as physician offices, hospitals, and federally qualified health centers that participated in a federal telemedicine demonstration program also qualified in most cases. CMS established geographic eligibility for originating site every year.

Some providers got around that roadblock by charging a flat fee to patients who wanted to use telehealth. Many consumers were indeed willing to pay for the convenience of accessing healthcare remotely, either to help manage a chronic condition or to be seen for a new ailment or injury.

It took a deadly virus tearing around the world to force the changes we needed in the United States. The Centers for Medicare & Medicaid Services (CMS) flattened the regulations limiting telehealth during the pandemic and the federal agency is now proposing expansion of telehealth permanently. The originating sites are no longer required, there are no provider penalties for telehealth visits regardless of diagnosis, and a payment structure on par with that of in-person interactions has been instituted.

Common office visits, mental health counseling and preventative health screenings are included, and clinicians can bill immediately for dates of service. Co-insurance and deductibles still apply. Since private payers tend to follow the lead of CMS, many of the largest insurance companies are working to equalize payments for remote visits as well. Thanks to telemedicine parity laws, most states and the District of Columbia now require private payers to reimburse for telehealth.

Incorporate Telehealth the Right Way

If a health system, private practice or urgent care facility is not yet using telehealth, it’s probably at least considering it. One of the most likely purposes of implementing a telehealth platform would be to limit the virus exposure and promote social distancing for the foreseeable future. Of course, not all illnesses or injuries can be assessed or treated remotely, but telehealth capability can significantly reduce in-person interactions between patients and providers.

Before investing in telehealth, providers should do some homework. They should first ask their largest payers about their reimbursement policies:

  • Are there restrictions on the location of the patient and/or provider?
  • Does the reimbursement rate match the in-person visit rate?
  • Does the visit documentation require specific notations?
  • For Medicare patients, which Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes can be completed via telehealth? Do we need to use a coding modifier for telehealth services?
  • Which providers are eligible: MDs? PAs? NPs?

It’s important to ask tough questions of prospective technology vendors, too. Ideally, providers want to be able to see current patients—and introduce themselves to new patients—in a safe way that also creates a positive patient experience and uses providers’ time wisely. Providers need to know if the telemedicine options they’re evaluating are:

  • Able to support multiple medical specialties (if applicable)
  • Accessible to patients with or without a portal account
  • Built specifically for medical usage
  • Convenient and consistent for office, home or mobile use
  • Designed to work with any EHR and patient portal
  • Equipped with optional pre-visit forms
  • HIPAA-compliant

The Telehealth ROI Keeps on Giving

Yes, telehealth addresses an obvious and urgent need right now. But it’s also a long-term investment that can help address the financial burdens of 2020.

By offering telehealth visits, providers can capture some of the revenues that would go elsewhere. If patients can see their own doctor, or perhaps a nurse practitioner (NP) or physician assistant (PA) in that practice remotely (and right away), they won’t sit in a hospital waiting room for hours. Besides avoiding emergency department costs, patients get the right level of service for their symptoms.

Telehealth enables providers to be more efficient and maximize billing opportunities. Perhaps, a practice decides that doctors will see patients who have in-person appointments, and the PAs and NPs will be available for scheduled and on-demand telehealth visits. Financially, this puts the providers where it makes the most sense, creates a better patient flow and uses everyone’s time wisely. Telehealth also means fewer missed appointments, resulting in revenue enhancement.

Telehealth is a competitive advantage. Patients are some of the best marketers out there. Once they know that a practice is offering telehealth options, from appointments to fitness apps, the word-of-mouth phenomenon will call attention to—and generate business for—providers who are bringing healthcare to the masses when, where and how they need it.

Telehealth opens multiple doors of engagement with patients. Once remote interaction is established, patients come to expect it as the norm. Providers can deliver follow-up information, offer surveys, educate patients about new treatments and healthcare advances and promote wellness programs. Even older patients, who didn’t grow up with the technologies available today, are learning to use telehealth (or allowing a proxy to do so) to reduce their risks. It allows them to make appointments for deferred wellness examinations or chronic condition check-ups.

Virtual Care Delivery Is Here To Stay

There’s no way to know when patients will be comfortable accessing in-person medical services without the fear of infecting themselves or others. And even when that time comes, telehealth will be so well established and widely accepted that it may become the most common form of care delivery. In fact, in its Medicare Physician Fee Schedule Proposed Rule, CMS adds services to the telehealth list—like home visits for established patients and psychological testing—and revises others.

From its ability to drive ongoing patient-practitioner relationships to providing patients with greater access to their health records, telehealth is poised to support consumers throughout the care continuum. It also enables providers to broaden and deepen their services to seize revenue opportunities. Now’s the time to step up to telehealth—it’s an incredible addition to any care arsenal.

Sponsored content. The views and opinions expressed in this content or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.

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