Telehealth Is Here to Stay
June 10, 2020
Bert Orlov, a Director in EisnerAmper’s Health Care Services Group, talks about the vital role of telehealth in the current health care environment. He discusses issues like insurance coding, revenue management, scheduling, and best practices for developing an effective telehealth infrastructure.
DP: Really, telehealth has gained a foothold as a result of COVID-19. It's really telehealth's moment in the sun. Tell our listeners how telehealth has made itself such a permanent part of the health care practice.
BO: I would love to. It's really a fascinating story. Telehealth has been gestating for 10 years. We've been talking really for that long about how it's just around the corner, it's really going to become popular, and there is growth that you can see. And then the pandemic happened, the world changed, and suddenly, offices have gone from 7% of their encounters on telehealth, to 70%. So it is here to stay because it's efficient. For many types of visits, it is really quite adequate and therefore easier for the patients. And so we really believe it's here to stay.
That said, we hasten to note that the high degree of flexibility present in the environment now, you could say telehealth is kind of the Wild West. No rules. Everybody's paying for it. No copays. Blah, blah, blah. We don't think it's going to stay that simple. And when you think about how to operate an integrated practice, where you've got some coming on site and doing some visits by telehealth, we believe practices are quickly going to realize that just doing a Zoom visit is not going to be adequate to meet the clinical needs, patient satisfaction, or billing and regulatory requirements. So they're going to need to be really good thinking about how to organize this, once it becomes a more consistent part of the practice. And frankly, as some of these lax regulations come into more structured form, staying on top of who pays for what and how to manage it is going to become more complicated. But it is here to stay, and for some practices, it will really represent a new tool to reach patients.
One thing that I think it might be helpful to do is to really define what telehealth means. In fact, there are four defined telehealth modalities, if you will. One is the audio visual. Think of Zoom or FaceTime but through a secure medium. Another is telephonic consult. The rules have been changed, and I don't think there's going back, that says doctors can get paid for talking to their patients via telephone. Analogously, exchanging emails. Patients have questions, answer them. Doctors are now going to get paid for that, and patients love the quick response. And finally, there are opportunities in what is not a modality but a set of services of monitoring. So, for things like, let's say, a heart failure patient, so that you can routinely be gathering data about their weight, their blood pressure, their pulse ox, et cetera. Those are part of the telehealth universe and should be part of every practice's thinking to the extent that it's applicable to their specialty.
DP: Yeah, it sounds like some really good tools that doctors now can put into their tool belt to communicate with patients. Talk about the revenue management aspect, when it comes to telehealth.
BO: Happy to. I think that revenue management, and we'll touch on it more later, is a whole strategy behind what is this as a distinct line of business. The revenue is going to be really critical because right now, as I said, the regulatory environment is very lax, but it won't stay that way forever. So every practice has to be aggressive in monitoring what commercial payers in particular, what services they cover, what is required to get paid for those services, rules, copays, co-insurance, deductibles. Even down to narrow things, if you think about it. When you go into a doctor's office, they take a picture of your license. They have you swipe the credit card machine to pay your copay. You can't do that in the same way.
So all of those things become important to managing telehealth revenues. And then on the backend of what we call the revenue cycle, is really tracking payment to make sure that the insurance plan is paying what they've said they would pay. That's going to require special attention to quickly pick up if there's something wrong. Because one of the great little trick of insurance plans is that they don't do what Medicare does and publish all the rules. You have to go hunt for the information, and if you don't get it, or it's not a payer you see all the time, they may change the rules, and you won't know about it until it's too late.
DP: Okay. So let's talk about coding. Every healthcare professional's favorite topic. Coding is certainly going to be a big part of this. How do we prevent errors here?
BO: Could not agree with you more, and we're very proud of our coding team, which is certified to the maximum degree possible. They lead us in this, but I think to underscore your point, insurers and government alike, leaders have been saying from the get go, they're terribly worried about telehealth fraud. They think that it is going to be easier to commit fraud and therefore, whenever audits come, we think there are two things that are likely to happen.
Number one, we may see audits sooner, focusing just on telehealth. And the second thing is that audits could come a year or two down the road and commercial insurance plans have been known to take money back. So that's all intended to underscore the imperative of doing it right at the outset. And that means understanding exactly, do I pay or what documentation is required, what the coding is for each of those types of services, making sure that that documentation is completed with all the required details. Often we, for practices that have been doing some telehealth, we would start by looking at what they've done as a basis for saying, maybe they're doing a great job, and the answer would be yeah, tweak a little bit, but continue as you are. For others, we may look at it retrospectively for a sample and find this is not what the carriers are going to need, and here are the trainings and monitorings that are going to be required to keep a practice compliant and safe from inevitable audits.
DP: Okay. So, let's say we have a practice that says to themselves, okay, you've convinced me, we're all in on telehealth. What are some best practices that you could offer them in developing that telehealth infrastructure?
BO: Sure. And infrastructure is such an important word because of the lax regulatory environment that's been in play since the beginning of the pandemic, a practice may be providing telehealth services, but not really have the right infrastructure. HIPAA compliance is going to be required. You're going to need a platform that's reliable, that is easy for the patients to access. We also think it's critical to make sure that each practice chooses a telehealth platform that interfaces with whatever electronic medical record it has, whatever scheduling system, whatever billings and collection system it has. So that it's not kind of standing off to one side, but it's integrated into how the practice operates. And then as you can imagine, selecting the right vendor is going to be a critical decision, balancing the extent of the services offered against the price point.
DP: Okay. Let's talk a little bit about timing. How is the telehealth process going to impact scheduling follow-ups? Give us a sense of the timeline here.
BO: Terrific. That's such a great question, David. Obviously, it will vary by practice, depending on how central telehealth is to what they do. But a core notion to keep in mind is that we think as practices get busy again and have a lot more, both onsite and telehealth visits, that you're going to have to be rigorous in managing punctuality. Patients, in theory, can sit in a waiting room for 10 minutes or 20 minutes or however late a doctor may be running for a given appointment. That's simply not going to work with telehealth. Stay on hold for 20 minutes? I don't think patients are going to do that. And so thinking about block time, scheduling by provider, what type of visits they'll be doing when, and reorganizing the day. And that pulls in the need for the administrative staff and the providers to all rethink what scheduling mean. We also think it's important to think about follow-up and relationship.
So those two things, how often should telehealth be used versus how often does a patient have to come in? What are the clinical criteria that the practice wants to put in place? And in terms of follow-up, if you think about a typical office experience, the provider will say, "Well, come in, in three months to follow up." And you go and you make the appointment. Well, telehealth doesn't do that so easily because you're not in the office. So thinking about that and how to maintain that continuity of care, and also, as I said, the balance of in-person and telehealth to maintain the individual relationship between the provider and the patient is going to be critical.
DP: Well, they say, Bert, that necessity is the mother of invention. So it sounds like telehealth is here to say, so thank you for giving us the ins and outs of telehealth.
BO: My pleasure. And one note I'd like to throw out is that for some practices, this will just be a substitute for inpatient visits that may last for a period of time. People get re-acclimated to going to the office, but there are other practices for which this is a growth strategy, where they can think of markets, particularly specialists in geographically isolated areas. There could be a real expansion of the practice that can be brought about by the greater use of telehealth services.
DP: Duly noted. So thanks, Bert.
BO: My pleasure.
DP: And thank you for listening to the EisnerAmper podcast series. Join us for our next EisnerAmper podcast, when we get down to business.