Top 10 Telehealth Practices During COVID-19

Athelas is a telehealth provider that helps you remotely monitor your patients, whether you’re in oncology, psychiatry, or another field. Read below for advice on maximizing your telehealth practice — and partner with us today to keep your patients healthy during COVID-19! Inquire at founders@athelas.com

Make the most of new opportunities to track objective data and subjective symptoms while medicine — and the world — go remote.

Telehealth coverage has expanded due to COVID-19, meaning you can expand or add telehealth programs

COVID-19 has forced rapid changes in care delivery, as well as in related legislation and billing. Those changes enable you to care for your patients now, and establish a robust, sustainable telehealth program that can serve you beyond the pandemic.

Medicare & Telehealth: What’s Changed?

Prior to 2019, Medicare covered telehealth in a very limited context. To qualify, patients had to live in designated rural areas, leave their home, travel to a healthcare facility (e.g. a hospital), and receive telehealth services at that facility through a remote provider. Those requirements negate the convenience and safety of telehealth, because patients still have to travel and be exposed to a healthcare environment.

In 2019, prior to COVID-19, Medicare began making payments for “Virtual Check-Ins”. Virtual Check-ins are brief patient-initiated audiovisual interactions — e.g. a phone call, video chat, or patient portal message — for established patients. (Medicare Part B pays separately for E-Visits, which are patient-initiated communications through a patient portal.)

In January, the HHS Secretary, Alex M. Azar, declared a public health emergency under Section 319 of the Public Health Service Act due to COVID-19. In March, President Trump declared a national emergency under the Stafford Act. Those two declarations enable CMS to invoke Section 1135 of the Social Security Act, allowing them to waive typical Medicare requirements.

The goal of the waiver is to prevent people — especially immunocompromised people — from unnecessary exposure. (Photo by visuals on Unsplash)

CMS’ application of the waiver allows clinicians to bill for Medicare Telehealth Visits, distinct from Virtual Check-Ins or E-Visits, at the same rate as in-person services. Here are the biggest changes:

• More clinicians are eligible. Doctors, nurse practitioners, licensed clinical social workers, clinical psychologists, and more can be paid for telehealth services.
• More tools are eligible. You can use any non-public facing remote communication product — like FaceTime or Skype — on your own smartphone to provide telehealth services. You won’t be penalized if you don’t have a Business Associate Agreement with the communications product provider, or for accidental violations in good faith that occur using those products.
• More settings are eligible. Your Medicare patients can receive telehealth services in their homes.
• More patients can sign up. CMS is waiving the established relationship requirement for Medicare Telehealth Visits. You can add new patients to your telehealth service during COVID-19! (Those requirements still stand for Virtual Check-Ins and E-Visits — see the table below!)
• Costs are lower. Medicare coinsurance and deductibles would typically apply to these services, but the HHS Office of Inspector General (OIG) is allowing clinicians to waive cost-sharing programs for federal healthcare programs during COVID-19.

Telehealth services covered by Medicare, with billing codes and relationship requirements. (Photo by CMS)

In short, you can use a variety of new tools to reach new and current patients, with little cost to them, regardless of your clinical specialty.

Telehealth falls into two broad categories — and you can use in-house tools, or outsource, for both

Part 1 of telehealth is real-time and asynchronous communication with patients. Here are some tools we like for those tasks.

• In-house: Apple FaceTime, Skype, Zoom, Google Meets, and texting. Real-time video chats are meant to replace in-person appointments, and you can supplement by answering questions and sending patients reminders over text. TigerConnect is a platform with HIPAA-compliant texting (including images), phone calls, and video chat. Intended for communication between clinicians or between clinicians and patients, it’s a good option if you want to improve remote communication within your team as well as with patients. The downside to all the in-house options is that it’s much harder to automate messages and reduce the workload for your staff.
• Outsource: Weave. Weave markets themselves as the “complete business toolkit” and provides a variety of tools. The ones we like most for telehealth are their two-way texting and scheduling services, which help you maintain a personal connection with patients even when you can’t see them face-to-face. Customize and schedule-send texts to remind patients about appointments, and prompt them to create a new appointment if you haven’t seen them in awhile. Weave combines the expediency and ease of use of the in-house platforms, but gives you more features and analytics. It’s a good option if you’ve got a large practice and busy staff.

Part 2 of telehealth is remote patient monitoring (RPM). RPM collects objective metrics, like vital signs. We recommend outsourcing for this one, unless you already have staff who go to patient homes. The options for RPM are vast and each one tends to focus on one field, so choose accordingly.

• Athelas. Athelas is unique among RPM companies for two reasons. 1) We created a point of care hematology analyzer, the Athelas One. Patients can get more complicated blood work in their home with a simple, user-friendly workflow. The Athelas One forms the core of our RPM offerings, which also include glucometry, pulse oximetry, blood pressure, weight tracking, urine toxicology, and more. Patients can continuously communicate vitals and other treatment-related metrics to you, without leaving their home. 2) If your patient is at home but can’t run tests themselves, we have a Concierge service that sends trained staff to run the tests for them.
• Hinge Health. Hinge Health focuses on remote management of chronic musculoskeletal problems. They provide wearable motion sensors and an Amazon Fire tablet with their app pre-downloaded. They use the sensors to guide physical therapy exercises in real-time, and also provide one-on-one health coaching and weekly articles on managing chronic pain. Hinge Health is offered through employers as a health benefit, so not all your patients will be eligible — but it’s a fantastic option to help people with chronic pain avoid surgeries and get unlimited support.
• Philips Healthcare. Philips’ goal is to reduce readmissions across specialties, and their platforms broadly useful. You can assign patients to different care pathways depending on condition and acuity level. Patients report requested metrics, fill out surveys, and receive reminders for assigned health tasks for their care pathway, through one convenient portal. A great option for higher functioning populations with chronic conditions, or people who have had recent surgeries.

There are dozens of options to choose from. If you’re an oncologist or psychiatrist, reach out to Athelas today! If you’re in a different specialty, check out this more comprehensive list of RPM companies.

So how do you choose the best platform and implement it successfully? Here are our top 10 telehealth tips!

Photo by National Cancer Institute on Unsplash

1. Choose how much you want to outsource. In-house will require more work onboarding patients to the program but gives you total control; outsourcing does most of the work for you, so you can concentrate on clinical care.
2. Pick your context. Are you interested in diagnosing patients early? Managing chronic conditions? Making senior citizens safer? The implementation you choose should be catered to that context. E.g. If you’re an oncologist or psychiatrist, check out Athelas!
3. Balance objective measurements and patient engagement. In some cases, the objective measurements, like lithium levels or whether or not your senior patient is inside their safety zone, are paramount. In others, you might want a mix — like remote vitals monitoring for your oncology patient, with frequent texts or video chats to supplement.
4. Inform your patients about the change as soon as possible. Send them a note via your patient portal or have your staff give them a call — we find that many patients want to take advantage of telehealth opportunities sooner than their next scheduled appointment.
5. Try out the technology with your staff. Put on the wearables, make sure data is getting transmitted, make sure your video chat is working…
6. Set clear expectations with your staff. Expanding current telehealth communications or adding an entirely new program will change your staff’s workflow, and they should have a clear understanding of their new responsibilities, as well as how to handle related questions from patients. If you’re outsourcing any component, make sure your staff have FAQ pages, product troubleshooting guides, etc, or at least have a good point of contact for the company you’re contracted with.
7. Decide how you’ll break up your telehealth work. One of the great benefits of telehealth, and RPM in particular, is that they give you more control over when you see patients or look at clinical data. Data comes to you in a constant stream, and you decide when and how to act on that information. Develop a system that maximizes efficiency and quality of life for you!
8. Check back in with your patients and staff. Is the set-up working for everyone? Just a subpopulation? What could be improved? Your implementation needs to be re-evaluated to ensure it’s sustainable! For us, texting was a better engagement solution than patient-facing web apps — which we only learned by asking.
9. Ensure whoever bills for you is aware of the most appropriate codes. See the CMS provider fact sheet for codes. Proactively follow up to ensure claims are submitted appropriately and getting reimbursed.
10. Keep up to date on telehealth regulations. This is especially important as COVID-19 marches on, since changes could still occur. It is also important if you primarily serve Medicaid/CHIP beneficiaries, as there isn’t as consolidated a source on what will be covered. Here’s a good list of state policies to get you started, and keep up to date with potential CMS changes here.

Do you have other recommendations? Let us know in the comments below! And please check out our website — we’d love to work with you!