Texas Children's went from nearly no daily telehealth visits to 2,200. How that affected billing & more from Richelle Fleischer, SVP for rev cycle

Before COVID-19, Texas Children's in Houston had dabbled in virtual health, but the visits represented less than 1 percent of scheduled visits. COVID-19 flipped this upside down. From late March to early April, Texas Children's went from executing a few virtual health visits to more than 2,200 a day.

"We went from probably having two providers trained for ehealth to over 700 providers," Richelle Fleischer, president of Texas Children's Physicians Group and senior vice president of Texas Children's Hospital Revenue Cycle Services, said in an interview with Becker's Hospital Review.

For Texas Children's and hospitals across the U.S., COVID-19 has kick-started technological changes — use of telehealth, cashless payments and online portals — that, while championed by the industry, have struggled to become ingrained in day-to-day operations in the same way they have during the pandemic. For comparison, Duke Health in Durham, N.C., completed 1,030 video visits and 3,400 phone visits in a given day the week of April 6, compared to just 100 visits per month before the pandemic.

Ms. Fleischer said the shift from in-person to virtual care at Texas Children's, which is used to scheduling 5,000 to 6,000 ambulatory outpatient visits a day, isn't uniform. Some Texas Children's patients have complex medical needs. Choosing the modality of the visit — or "triaging" which visits can be completed over the phone, video or in person — is a new job Ms. Fleischer's scheduling team has taken on amid COVID-19. Same-day visits aren't available, as the scheduling team needs to push out the visit at least two days to give clinician teams time to triage which modality the patient can be seen in. 

So far, the hospital's big pivot to digital hasn't dampened reimbursement. The payers Texas Children's works with, which are largely Medicaid and managed care organizations, have indicated they'll pay the same amount for a virtual visit as they do for an in-person visit. And like other hospitals, Texas Children's also isn't collecting payment upfront from COVID-19 patients and is waiting until plans adjudicate on the back end.

Ms. Fleischer said what helped her team get ahead of the curve was developing a four-page document with talking points about how to correctly code for virtual visits. Her department continues to offer hourlong education opportunities on coding and documenting changes, and drops all virtual visits into a coding work queue so coders can review them for accuracy until providers are caught up to speed. 

Still, like nearly all hospitals nationwide, Texas Children's is facing another financial challenge: decreases in volume. But Ms. Fleischer is directing her team to work on the hospital's online scheduling platform to prepare for when volume returns.

"Once life returns to normal, and there's this influx of volume — because normally there's a 14-day wait to get in to see certain specialists — we're going to get overwhelmed by demand. I want to make sure we have as many options as possible for our patients for online scheduling to get that volume back in the door as quickly as possible," she said. 

More articles on healthcare finance:
Hospital CEOs blast distributing stimulus funds based on Medicare revenue
Mayo Clinic projects $900M shortfall, implements cost-cutting measures
State-by-state breakdown of federal aid per COVID-19 case

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