5 answers to clinicians' common questions about telehealth


The demand for telehealth continues to surge, and there is no indication this demand is going to slow any time soon. By some estimates, the U.S. market for virtual consultations is slated for 78 percent growth, reaching 27 million virtual visits by 2020. At the 13th annual World Health Care Congress in Washington, D.C., in April, Robert Pearl, MD, executive director and CEO of Permanente Medical Group and president and CEO of the Mid-Atlantic Permanente Medical Group, said the health organization expects to do more video visits than in-person visits in 2018.

Peter Antall, MD, CMO of American Well, said in an April 27 webinar that there has been a diversification of telehealth services, both on the vendor side and the provider side. "We have seen an explosion of telehealth utilization," Dr. Antall said. "Much of that is now driven by vendors who are providing telehealth services, acute care and behavioral health. But a great proportion of new growth is [from] providers adopting telehealth to provide new types of care [delivery] to patients."

However, some providers remain apprehensive about adopting telehealth. According to a 2015 survey from telehealth provider American Well, conducted by Quantia, slightly more than half of providers (57 percent) said they are willing and ready to see patients via video. "What was interesting was of the group that was not yet ready or didn’t know, the vast majority of them said they’re just not sure yet. They’d like to learn more about it,” said Dr. Antall.

In the webinar, Dr. Antall outlined key questions clinicians often have regarding telehealth. Here are five common questions and answers.

1. How does telehealth work?
Dr. Antall said clinicians often want to know more about the basics of telehealth. What does it look like? What does it really mean?

While there are a number of telehealth platforms, there are commonalities among them all. On the patient side, a user can simply access the telehealth app with a few clicks on a smartphone. After selecting a provider and choosing a pharmacy — should a prescription be needed — they go right into the visit.

On the provider side, the platform displays the patient’s current issue, along with prescription data, biometric data and vitals, along with other clinical information. Dr. Antall said the simplicity of such platforms helps unlock the availability of the provider in new ways, which is a core goal of telehealth.

“It might seem like very simple steps, but that’s by design,” Dr. Antall said. “The goal of telehealth is to make it simple, easy and friendly on both the patient and provider side.”

Additionally, Dr. Antall discussed how telehealth can facilitate provider-to-provider communication. He said traditionally, clinicians "haven’t leveraged the technology to communicate with each other,” he said. “We who take care of patients in the inpatient setting do rounds, leave a note and read each others’ notes. That’s not communication.”

Using a telehealth platform, a provider in the hospital who needs a specialist consult can push a button and be connected to someone who fits their criteria.

2. How can I get paid?
Telehealth has historically been caught in the crosshairs of reimbursement questions, but as both the demand and utilization of telehealth grows, payment is progressing in a positive direction, Dr. Antall said.

Variance between states and how they pay remains; while some states mandate parity — requiring services to be reimbursed at the same rate they would be for in-person visits — others allow payers and the market to decide.

While government insurance programs do tend to place restrictions on telehealth reimbursement policies, many commercial players are initiating reimbursement for telehealth. For example, in May 2014, Minneapolis-based UnitedHealthcare partnered with three telehealth service providers (one of which is American Well) and will cover those visits.

3. What conditions should I treat?
Telehealth is predominantly used for cases that mirror those seen in urgent care — respiratory infections, influenza, bronchitis and the like. However, there is a shift in telehealth care that is moving from acute care to further integrating into the fabric of healthcare delivery. Dr. Antall calls this the shift from telehealth 1.0 to telehealth 2.0. “Urgent care is just the beginning. A list of some of the areas in which hospital systems and providers are really building use [include] chronic care management, population health, readmission reduction programs, diversion in urgent care centers, minor acute care conditions, behavioral health and medication consultations,” Dr. Antall said.

4. How do I examine a patient?
“We as physicians feel like we have to put hands on a patient,” Dr. Antall said, but by returning to basics learned at medical school with a touch of creativity, a provider can gather all the information needed.

Patient history is critically important, but video visits also enable clinicians to observe the patient’s appearance, such as noting if the patient is in obvious pain, if the patient’s mental state seems clouded or if the patient is in respiratory distress.

Additionally, clinicians can use the patient themselves to assist in the exam. Dr. Antall said clinicians can have the patient push on certain areas or jump up and down to see if such movement elicits pain.

Seeing patients in their own home also offers valuable information about a patient’s socioeconomic situation, whether there may be overcrowding or tension in the home, even asking the patient to look in their refrigerator to assess how nutrition may be affecting their health.

“If nothing else, use your exam to narrow down your differential,” Dr. Antall said. “There may be a case where you can’t come to a diagnosis, but you can rule [some things] out.”

5. Why should I do telehealth?
For providers, the benefits of telehealth are largely in the form of efficiency. As a strategic telehealth practice fits within an existing clinical workflow, the capability to offer virtual visits maximizes provider availability.

But one of the key benefits of offering telehealth is simple: it is what many patients want. “A lot of the low-hanging fruit is about patient satisfaction,” Dr. Antall said. “They love this kind of care, they love physicians are willing to be innovative and use this type of modality. That translates into happy patients that stay with you and the acquisition of new patients to build or grow your practice.”

To view the webinar, click here. To download the webinar slides, click here.

To view past webinars, click here.

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