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Telehealth Trends in 2019

As telehealth grows to new specialties and organizations across the world, the technology continues to evolve to provide more convenience and enhanced treatment tools. The global push to increase access to care is going to bring telehealth to patients in nearly every corner, and new integrated tools and simpler to use interfaces have emerged. The changes represent a general excitement and interest in innovative treatment, and they offer significant changes to the telehealth landscape in 2019.

Better Understanding

The biggest change in the telehealth landscape in 2019 is the general understanding of what is telehealth. In the past, telehealth has been met with resistance due to a lack of understanding of the availability and ease of use of the technology. As insurers, health systems and providers are introduced to the concept and evidence-based practices, comfortability with the tools is more commonplace. Individuals are more comfortable with the technology, and providers have learned about scenarios and opportunities telehealth is impactful with their patients. As reimbursements grow and become more common, telehealth excitement and proliferation grows.

Patient Excitement

Patients are excited to see physicians from home or work without having to travel. They are happy to wait at home rather than a crowded waiting room, and they are eager to reduce the hassle of receiving medical treatment. For non-emergency treatment, patients are educated on how to connect via their mobile device or computer, and ease of access is becoming more of a standard than an ancillary service.

Health Connected-Patients

Devices that allow patients to track their health can be bought at nearly every electronics store. This means that patients are more in-tune with their health, and that can translate into better outcomes for telehealth. The most recent incarnations of smart devices employ a version of heart rate trackers and blood pressure monitors that allow patients to electronically track their activity. Blood glucose meters now sync with smartphones, and pulse oximeters come with bluetooth chips. This information can be easily transmitted to providers via secure messages, which makes the distance evaluation more effective. While these tools are not often directly integrated into the telehealth software, the availability of tracked data enhances the treatment experience for patients and empowers providers to make treatment decisions based on a body of data, rather than just a single moment in time.

No Software

The easier the platform, the better. In 2019, expect the best platforms to operate without any software to download. Patients should be able to log in with just a few clicks. Patients can become as autonomous as the practice wants, with the most flexible platforms offering patients scheduling, rescheduling and cancellation. Platforms will move the burden of patient management from humans to servers as the innovations in scheduling and on-boarding from other industries makes it way to healthcare.

Growing Platforms

Telehealth can no longer be just a video connection. Telehealth platforms require robust schedulers, group scheduling tools, customized forms, messaging features, image transmission and more. The platform should offer integrations with EMRs to reduce double entry, and they should provide the full in-person experience to patients who are located at a distance. The best telehealth solutions make all of this available so that, regardless of the patient location, the provider has the full breadth of information that they need, and the patient receives the same robust treatment.

Telehealth is about the patient

The change in telehealth in 2019 focuses on the patient. While the convenience of telehealth solutions has been and still is the biggest advantage to the patient, convenience is not enough. It also has to be complete and patient-friendly. Patients should have access to their providers with just a few clicks, and providers should be able to offer the full in-person experience in a virtual platform. With tools like Mend, all of this can be achieved with a few taps on a mobile phone screen.

How Telemedicine Benefits Your Medical Practice

The convenience of telemedicine is well established for patients, but many providers and organizations wonder what the benefit is to their operation. While patients would love the opportunity to be seen at home, over-filled clinics may not conceptualize the immediate benefit if they’re already seeing patients throughout the day and rushing from room to room. Telemedicine provides an alternative for additional billable opportunities while also increasing efficiency within the practices. By working with the right platform and establishing protocols for delivering care, organizations across the country are increasing access and revenue while reducing administrative overhead. 

Increasing Efficiency

Telemedicine appointments for low acuity concerns are able to deliver the same quality of care in a shorter period of time. Patients wait for less time in the office, and providers are able to diagnose and evaluate complaints more quickly. By triaging patients who do not require a hands-on evaluation and utilizing a telemedicine appointment instead of in-person exam room, patients can receive the care they need without the travel to the office or wait time. Providers can see more patients and complete visits more efficiently while still providing high quality care.

Be In Multiple Places At Once

Providers with multiple offices are able to treat patients in varying locations without traveling to different sites. By working with a kiosk telemedicine solution, providers can treat patients at another location seamlessly. With the right platform, each facility can utilize existing technology to connect patients and providers, and providers can treat patients with just a few clicks. Patients have better access to care and facilities increase treatment hours considerably.

Turn Free Work Into Billable Hours

Many physicians spend hours outside of the office on the phone with patients. Whether they’re addressing emergencies or answering questions that seem like emergencies, those interactions are rarely billable— even though they take the physician’s time. The codes for billing phone calls limit the billable time based on when the provider last interacted with the patient in person. Even if the timing requirement is met, the copay for the visit is often higher than reasonable and customary, so providers receive nothing for their time. By transitioning those telephone calls into telemedicine visits, the providers are creating opportunities for actual, billable, face-to-face encounters. Telemedicine visits are billed using the same codes as in-person visits, so there are no timing requirements like phone calls often have. Providers can introduce the ability to work with patients at a distance, get paid for that on-call time, and still offer valuable medical direction to their patients.

Patient Satisfaction

Satisfaction scores for telemedicine visits often rank higher than in-person treatment. Patients appreciate the convenience first and foremost, and they rank the quality of care of telemedicine on par with in-person treatment for low acuity complaints. As we look more and more to patient satisfaction as a metric that determines reimbursement rates, telemedicine can be an important way to bolster those responses.

The Future Is More Efficient

Groups of all sizes and specialties are introducing telemedicine as a way to create opportunities to improve care. Patients with low acuity or urgent-but-not-emergent complaints can be seen quickly and easily without transportation or significant wait times. Patient satisfaction with telehealth is high, and it can lead to opportunities to bolster revenue, reduce no-shows and introduce more efficiency throughout your organization.  

What Your Patient Scheduling System Must Have

In 2019, patients want access to the full schedule so they can compare your availability to theirs and make the best decision for what their days allow without having to speak to a human. Healthcare is one of the last industries that require patients to call for appointments, and it’s not an efficient use of staff time. Self-scheduling is an emerging tool in the healthcare software market. The best tools make scheduling easy, remove the administrative burden from staff, and still give the practice the necessary control over their schedule to ensure that the schedule is always accessible and accurate.

Appointment Approvals

One of the biggest hesitations to implementing a patient scheduling system into practice is the access that patients will have to the schedule. Practices and providers worry that patients will have unlimited access to schedule when providers aren’t available or when the office is closed. Your scheduling solution should allow practices who require it to have approval over any patient-initiated scheduling, so that the appointment doesn’t go onto the schedule until it is confirmed by a staff member. This ensures that staff still has full control over the schedule while reducing the time to schedule appointments from minutes to seconds.

Flexible Provider Schedules

Provider schedules change, and your scheduling solution should make accommodating that simple. Your patient scheduling system should allow each provider to have a different schedule, and make changes to that schedule as simple as tapping a few buttons. This will ensure that, with or without appointment approvals, your day are always correct and that patients only have access to times when the provider is confirmed to be available.

Patient Triage

Keeping healthcare safe has to be the primary goal of every technological solution that is introduced into the field. When new or existing patients are scheduling their own appointments, the practice still has a responsibility to ensure those patients are scheduled correctly. Your patient scheduling tool should have a triage tool that directs patients to the correct appointments and providers. Triage ensures that patients are scheduled for the appointments that their symptoms or situation is most appropriate for without requiring a person to walk them through the questions. Triage can be used to ensure that patients are safe to wait for an appointment, that they don’t need to be seen urgently at another location, or that they are scheduling with the correct location. Your triage solution should be robust and customizable to the needs of the organization.

Multiple Locations

A flexible patient scheduling tool should have the ability to manage multiple locations and multiple providers in each location. By integrating with the patient triage, patients should easily be able to select their provider, location and verify that they are scheduling in the correct location. The tool should require just a few taps from the patient but still direct them to the correct location for treatment and scheduling.

Full Integration

The scheduling tool isn’t complete if it requires double entry into the EMR or practice management system. If staff have to move scheduled appointments to another system, there isn’t a time savings over manually scheduling them via phone. Integrations are not one-size-fits-all solutions, however. The scheduling partner should have access to an arsenal of integration tools so that all organizations, from health systems to single provider practices, can find a tool that works for them. Not all scheduling integrations require a full, five-figure, HL-7 interface.

Save Time While Ensuring Accuracy

With the right scheduling partner, practices and organizations can ensure that their schedule is correct, that patients have 24/7 access, and that providers are comfortable with the level of access provided to patients. Self-scheduling doesn’t mean handing over full control to patients, but it does mean moving the burden of managing the schedule from an overworked team who manage thousands of patients to a server with unlimited capacity. Staff can then be reallocated to more important tasks that better support the organization.

Patient Appointment Reminders Can Increase Practice Revenue

Some practices experience no-show rates as high as 50 percent. The impact on daily revenue is considerable, but allocating human staff to rectifying the problem can often cancel out the lost revenue. Organizations across the country are looking for tools to reduce this ongoing issue in nearly every patient population. By working with integrated platforms that can provide innovative solutions for appointment reminders and patient communication, organizations can reduce their no-show rates significantly without dedicating additional staff to the effort. With the right tools, human capital is not necessary. Work with an integrated solution that pulls data from the scheduling system and can drop in changes and reschedules when necessary. By utilizing interfaces with an EMR or practice management system, changes made in the primary system will be automatically reflected in the appointment reminder tool, and changes made by patients or staff in the scheduled appointments can be pushed back seamlessly as well. Technology partners with existing integrations make it possible to implement solutions like this so that all of the data movement is done silently in the background while staff are not required to significantly change their workflow.

Do More Than Remind

Reminders that go out to patients are the first step in ensuring patients are in the loop about their scheduled medical appointments, but a single reminder is rarely enough, and more than one method of contact should be required. People receive information through a number of different channels, and capitalizing on at least two of them reduces the chance of an avoidable no-show. Reminders can go out via text message, email, and phone. For patients that don’t have mobile phones or who have not provided that contact information, phone calls should be a requirement. The technology partner should be able to identify the type of number to ensure that the appropriate phone-based communication goes out without requiring a human to verify the information. By utilizing the phone number that is already present in the patient’s demographics, staff can be certain that patients will receive a reminder while the intelligent system does the remainder of the administrative work.

Multiple Notifications

It can be easy to forget about something you have to do next week, so your solution should send out multiple reminders to catch patients when they are most likely to remember. Patients should receive initial confirmations and then follow up reminders at set intervals throughout the process. Three touches are more likely to ensure that the patient arrives for the visit, and the multiple platforms ensures that they receive the notification regardless of what tools they are looking at regularly.

Built In Additional Resources

The reminder solution should also make it possible for the patient to include the appointment on their calendar with just a tap. They should provide the patient everything that they need to know with customized language for their appointment, and they should give the patient the ability to confirm. Engaging with the technology ensures that the patient is more likely to remember the visit.

Revenue Increases By Refining Existing Protocols

If a physician sees 20 patients a day and experiences a 30 percent no show rate, the lost revenue over a year is substantial. If each of those missed visit represents a reduction in revenue of $60, the physician is losing $360 per day, $1800 per week and $90,000 over a 50-week year. That’s nearly $100,000 that the practice is losing for a single physician. By just solving half of that problem with a simple to use technology solution that requires little-to-no-manpower, practices can add $50,000 in revenue per physician. You can calculate your practice's ROI with our ROI Calculator.

Add Tools For More Impact

Empowering patients to review their own healthcare tools removes some of the burden from staff while still giving them the control over the internal schedule. Technology solutions that allow patients to confirm, reschedule or cancel appointments keep the phone lines clear for more pressing needs while still giving patients the access that the need for their own healthcare. These tools work with appointment reminders to reduce the rate of no-shows and provide appropriate notice for appointments that cannot be completed. Want more information on how these tools can impact your operations and improve appointment retention? Fill out our demo form!

Telehealth Outcomes in Dermatology Match In-Person Care

Telemedicine has a lot to offer for treatment of common dermatologic conditions according to a study completed by the Keck School of Medicine at University of Southern California. In fact, a group who completed treatment for psoriasis via telemedicine reported on par or improved outcomes when compared to the control group for the same diagnoses. Telemedicine was indicated to meet the standard for in-person care, and it presents solutions to shortages of dermatologists and care gaps throughout the country.

Two Groups Provide Considerable Insight

Three hundred people were sorted into two different groups: telemedicine and in-person care. For those who participated in the telemedicine program, the focus was on reducing the time to care by providing images to the physicians rather than treating the patient with an office visit. The type of care and the access to the physician was shifted to a different entry point than the traditional care model and even some more common telemedicine solutions. The telemedicine patients were evaluated based on images and both groups participated in standardized clinical assessments that were compared.

Asynchronous Care For Better Outcomes

The study completed by the Keck School utilized asynchronous telemedicine rather than live-video. The patient's symptoms were documented via image and forwarded to a physician for review at a later time. The provider would then review the images from the secure upload and provide a diagnosis or treatment plan. The information was either uploaded by the patient or the patient's primary physician who would then receive an update with the diagnoses and treatment plan recommendation.

Sample Specific

Patients with psoriasis were invited to participate in the program. Researchers were able to compare disease severity and symptoms over all patients. They evaluated patients with the Patient Global Assessment scale to review the patient's perception of their illness as well as the efficacy of treatment that was provided. They also used tools specific to psoriasis and dermatologic illness to verify improvement as well as initial severity.

Fewer Symptoms Overall

Potentially the most important outcome from the study was a reported reduction in symptoms for patients in the telemedicine group. Those who received the remote care reported lower perceived severity than those who presented in person. Though the difference was slight, there was a trend toward an overall reduction on complaints for those who were treated via telemedicine. Outcomes for patients in the telemedicine group were comparable or improved overall to those who received in-person care.

Low Acuity Patients Seen In A Snap

The ease of use telemedicine solutions can make near immediate treatment a reality for patients in several different stages of care. Asynchronous file sharing allows patients and providers to share images of dermatologic illness for multiple purposes. Providers can share images for consult to determine the acuity of the issue. Patients can receive treatment for minor complaints, and providers can reserve office hours for patients with more severe diagnoses that require in-person evaluation.

A Few Clicks Away From Asynchronous Solutions

By working with a solution that specializes in telemedicine and ease-of-use for all parties, dermatologists can make getting information, providing diagnoses and communicating as simple as a few clicks. Mend - one of the best telemedicine companies offers drag and drop solutions for asynchronous telemedicine that can handle high resolution images from patients, providers and third parties. Our automated forms can allow parties to upload images directly to their patient paperwork, and information can be provided by multiple parties. For more information on how your organization can utilize Mend's suite of asynchronous and HIPAA compliant live video telemedicine tools, request a demo above. A workflow and implementation specialist can help you design a customized solution to meet your needs.

Medicaid Reimbursement For Telehealth Services Is Expanding

While telehealth for Medicaid patients isn't a new tool, the delivery methods are certainly changing as access to technology increases. For many years, most Medicaid plans followed CMS guidelines that required that patients present to an "originating site" or a healthcare facility to connect with a remote provider. A recent evaluation of Medicaid plans throughout the country, however, indicates a major shift toward home-based care. While Medicare still strictly enforces originating site restrictions as well as restrictions for rural areas, many Medicaid plans are taking a more forward-thinking approach.

What Is An Originating Site?

An originating site is a medical office, hospital or affiliated site that facilitates telemedicine care for patients who can present in person. While originating site-based telemedicine can be valuable for increasing provider availability and delivering specialty care into underserved areas, it does not bridge what is often the largest barrier in access to care-transportation. Patients still struggle to present to the originating site, and they are often required to rely on transportation services with limited availability that can only transport the patient. By switching to home-based care delivery, patients are able to bypass transportation barriers while still receiving high-quality care for many diagnoses.

Changes To State Rules Have Made It Possible

According to the Center For Connected Health Policy's State Telehealth Laws and Reimbursement Policy publication, Medicaid plans in 10 additional states now recognize the home as a valid originating site. Colorado, Delaware, Maryland, Michigan, Minnesota, Missouri, New York, Texas, Washington and Wyoming have all opted to forego facility-based care and enable patients to receive care in the home when medically appropriate.

Still a Long Way To Go

While the change is big move in the right direction, there are still many states who don't allow care in the home for this often-underserved population. The report provides hope but notes that there is a long way to go to realizing full parity for all payers across the country. Some of this is significantly limited by state law while others still report significant disparity for reimbursement due to a lack of payment parity.

Schools Are Now An Option

One indication that we are moving toward more patient-focused care is the intermediate step of offering school-based telemedicine for students. According to the report, 16 states have now include schools as valid originating sites. One of the biggest barriers in providing school-based care, however, is the access to consent from parents and custodial adults. Telemedicine care often cannot be provided in school if there is no signed consent on file. By working with a solution like Mend, providers and schools can communicate seamlessly with parents to receive updates and request consents without the parent leaving work or being there in person. While school-based telemedicine does not apply to all patients or providers, it does provide a huge option to treat often underserved children in a location where they are already present. There is evidence to support improved treatment of chronic disease in children due to school-based telemedicine, and state Medicaid plans do appear to be shifting to accommodate this.

Telemedicine In The Home Is Becoming More Prevalent

While it's not a perfect landscape, the access to telemedicine-based care in the home for patients with Medicaid is progressively getting more realistic. The increase in coverage and reduction in states with strict originating site requirements makes a large difference in the ability to deliver care. Now that smart phones, computers and high-speed internet connections can deliver low-cost internet into homes, patient not only have access to communication, but they are emerging as an appropriate, targeted group for telehealth in the home. As this innovation continues, we can expect more states and more payers to accept low-cost telemedicine alternatives to in-person care. h/t http://mhealthintelligence.com/news/state-medicaid-programs-are-seeing-the-value-of-telehealth-at-home

Kansas’s Telemedicine Bill Becomes Law With Governor’s Signature

Kansas has hopped on the telemedicine train. In May, Governor Jeff Colyer signed a recently passed bill that mandates some coverage for telemedicine, though there are restrictions in the new language. In certain areas, Kansas's law is more restrictive than just about any in the nation with language that requires for nullification of the entire bill if specific areas are struck down by state courts.

Coverage Parity But No Payment Parity

The new law does require that payers cover telemedicine as they would in-person services when it is medically necessary or appropriate. What it doesn't do is mandate payment parity. This means that insurers can set their own rates for telemedicine reimbursement, which could equate to either higher or lower payment than in-person services. Odd are, it will vary considerably by payer. Some payers could decide to reimburse for telemedicine services commensurate to in-person treatment, but there is no guarantee of this for contracted providers, facilities or health systems.

Additional Medicaid Coverage

The law as written focuses mainly on medical services, but it will expand to additional allied health specialties through Medicaid coverage beginning in 2019. Eventually, audiology and speech language pathology coverage will also be mandated.

Establish Care Via Telemedicine

One of the most important provisions of the new law is that it is now acceptable for providers to establish care with new patients without an in-person evaluation. It is unclear at this time whether providers can prescribe medications to patients who were not evaluated in person. In other states, controlled substance prescribing is allowed while some only permit non-controlled prescribing. Some outlaw prescribing via telemedicine outright. Prescribing laws have not been established, but the Board of Medicine has been instructed to complete these provisions by the end of 2018.

Real Time Or Asynchronous

The Kansas law covers real-time video telemedicine, as most state laws do, but it also requires insurers to cover asynchronous communication through telemedicine. Asynchronous (also called store-and-forward) telemedicine includes the collection of telemedicine data for later review by a physician or appropriate healthcare provider. This could mean that images, x-rays, recorded video or other non-real-time healthcare information is provided to the physician who reviews at a later time and provides a diagnosis or opinion on the information provided. It is an especially important tool for remote radiology and image review, but it has implications in pediatrics, dermatology, ophthalmology, psychiatry and many other specialties.

Abortion Ban Could Undo The Whole Law

The most controversial aspect of the law is language related to abortion services provided via telemedicine. The law specifically indicates that telemedicine cannot be used for remote consultation related to abortion, and the law goes even further to indicate that, should a court strike down the provision regarding abortion services, the entire law will be null and void. This controversial language created some significant conflict during the process.

The Future of Healthcare for Kansas

Though the bill has been fraught with controversy since its earliest phases, it is now law and does provide increased access to many important treatments for residents of Kansas. Rural communities could substantially benefit from the remote services, and the provider shortage can be bridged by more efficient staffing and additional hours without brick and mortar locations. There are many possibilities of how this can improve treatment throughout the state. For more information on how you can implement telemedicine into your practice, request a demo above and one of our workflow specialists can design a customized plan for our organization. h/t http://mhealthintelligence.com/news/kansas-enacts-new-telemedicine-law-with-anti-abortion-language

The Next Step In Telehealth Services: Care In The Home

While telehealth, especially telepsychiatry and telemental health care, are not new, the treatment method is experiencing a renaissance of sorts as access to technology expands beyond big facilities and urban areas. Telehealth has traditionally utilized a "hub and spoke" or "site-to-site" model. In this set up, the patient still presents to a facility, but the provider is remote. This allowed for better provider coverage at multiple facilities, but it did not directly address some of the larger barriers in healthcare delivery. The first proliferation of telehealth was definitely a step in the right direction. At a minimum, it has shown healthcare providers and administrators that remote care can still be high quality and simple to deliver. This reinforcement has prepared the telehealth company and the medical community for the next step of care: delivering medically appropriate services directly into the home and removing the originating site requirement. We're graduating from Telehealth 101 to next-generation care delivery.

Originating Site Matters

Up until recently, transportation barriers have been addressed as an issue to resolve for healthcare providers rather than a barrier that actually keeps patients from receiving reliable and consistent care. Long drives and traveling to multiple sites reduce the amount of care that a physician can provide. Increasing available treatment hours, however, does not directly assist patients who do not have reliable transportation or who are unable to travel. Those patients are still excluded from services. By delivering telehealth services into the home using a reliable and secure platform, patients who are limited by transportation can now receive quality care. Patients without access to reliable public transportation are not precluded from meeting with their providers. Furthermore, telehealth reduces costs from the payer perspective by reducing healthcare sponsored transportation, which can be expensive and frequently unreliable.

Overcoming Childcare Issues

Keeping patients in the home when it's appropriate also reduces the childcare burden that most affects many patients' ability to access care. While both mother and fathers arrange child care to go to the doctor, the issues disproportionately impact low-income mothers. While they may be able to access transportation through their insurance coverage, these options are usually only for the patient. Children are unable to access them to accompany the parent and cannot "tag along." Impower, a large behavioral health organization in Central Florida, has been able to deliver care to single mothers who would otherwise be unable to access it by delivering it into the home on a schedule where the parent can be engaged rather than distracted.

Reduce Impact on Employment

Most physician's offices and treatment programs operate on banker's hours. Patients have to make it into the office between 9 and 5. For many, missing work isn't an option, so they forgo care to protect their employment. By offering telehealth that can be accessed from anywhere, patients can connect with providers from a secure location on their lunch breaks rather than using personal time or missing a half-day of work.

When In-Person Care Isn't Required

Not every patient or situation will qualify for telehealth services. Further, a patient who qualified last time might not meet the standard the next time. This can be addressed with internal protocols and by using a platform like Mend that gives you tools to triage patients to the right type of care while informing patients who don't qualify. Some groups will only allow a certain number of telehealth visits before they require a follow-up in-person. Others will allow unlimited telehealth visits for a certain set of diagnoses but limit access for those who do not fit the criteria. There are groups who use combinations of site-to-site and in-home access so they can get vitals are regular intervals while still reducing physician travel. Work with a partner who understands that importance of a customized workflow and can offer the tools to take the burden of enforcing that workflow off of your staff.

Not An Option Everywhere

Some state laws have not kept the pace of the technological revolution, and what's on the books still restricts telehealth care to an approved originating site, though these laws are being changed daily. The difference varies considerably by state. The Center For Connected Health Policy is an excellent resource on location restrictions based on current state law.

Increase Access To Care

Site-to-site telehealth was a huge boon for provider convenience, but it has not entirely bridged the gap for patients who face many barriers to treatment. By delivering medically appropriate care into the home, facilities and providers can offer high quality care to those who would not otherwise have access. For more information on how this can affect your practice or facility, request a demo above. One of our workflow specialists will be happy to walk you through how this fits for your organization.

Telemedicine In The Operating Room: Bringing in Physicians and Family

Bringing telemedicine into the operating room is a reality in some hospitals. Abington-Jefferson Health, specifically, is using the technology to deliver consulting providers as well as patient families into the previously restricted space. By using a live-video connection during the procedure, the surgeons and staff can openly and easily communicate and reduce wait times for family updates. Dr. Mauricio Garrido, a cardiothoracic surgeon at the hospital, stated in a press release that by utilizing technology, they are "opening the blinds to the classically inaccessible sanctum of the operating room and reimagining a more respectful experience for those waiting anxiously for their loved ones." "We take immense pride in the service we provide to families with each patient we care for."

Instant Consult

A patient may have multiple providers included in their care, but those additional physicians receive updates similarly to how the family does: once the procedure is completed and when the surgeon has time. Furthermore, input from physicians who are required throughout the operation often has to be provided in person and can delay completion. Some facilities have audio connections that can be accessed, but they may be insufficient or unreliable. These communication barriers also lead to backups and delayed start times for those who are scheduled afterward. Guidance, oversight and feedback during the operation can be limited. By utilizing telemedicine, treating physicians are now able to communicate with other providers who are involved in the care as well as specialists who may be able to provide insight from a distance. For cardiac procedures at Abbington-Jefferson Health, the video connection provides an additional level of oversight and collaboration that has been difficult to achieve prior to the addition of these technologies.

Reducing The Time On The Table

These consults provide a greater impact than just offering valuable information or feedback. For those patients who require intervention from another provider prior to the conclusion of a procedure or operation, the live video solution allows other physicians to get the information that they need to proceed to the next step. "In cases where a remote consult is performed immediately," Garrido stated. "Abington's surgical team can potentially reduce a patient's time on bypass or under anesthesia."

Reducing The Wait

By introducing HIPAA compliant live video into the operating room, the facilities can focus on important elements of treatment that go beyond the operating room. While a family member or loved one is being operated on, the wait time for the family can seem eternal. There are few updates, especially on very long procedures, because the people who could update are actually providing the service. The operating room is a sterile environment that should limit the number of people who enter and leave during the procedure. By introducing a secure way to communicate with people outside of the operating room, family members can receive updates during a time where they are typically in the dark while still preserving the operating room environment is preserved.

Telemedicine Is Just The Beginning, But It's Available Now

Over time, live video connections will work alongside robotic tools and remote monitoring devices to offer a more complex level of care and supervision than patients have ever experienced. We get closer to this every day. Telemedicine, however, can be implemented quickly without considerable overhead. It's is the simplest part of the equation for these facilities, and it can provide tools for oversight, supervision and input. It also eases of the emotional burden for families. For more information on how telemedicine can be implemented into the surgical theatre for your facility, request a Mend telemedicine demo above! One of our workflow specialist can help you design an ideal solution for your team. h/t http://www.bizjournals.com/philadelphia/news/2018/05/10/abington-hospital-jefferson-telemedicine-surgery.html

Telemedicine Benefits: How It Bridges Cultural Gaps & Delivers Care To All

While telemedicine services increase access to care in different ways, one of the most transformative effects of telemedicine is that it opens access for patients to receive care that aligns with their ethnic or cultural background. Facilities that previously had limited access to translators and few providers with knowledge of specific culture can now expand their panels to include providers who may be physically located elsewhere but who can bridge the cultural gaps that often keep patients away from medical care.

Cultural Background Matters

While medical diagnoses may have the same symptoms regardless of a patient's background, the ability to effectively treat conditions can be limited by language barriers and patient comfort level. In the past, the solution has been for large entities to provide translators to patients. While translators provide a valuable service, translators alone have been proven insufficient to engender physician trust and manage cultural disparities. This gaps can hinder delivery of high quality care and lower patient satisfaction. A study published in 2015 in the Internal Journal of Dermatology found that that the challenges of communicating with patients with language and cultural barriers "can lead to compromises in the quality of care." A study completed in Denmark in 2010 and published in the Journal of Telemedicine and Telecare reported that patients were more comfortable and had better outcomes when communicating with physicians in their "mother tongue" through telemedicine and it was preferred over interpreter assistance. In the most basic sense, having a translator in the room with a patient draws the patient's attention away from the physician and limits the direct transference between patient and provider. The nuances of body language and nonverbal communication are frequently lost in this interaction, and this can impact both the patient and the provider. If the provider is focused on a translator rather than the patient, he or she may miss important aspects of the patient's behavior that could impact the diagnosis.

Family Gets Lost In Communication

Smaller healthcare facilities and offices may not have access to a robust team of interpreters, and family may be used as a replacement. Patients may be less likely to communicate fully with a provider in front of a family member, and they do not get to enjoy the same level of confidentiality that is afforded to a patient who speaks the same language as the provider.

Telemedicine Provides Solutions

Telemedicine services enable practices and facilities to identify providers who may best suit their patient population and connect those patients to them without significant travel. Telemedicine enhances access to culturally competent care by reducing geographic boundaries and enabling facilities to work with providers who bridge the need for certain languages or who have experience with different ethnic backgrounds. While translators will still have an important place in medical treatment, the ability to deliver multilingual providers enhances care and treatment outcomes by increasing patient comfort level, transference and satisfaction.

Matching Patients With Appropriate Providers

Impower, a telemedicine behavioral health agency based out of Central Florida, reported that telemedicine has enabled them to match patients with the right provider, not just any provider. Vice President of Behavioral Health, Amy Blakely, stated that they have had noted positive outcomes by scheduling patients with the providers who they feel will not only meet the patient's mental health needs but also their cultural needs. They have young female patients who have recently moved to the United States and speak primarily Spanish. The flexibility of telemedicine has allowed them to match those patients to bilingual providers who understand the culture of the patient's home. By identifying the patient's chosen language as well as their age and reported cultural needs, they are realizing better treatment compliance and outcomes.

Connect Patients With The Right Providers

Telemedicine services offer solutions to cultural and geographic barriers that were previously only a healthcare pipedream. Remote services make it possible to locate and contract with distant providers who can elevate the level of care. Telemedicine allows patients to appreciate the nuances of communication that are often lost through a translator, and patients report better outcomes and higher satisfaction levels with these interventions.

How Telehealth Fits Into Your Schedule

When adding a new type of care to your schedule, there are often questions related to how to include these patients into your daily routine without disruption to existing structures and without missing appointments. New and innovative care delivery also must be easy to access for the provider and patient, and it can't disrupt in-person care or push the remainder of the schedule behind. By evaluating your workflow as well as the goals for telehealth, groups can choose from several solutions that work alone or in tandem to meet your needs.

Telemedicine Time Block

By far the most popular scheduling solution we see is the telemedicine time block. Telemedicine time blocks reduce double scheduling while keeping the schedule organized. Providers or administrators will determine a period that is set aside for telemedicine scheduling only. This could be a considerable stretch or a short burst, but the most common increment is about 2 hours. On the master schedule, this time is blocked out for telemedicine, and all the appointment scheduling happens on the telemedicine platforms. For patients who are self-scheduling, they are only able to schedule within the time block. While staff can schedule at other times, it is recommended that telemedicine scheduling be restricted to ensure that patients do not get missed or left waiting. Some groups block out time daily while others reserve it for a single period throughout the week. This will be dictated by volume and the needs of the organization, and can be designed specifically depending on the use case.

Telemedicine Days

For providers who will frequently be remote or who may provide administrative services that keep them out of in-person examination rooms, days dedicated to telemedicine may meet their availability. In this case, they offer telemedicine services throughout the day on one or more days per week, and they provide those services as scheduled while still completing non-clinical work. Providers who travel or may frequently be outside of the office can benefit from this workflow if they know that they will be in one location for long periods of time.

On-Call Scheduling

In situations where providers want to offer telemedicine services during off hours, maybe in lieu of after-hours phone calls, on-call scheduling offers flexibility. Often, providers who utilize on on-call schedule also require prior approval of all scheduled appointments to ensure that availability at the scheduled times. On-call schedules can still be limited to specific time periods, and appointments that are scheduled at inopportune times can be rescheduled with a few clicks. Groups with multiple providers can use on-call scheduling similarly to the how they provide phone coverage for after-hours calls. The biggest difference between the two is that an after-hours phone call is rarely reimbursed, while an after-hours telemedicine session is considered a reimbursable office visit in many cases.

Open Schedule

This is the least used scheduling option, but it is a tool that providers who have open schedules or who provide clinical services secondary to another position may use. For those who have are able to review and approve appointments throughout the day or who want to offer urgent care appointments with some flexibility, the open schedule option is available. It's highly recommended to use an appointment approval process to ensure that the provider is notified prior to the official scheduling of any visits. Open scheduling is a great tool for large groups who use a queueing system and can transfer patients to the appropriate provider. It's more complicated and requires more management for patients who are trying to schedule for a specific provider, but it is still an available solution in the right situation.

Use One Or All

The scheduling solution that fits best for your organization will vary based on your needs and use cases. You might opt for one or have different situations where all of the above are used. The trick is to work with a platform that has flexible tools that can support your needs as well as workflow experts who can help you design the best solution. Mend has both of the tools and the support, and we'll help you to design these solutions in a way that is easy to implement. For more information, request a demo above!

Veterans Affairs Expands Telehealth Across State Lines

The Department of Veterans Affairs serves more than nine million veterans a year at 170 medical centers and over a thousand outpatient locations. Provider shortages and delays in treatment have been well-publicized over the last several years. In an attempt to shorten wait times and increase access to care for patients who are entitled to the care, the Department of Veterans Affairs amended rules for providers and telehealth as of June 11, 2018. Through telemedicine, Veterans Affairs providers can now offer services to patients regardless of the state where the patient resides, and the services can extend to the home site as well. This is a monumental change that will open up access to care for important and often life-saving services.

Access to Many Specialties

Now, providers in many different areas can offer telehealth solutions to patients who may be located anywhere in the country. The provider does not have to be licensed in multiple locations to offer these services as long as the patient is under the care of Veterans Affairs. According to the rule as published by The Office of the Federal Register, "Telehealth enhances VA's capacity to deliver essential and critical health care services to beneficiaries located in areas where certain health care providers may be unavailable or to beneficiaries who may be unable to travel to the nearest VA medical facility for care because of their medical conditions." This is a large divergence from the previous policy. Before, providers were required to follow state laws for licensing, which often limit the provider to offering telemedicine services only to patients who reside in states where the provider has a license. While the most frequently discussed implementation of these telehealth software programs is in mental health, primary care and medical specialists can also look forward to using technology to deliver care to patients who may be remote or located in rural areas. As long as the care is medically necessary and within the standard of treatment, all Veterans Affairs beneficiaries qualify.

The rule further states:

"By providing health care services by telehealth from one State to a beneficiary located in another State or within the same State, whether that beneficiary is located at a VA medical facility or in his or her own home, VA can use its limited health care resources most cost efficiently."

Why Does It Matter?

With considerable provider shortages and often long wait times at VA facilities across the country, telehealth provides an alternative while still offering quality medical care to our nation's veterans. Up until the rule change, VA facilities were required to follow state laws for licensing and practice that limited providers within the system from accessing patients who may be over state lines or located in the home. Facilities that did have the specialists or staff were unable to assist locations that were underserved. The rule change means that "providers may exercise their authority to provide health care through the use of telehealth, notwithstanding any State laws, rules, licensure, registration, or certification requirements to the contrary."

What Isn't Allowed?

While providers are now able to practice over state lines, that flexibility does not extend to the prescribing of controlled substance. Prescribing, in many cases, is still subject to state laws and limitations, and providers will not be able to write controlled medications for patients who are located outside of the state unless state law specifies that this is allowed. Some states do not allow prescription of controlled substances via telemedicine at all, while others limit it to specific medications or specialties. The laws vary considerably by state, and the new rule does not provide any variability for access. The rule does not specify how this will be managed by the VA health centers.

Costs and Competition

While the goal of the rule was to extend care to veterans who may otherwise be underserved, the added advantage is the access to more technologies as well as making the VA more attractive to talent. The agency is positioned at the forefront of distant medical delivery, and the flexibility that is afforded by this schedule enables them to hire providers from all corners of the country. They can meet care gaps while expanding the pool of available specialists and strengthening the organization overall. h/t http://www.federalregister.gov/documents/2018/05/11/2018-10114/authority-of-health-care-providers-to-practice-telehealth

Pennsylvania Closer Than Ever Before To Telemedicine Parity Law

While the law still isn't on the books, Pennsylvania is much closer to introducing a telemedicine parity law that would ensure that payers cover telemedicine. A bill passed the state Senate on June 13, 2018, and it now travels to the State House for consideration. While the bill will go through several revisions before finding its way to the governor's desk, this is a definite step in the right direction for service coverage in Pennsylvania.

Joining Many Other States

More than 30 states have telemedicine parity laws that require some sort of coverage for services provided via telemedicine. This makes Pennsylvania one of a handful of states left that haven't passed a law encouraging technology as a means for expanding access to care for both rural and urban communities. Telemedicine services have been shown to reduce emergency room utilization, cut down on travel and expand treatment to frequently underserved areas, but the actual legislation to support it is often slow moving. New Jersey passed a similar telemedicine law in 2017 that is still being regulated, even after it was signed by then-Governor Christie last year.

The Good News

Even though it's not a fast track to success, the bill, introduced by State Senator Elder Vogel, Jr., unanimously passed the State Senate after going through committee last year. This is a drastic change from previous attempts in 2016 that were never up for a vote. The shift in readiness to review and pass these bills signifies a considerable change in attitude toward the realities of problems with access to care.

Considerable Support From Big Entities

Big organizations have put their weight behind the telemedicine bill, which encourages payers to cover these services. Pennsylvania medical society, hospital association and the AARP have thrown their weight behind the bill and eventual plans to introduce telemedicine as a covered benefit. These organizations focus on a variety of different perspective when tracking healthcare-related outcomes, and it's a clear recommendation for telemedicine that they're all behind the bill. AARP focuses on patient-centered outcomes that improve things for the lives of seniors. Hospital associations generally look the balance between quality of care and cost of care, and they also engage with solutions that increase patient satisfaction overall. Medical societies often consider a provider-centric perspective of utilizing technology to reduce burden on care delivery while still providing quality care with outcomes-driven goals.

What Will The Coverage Be Like?

It's much too early to tell. The bill still has to pass the State House and be signed into law by the governor. There are two different kinds of parity that could be included in the finished law as well as a few pitfalls that can weaken laws once they're on the books.

Coverage Parity Versus Payment Parity

Many telemedicine laws include provisions for coverage parity. This means that services that are medically necessary and appropriate for telemedicine must be covered if they would be covered as an in-person service. Laws that include coverage parity do not automatically include payment parity. Payment parity is the guarantee that services provided via telemedicine with be reimbursed at the same rate as in-person services. Without language that guarantees payment, providers can be reimbursed at a substantially lower rate for telemedicine services. In some cases, the rate (or a minimum rate) is specified in the law, while in others there is no language that addresses how much providers should be paid. Bills can change many times between being written and becoming law, so there is no way to know how broad Pennsylvania's law will be--if it makes it to the governor's desk. Further, once the bill is law, there are simple language additions that can weaken it even when everything looks good. Additions of phrases like "subject to plan language" can mean that the service is covered if the plan itself covers the service, which isn't much different than not having a law at all. For the most part, it will be a waiting game to determine what's next.

What Do We Do Without A Law?

In the meantime, providers in Pennsylvania may be able to secure telemedicine reimbursement by approaching their individual payers to have the services added to their contracts. Providers across the country have success without a parity law. For more information on how Mend - one of the best telemedicine companies can help you see more patients and increase access to care, request a demo above! h/t http://www.timesonline.com/news/20180614/pa-senate-unanimously-passes-vogels-telemedicine-bill

Originating Sites? Medicare Now Reimburses for (Some) Remote Services

The Centers for Medicare and Medicaid Services is the largest payer of health insurance claims in the United States, but they have been one of the slowest to move on reimbursing for new technologies offered by the best telemedicine companies that reduce overall healthcare costs while allowing the patient to remain in the home. As of early 2018, however, some of those restrictions were eased to open to the door for patients who most need additional supervision. CMS will now pay for code 99091 for remote patient monitoring or "collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time." The information provided here is a guideline based on the available information, and it does not constitute billing advice. For more information, we recommend following up with your billing department, payers or legal team. Each organization is responsible for their billing decisions.

The Code Isn't New

Billers may be familiar with 99091 because it has been in the manual for a while. Previous uses of 99091 required that it be a bundled service with other codes for chronic care management and similar programs. Facilities and physicians were informing CMS that the service was provided, but they weren't receiving reimbursement for performing the service.

But Is That Actually Telemedicine?

To be clear, according to the code, this is not a telemedicine service. The code covers the monitoring of data collected remotely through a variety of modalities. While virtual interaction may be an element of the data review included,, the telemedicine service isn't enough to qualify for reimbursement for a patient who is located outside of a rural area and isn't at a healthcare facility. Telemedicine services are still limited under current Medicare rules. That being said, telemedicine could be part of that 30 minute minimum. A telehealth connection isn't required, but it could offer added value for assisting providers in collecting or reviewing data with the patient and family. Providers who bill 99091 are not billing directly for the face-to-face connection, but they can be reimbursed for remote patient monitoring that is provided while the patient is located in the home.

So What Service Is Billable?

99091 focuses on the collection of what is called Patient-Generated Health Data, or PGHD. This information is collected through tools that monitor the patient and report back to the healthcare entity with the information. Providers bill for reviewing the data that was collected through the tools that provide an "active feedback loop."

When Can I Bill It?

99091 is billed for 30 or more minutes of service, and one unit can be billed within a 30-day period. It can be billed alongside other health services. There are no clear restrictions on how many times it can be billed as long as the service is identified as medically necessary and it's not billed more often than once every 30 days. For patients who need the higher level of care, providers can engage in remote monitoring of medical conditions one time in a 30 day period and be reimbursed for those services. Before billing 99091, providers should see the patient in person and document the medical services that the patient requires to treat their ongoing medical conditions. For established patients who have been seen in the year prior to the beginning of remote monitoring, there is no need for an additional in-person visit.

How Is It Different From Chronic Care Management?

It could be easy to confuse remote monitoring with the services provided under Chronic Care Management. In fact, remote monitoring was frequently bundled with CCM prior to 2018. The biggest difference between the two is that CCM can only be billed for patients with ongoing chronic illness that requires additional intervention, and remote monitoring can be used for patients who meet medical necessity but might not have a chronic illness. The patients who meet this criteria will be identified in their care plan, and the provider will still be collecting remote monitored data on them. Remote monitoring can also be billed for patients in a CCM program as a separately identified service.

Express Consent Is Required

Before beginning a monitoring program, providers must get express consent from their patients or the patient's proxy. Advanced beneficiary consent should be on file in the patient's chart prior to billing for the services.

So What Exactly Does 99091 Cover?

That's still a little unclear. The code as described above clearly covers the review and analysis of data related to the patient's medical diagnoses, and we know that that information is collected and provided to the treating practitioner or "other qualified healthcare professional." Other guidelines on what kind of data qualifies or doesn't qualify are limited.

Your Patients and Your Practice

While this isn't a slam dunk for telehealth, it does provide additional opportunities to meaningfully interact with patients, which could lead to improved health outcomes across the board. By evaluating reliable health data, providers can replace some aspects of patient self-report with analytics. Remote monitoring programs promote patient engagement and compliance outside of the exam room. The improved outcomes often lead to fewer emergency medical care visits for patients with chronic illness, and patients are more likely to be able to remain in their home environment because their ongoing health data is reviewed.

Children with Autism Benefit from Telehealth Services

For patients on the Autism Spectrum, finding the right balance of treatment and social interventions can be difficult, especially for families located in rural communities. Recent studies have shown that outcomes for these patients improve when telehealth programs are implemented in both the home and clinic-based settings. By increasing this access to care, behavioral triggers can be evaluated more quickly, and family members can receive more comprehensive training on how to support their children.

Limited Access In All Communities

While rural communities tend to have the most difficulty accessing in-person treatment services, there is a national shortage of targeted treatment available for patients with Autism Spectrum Disorders. Some urban areas boast a few hundred specialists who are tasked to provide services to thousands of clients over vast geographic regions. ABA therapists who do serve rural areas often have to travel substantial distances and lose valuable time that could be dedicated to other clients who are similarly underserved.

Telemedicine Improves Outcomes

The University of Iowa Stead Family and Children's Hospital has completed two studies on telehealth usage for behavioral interventions in Autism Spectrum Disorders. A review of services in 2018 focused on observation of children in their home environment. By working with the parents and focusing on behaviors as they were happening, remote therapists were able to provide education and interventional tactics to family members that improved or resolved these behaviors. The patients were monitored for 9 months. While they were generally located in the home, there were instances where patients presented to a local health clinic or pediatrician to connect. This enabled other treatment providers to participate and provide feedback on the patients' progress.

Small Study, Big Outcomes

While the most recent review at University of Iowa focused on just 17 families, the numbers show big improvement in the small population. Of the participants, 86 percent noted that telemedicine care resulted in reduced negative behaviors and improvement overall. These results were similar to outcomes with in-person treatment, but they were available to patients without access to that treatment. Furthermore, families and treatment providers reported notable reduction in negative behaviors.

Cutting Costs By A Wide Margin

In 2016, the same program at University of Iowa completed a review of other programs that utilized telemedicine in treatment for Autism Spectrum Disorder. Published in The Journal of Pediatrics, the study revealed that training programs and treatment provided via telemedicine cost, on average, $2,100 over the treatment period. In-person care cost approximately $6,000 per patient. Telemedicine care was delivered into the home environment or into local clinics for a third of the cost of traditional methods with no reported negative impact on outcomes.

Focus On The Family

While the patient was the center of all ABA treatment and common interventions, the focus on family allowed the practitioners to reinforce behavioral modification techniques by educating the family on how to implement them. By watching the patient in his or her natural environment while remaining remote, therapists were able to observe behaviors as the family experienced them and educate on methods to redirect and intervene. Rural families especially benefited from this more consistent access to treatment and support.

Impacting Outcomes, Transportation and Overall Cost

The impact of telemedicine for treatment of Autism Spectrum Disorders cannot be overstated. Delivering easily accessible care into homes and local facilities increases access substantially while reducing costs by as much as two thirds. Participants reported similar or improved outcomes and practitioners are able to reach more patients. By working with a simple-to-use technology like Mend, groups can benefit considerably from easy-to-implement and cost-effective telehealth software. For more information on how Mend can help connect patients and providers with just a few taps, click our demo request above. h/t- http://www.videoconferencingdaily.com/healthcare/telemedicine-is-improving-patient-outcomes-for-children-with-autism/ h/t- http://medcom.uiowa.edu/theloop/news/telemedicine-can-save-time-money-for-families-with-children-on-the-autism-spectrum

CMS Recommends Telehealth For Combating the Opioid Crisis

Payers should look to telehealth for combating the opioid crisis, according to guidance from the Centers for Medicare & Medicaid Services that was released on June 11, 2018. The letter from the acting director of CMS guides local Medicaid agencies on methods for using technology and monitoring tools to facilitate both preventative medicine and treatment. CMS recommends a comprehensive approach to patient supervision, identification of problem behaviors and recommendations for treatment that utilize technology to bridge care gaps.

Telehealth Reduces Care Barriers For Preventative Care and Ongoing Treatment

CMS encourages Medicaid payers to evaluate telehealth as a solution for both increasing access to care and improving care coordination for patients who are high-risk or who are actively seeking treatment. These recommendations are specifically for Medicaid payers and do not apply to Medicare or Medicare Advantage plans, though the evidence applies to all demographics. Telehealth helps bridge provider shortages and reduce wait times for patients who are seeking treatment, and CMS is encouraging payers to support implementation of telehealth tools to limit these gaps. Federal funding is tied to efforts to use technology for care coordination, which can be managed through telehealth at limited cost to the payer or the provider. Telehealth is recommended as part of a Medication Assisted Treatment program when access is limited and when it is appropriate for the patient. CMS goes as far as recommending options for virtual treatment centers and utilizing remote counseling options. The letter supports telehealth for service planning and coordination, facilitation of services, advocating for the member, and monitoring and reassessment of services. These categories offer broad support for utilization of telehealth when clinically appropriate and within the standard of care to deliver services.

Funding May Be Available

Medicaid agencies may have access to funding to support their efforts to implement these strategies. The HITECH act can match up to 90 percent of funding for activities related to health information management, and the letter from CMS indicates that these efforts potentially fall under that category. States could receive up to 90 percent match for designing and implementing programs to meet these needs and up to 75 percent funding for maintenance of the programs once they’re implemented. EHRs were the primary drivers behind the HITECH funding, and CMS notes that many behavioral health providers lack access to EMRs. By supporting these providers with funding as well as the tools to bridge care gaps, HITECH increases access to care by offering funding to payers who can then support providers in these efforts.

Who Qualifies For Funding?

There are several things taken into consideration when evaluating which agencies qualify for the match funding under the HITECH act, but at a minimum, programs should be categorized as a Section 1115 demonstration program under the Social Security Act. Section 1115 focuses on state-specific programs for improvements in Medicaid populations.

Non-Telehealth Recommendations

The letter also emphasized the importance of prescription drug monitoring programs (PDMPs) and recommends that these programs begin integrating with Electronic Medical Records to reduce the number of programs that facilities need to use to e-prescribe and check prescription records. Clinical workflow is important in these instances, and CMS recommends that PDMPs be integrated with Prescribe programs to take advantage of single sign on and make warnings available to providers from within the program.

Big Steps For Medicaid Populations

While telehealth reimbursement from CMS still lags behind for Medicare patients, national steps are being taken to support states in finding ways to combat the opioid epidemic, and telehealth is being recognized at the national level. Payers are empowered through funding and support to increase access to care, utilize more providers and share best practices for implementation and maintaining these programs. To get more information about how telehealth company can help your program, request a demo above. Our team can assist in customizing workflows and developing a program just for your use case. For more information on the CMS Recommendations, click here: http://www.medicaid.gov/federal-policy-guidance/downloads/smd18006.pdf

Occupational Therapy Telehealth – Bringing Supportive Care In House

While telemedicine is often considered to be a tool for emergency care, monitoring and traditional outpatient care models, the use cases are expanding quickly into other allied health care areas like physical therapy, occupational therapy, nutrition and more. "Telerehabilitation" has proven to improve clinical outcomes for patients in many instances without the considerable cost of travel for providers. While telemedicine may not be a full replacement for in-person occupational therapy care, the supplemental benefits are considerable, and the increased access to care for those in remote areas or without access to transportation and in-home care is tremendous. The American Occupational Therapy Association, as reported in the American Journal of Occupational Therapy, supports telerehabilitation and telehealth in the field. Both sources note that more study is needed on outcomes, but the information that is presently available indicates similar or better outcomes for patients who participate in a telehealth program for occupational therapy.

Increase Access To Care

Occupational therapy telehealth significantly impacts access to care for patients in remote areas who do not have access to services often found in urban areas. While home health care and in-facility care may be plentiful in more populous areas, those who need rehabilitative care in rural locations often go without treatment due to distance. Telerehabilitation provides a viable solution without the increased cost burden of physically delivering individuals into rural areas for short periods of time.

Improving Access to Specialty Care

Treatment shortages are prevalent even in highly populous areas, and telerehabilitation extends access to care by reducing distance and allowing highly skilled therapists to visit multiple locations without travel. These services often work in tandem with occupational therapy assistants who can facilitate in-person treatment while the occupational therapist remotely monitors treatment. In some cases, even the assistants may be able to interact with the patient remotely. While there are different workflows and use cases for each program, there are many new options for delivering care. By working with the right telehealth company, like Mend, organizations can develop customized workflows that meet their specific needs.

Where Occupational Therapy Telehealth Can Impact

According to the American Journal of Occupational Therapy, telehealth has implications in multiple treatment areas including "developing skills; incorporating assistive technology and adaptive techniques; modifying work, home, or school environments; and creating health-promoting habits and routines." These vital skills can be evaluated without in-person care. Remote occupational therapists can examine environments and make suggestions for improvement. They can review current field-specific technological usage from a distance while still providing valuable feedback and direction for the patient. Telerehabilitation services can be used to discuss routines, provide feedback on areas that require improvement and offer supportive direction for those who need motivational interviewing. AJOT also noted that telehealth for occupational therapy can improve access to services and therefore improve quality of life.

No Limit On Age or Demographics

The American Journal of Occupational Therapy does not note any specific restrictions on age or demographics for telehealth. In fact, they report multiple populations where tools have proven efficacy, and some that they feel could continue to improve with further study. Telerehabilitation is supported for children and adolescents in school-based settings for skills development, aging populations for reducing hospitalizations and improving self-management and rehabilitation/mental health for assistance with activities of daily living in multiple affected populations. While occupational therapy telehealth remains an emerging field and requires additional study to further grow the available knowledge base, the numbers that exist show improvement in fields regardless of age, location or demographic. Telerehabilitation may not replace the value of in-person care in some instances, but it can provide supportive and supplemental care that, at a minimum, increases access to services and considerably reduces the cost of care delivery.

Rural Telemedicine Programs Get A Funding Boost

The value of telehealth in rural communities can hardly be overstated, but the funding for those programs can be difficult to come by. The Federal Communications Commission took steps to alleviate some of this burden on June 6 when they increased the budget for the Universal Service Fund's Rural Telemedicine Healthcare Program. These funds can be allocated for telemedicine programs in rural areas.

What is the Rural Healthcare Program?

The FCC isn't a medical agency, so you might ask why would they allot funds for telemedicine services. And that's a good question. The money that they provide doesn't go directly to starting healthcare programs or subsidizing treatment. It does, however, offer reduced cost high-speed internet connections to these programs, who are then more able to facilitate treatment that requires technology that they did not previously have access to. The funding for the program goes directly to "reduced rates for broadband and telecom services." The Federal Communications Commission is the agency that regulates internet and telephony services throughout the United States, so they are responsible for managing the grant that brings these services to rural America. The Rural Healthcare Program is divided into the Healthcare Connect Fund Program and the Telecommunications Program.

The Healthcare Connect Fund

The first of the two subdivisions of the Rural Healthcare Program offers qualified programs a 65 percent discount on costs associated with the tools needed for telemedicine services. Specifically, they offer cost reductions on broadband expenses and network equipment necessary to facilitate a high speed connection in areas that might not have much access.

Telecommunications Program

Participants in the Telecommunications Program are offered a discount that varies by locality and is based on the difference in cost between services in urban areas and services in rural areas.

Why Did They Need an Increase?

Telehealth utilization is growing, but access to the necessary high-speed internet in rural communities was not meeting this pace. For many health clinics in remote areas, reliable broadband connections and the equipment to facilitate those connections were cost-prohibitive. While broadband connections could deliver healthcare into their facilities that their patients would not otherwise have access to, they didn't have the tools to take advantage of the opportunity. These programs made it possible for clinics to get the access that they need, but the growing prevalence of telemedicine and huge care gaps outpaced access to these funds.

A Large Increase

The increase was substantial. The formerly $400 million budget now tops out at $571 million. The reason for the change is pretty straight forward. The budget was set in 1997, and there was no language that allowed for inflation adjustment. Thus, the funding has remained stagnant for 20 years despite changes in technology and sharp decreases in available care to rural areas. More than just increased funding, however, the budget now allows for funds to roll over from one year to the next. If a program doesn't use all of their funding within the initially allotted time, it can be put toward programs the following year.

Do We Qualify?

For more information on the June 6 change and to find out whether your team qualifies for the extended funding, go to usac.org/rhc. For more information on whether telehealth and working with the best telemedicine companies is the right choice for your rural health clinic, request a demo and a Mend team member will be happy to walk you through how telehealth can improve access to care and reduce costs overall.

Studies Show That Telemedicine Saves Critically Ill Patients

There is considerable evidence to support that telemedicine consultations reduce travel and introduce convenience from an outpatient perspective, but a recent study takes telemedicine from a matter of convenience and proves it to be a life-saving clinical measure. The study completed by the Agency for Healthcare Research and Quality confirms that telemedicine in certain settings has a considerable impact on patient survival. The study evaluated outcomes of telemedicine programs at the inpatient, emergency and outpatient level of care. Specifically for patients in the ICU, access to telehealth care for monitoring and ongoing intervention is indicated to have reduced patient mortality.

Telehealth Saves Lives

You read that right. Patient populations who were treated via telehealth or remote ICU care (in addition to the high-level care provided) had reduced mortality rates. Overall, the studies that followed patients at these levels of care reported a reduction of between 2 and 6 percent on average. In one instance, the hospital that implemented the remote ICU program determined that the odds of mortality were reduced by 40 percent, and the actual mortality rate was 29.5 percent lower than the estimates before the program was introduced. These patients often participated in remote monitoring programs or had medical interventions that were assessed as necessary through a telemedicine consultation. Remote care, though not a replacement for in-person treatment for these critical patients, did assist in delivering necessary care and reducing mortality overall in the cases reviewed. In short, telemedicine consultations and evaluation save lives in high-risk populations.

No Evidence of Harm

While there were some metrics that didn't demonstrate substantial improvement, telemedicine consultations and remote monitoring were not indicated to cause harm in any of the instances studied by the agency. It's possible to implement programs with inexpensive technology and cost-effective platforms. Those costs for the platforms are miniscule when compared with the potential positive outcomes, and there is no evidence of clinical or administrative harm, either.

Accelerating Step Down

Additionally, there was evidence to suggest that treatment via telemedicine consultation could also reduce length of stay at higher levels of care, such as Intensive Care Treatment. While the correlation between treatment duration and telehealth was not as substantial as the reduction in patient mortality, there is evidence to support that telemedicine also impacts the cost of care by reducing ICU time or high-intensity care duration. Diverting unnecessary emergency care also leads to considerable cost savings in healthcare, and the study revealed a reduction in emergency room utilization when specialty care is made available through telehealth. Telemedicine care reduces the likelihood that patients will utilize the emergency room as a means to access specialty care. Further, patients who do present to the Emergency Department receive treatment faster when telehealth is an option. More patients who require treatment are admitted appropriately, while other patients are more quickly redirected to the appropriate level of care.

Reducing Hospital Costs

Possibly the most telling impact on emergency care is the reduction in costs for rural facilities by delivering specialty care through telemedicine consultation to emergency department patients. The overall cost of emergency department care was reduced in 7 emergency departments located in rural areas from $7.6 million to $1.1 million. Not only are patients getting increased access to difficult to secure specialties without considerable travel, but the hospitals are reporting a reduction in expenditure. Patients remain at local facilities rather than being transferred to distant metropolitan areas for evaluations that may not require further inpatient treatment. This enhances both the patient experience as well as the quality of care that is available.

Telehealth Saves

We knew that telehealth software had the potential to save money, but this shows evidence of cost reduction in the millions. More than financial, however, are the considerable impacts on patient mortality in our highest risk populations. By working with a reliable and simple-to-use platform, facilities from across the country can impact their patients directly while offering care remotely. For more information on how Mend can help you achieve this, fill out our demo request form. For more information on the study, click here: http://effectivehealthcare.ahrq.gov/sites/default/files/pdf/telehealth-draft-report.pdf

Telemedicine Billing: How to Make It Easy

Simplifying Telemedicine CPT Codes for Billing Claims

One of the questions that we get most often from providers and organizations interested in offering virtual services is about telemedicine CPT codes for billing claims. Billing telemedicine can seem confusing and overwhelming, but the actual codes used are probably the simplest part of implementing a telemedicine program. One of the things to remember is that, as with any insurance claim, there is no guarantee of payment unless it's a covered benefit and in your contract with the organization. That being said, if you're ready to submit the claims and you just need to be pointed in the right direction, it's a pretty straight path to the right options.

Know Your Modifiers

In most cases, billing for telemedicine looks a whole lot like billing for in-person evaluation and medication management. The biggest difference is that you will add a modifier. There are three potential modifiers that earmark a claim as telehealth: GT, GQ and 95.

GT Modifier

GT is the modifier that is most commonly used for telehealth claims. Per the AMA, the modifier means "via interactive audio and video telecommunications systems." You can append GT to any CPT code for services that were provided via telemedicine. It is most often used for codes like 99201-05, 99211-15, behavioral health codes and other services that are medically appropriate for telemedicine.

95 Modifier

Modifier 95 is similar to GT in use cases, but, unlike GT, there are limits to the codes that it can be appended to. Modifier 95 was introduced in January 2017, and it is one of the newest additions to the telemedicine billing landscape. Per the AMA, modifier 95 means: "synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system." Modifier 95 is only for codes that are listed in Appendix P of the CPT manual. There is considerable overlap between situations for using GT and 95. Codes listed in Appendix P are likely to fall under the following categories: The specific codes include:

In What Situations Do I Use GT? 95?

In short, ask your payers. Rules vary by payer, with some requiring one while others will prefer the other. It's pretty difficult to predict, so asking is the right way to go. Reimbursement should be the same regardless of the modifier, but that might be a good question to ask as well.

GQ Modifier

GQ is an option for certain situations where asynchronous telemedicine would be appropriate. Per the AMA, GQ means, "Via an asynchronous telecommunications system." Asynchronous telemedicine means that medical care was provided via image and video that was not provided in real-time. A patient will undergo a service that is recorded as video or captured as an image, and the provider will evaluate it at a later time. Usually, the evaluation is completed within the same day, but there may be situations where that is not the case. GQ is reimbursed by some payers, but the reimbursement is not as common as the GT modifier. Most use cases for asynchronous telemedicine are in spaces where providers would normally be reviewing the information after the service. It's frequent with imaging studies and ophthalmology, but there are many use cases.

Place of Service

A frequent area of confusion for billing telemedicine CPT codes was whether the place of service changes. If the provider is at the facility but the patient is at home, is the place of service still 11? As of January 1, 2017, the recommended Place of Service for telemedicine was “02”. This references a location where the service is received through telemedicine technology. Not all payers require the 02 place of service to bill a telemedicine claim, but it's good information to have if you receive remittance advice indicating that the Place of Service is incorrect.

A Few More Codes To Consider

There are a few codes that are specific to telemedicine, but they do not have to be used to bill telemedicine. 99444 can be used to bill an online E/M service provided by a physician and 98969 is meant for online assessment and management services.

Are You Ready To Get Billing?

Knowing how to submit the claims is actually the easy part. What you need now is a partner who can finish out the rest of the picture and make the technology and implementation just as simple. That's what the best telemedicine companies like Mend can do. If you're ready to get started, request a demo from our website!

What Do Patients Expect From a Telemedicine Platform and Provider?

The patient experience is the most important part of delivering telemedicine services. If it isn't simple, patients won't take part, and you will have invested in a system that doesn't provide significant benefit to your practice. We'll explore some patient requirements and why it's important to work with someone who can manage them for you.

Patients Expect to Connect Without Hassle

Patients don't only want a telemedicine platform-- they want telemedicine that is simple to access. Pick a telemedicine platform that limits the number of steps necessary for patients to connect to an appointment. While telemedicine can represent a huge improvement in convenience, downloading software, setting up usernames and passwords, verifying email addresses and entering account information is cumbersome for those who aren't tech savvy and tedious for those who are. With Mend, patients click a link, enter their birthdate and connect to the virtual exam room for access to their telemedicine provider. It's that simple. They can access telemedicine from any device with an internet connection, camera and microphone. The technology is fully HIPAA-compliant and secure while simultaneously offering the simplest-to-use interface on the market.

Patients Expect Status Updates

Doctors run late. Most patients understand that reality, but they appreciate being kept in the loop if the practice is running behind. With telemedicine, there is no human at the front desk to ask about wait times. Mend understands the importance of patient experience with a telemedicine platform, so we built tools to enable staff and providers to communicate with patients. If a provider is running behind and another patient logs in while the provider is with the last patient, the provider receives a notification and can send a text to the waiting patient with just one click.  If a patient is waiting in a session and the telemedicine provider is not logged in, a text is sent to the provider to let them know. Providers and staff can easily send text messages to patients with wait times, last-minute reminders and other information, and these messages are one-way communications that patients cannot reply to. Patients are aware of the status of their appointment with just a few clicks. Working with a telemedicine platform partner who understands the patient experience makes all the difference.

Patients Expect Reliability

You should be confident that your patients will be able to connect to the telemedicine platform every time they try. When you're selecting your platform, check into the reliability and session completion rates for each different option. If a platform has a 10 percent non-completion rate, that means that you could miss 10 percent of your sessions every day because the solution isn't reliable. 99.85 percent of sessions that are started in Mend are successfully completed.

Patients Expect Technical Help Right Away

We'll leave the medical advice and follow up to the medical professionals, but technical support shouldn't fall on medical office staff or providers. Pick a telemedicine platform partner who has incredibly low support utilization but who still offers unlimited support without additional fees. Low support utilization means that people rarely need technical support, but the availability indicates that the help is there if necessary. Technical support has to be reactive, but it should also be proactive. Your solutions should be able to diagnose potential connection issues prior to report so they can be automatically resolved. Mend identifies potential connection issues, tests the microphone and camera and verifies that the patient is on a sufficient Internet connection. We offer free, unlimited, instant, in-house support for patients, providers and staff, so that help is there in the rare instance that you need it.

How Will You Handle Patient Expectations?

The convenience of telemedicine cannot be overstated, but it has to be matched with simplicity to be a truly valuable tool for your organization. Mend can offer all of the above and more while adding considerable value to your daily operations.

Informed Consents for Telemedicine: What To Know In Your State

In-person patients usually complete a stack of paperwork prior to their first visit and again at set intervals throughout the patient's time with the practice. The consents that are completed at that time provide important protection for the provider and give the patient valuable information about the services that they are about to receive, storage of patient records, explicit patient consent policies, and more. These patient consent forms are just as important for telehealth, and some states actually require a specialized telemedicine paitent informed consent form prior to treatment. The laws vary drastically by state, but informed consents for telehealth are a good practice whether they're required or not. There are a lot of good examples throughout the web of what should be included in your informed consent. If you work with a seasoned platform partner like Mend, those consents are already included in your licensing fee, and we can customize them to your needs.

What is a Telehealth Informed Consent?

An Informed Consent explains the services that the provider offers as well as the risks and benefits associated with that treatment. A telehealth informed consent does the same, but it also focuses on ensuring that the patient understands the medium through which care is going to be delivered as well as the limitations of the treatment provided via telemedicine.

What Should My Informed Consent Include?

You'll want to explain what telemedicine is, who provides telemedicine services, who the telemedicine provider is, and what information may be shared over telemedicine. Most informed consents include an explanation of the type of technology that is being used and the different ways that patients can use it. You can list the benefits of telehealth, but you will also want to list the possible risks and what the patient should do in the event of an emergency. Next, the patient consent portion of the document explains that the patient is consenting to remote treatment and explains that this treatment is voluntary. There should be a discussion of state and federal law and an acknowledgement that the patient is aware that these services are delivered in compliance with those laws. The American Telemedicine Association's Practice Guidelines for Live, On-Demand Primary Urgent Care, includes an extensive list of what the patient should be informed of prior to or during the telemedicine visit. They recommend informing the patient about the nature of the visit, the timing of the service and the record keeping methods. They also encourage telemedicine providers to discuss: Mend supplies sample patient consent forms that can be used as-is or edited to the needs of the organization. When choosing a patient consent form for treatment, ensure it was written by a reputable source or have one drafted by your counsel.

State-by-State Breakdown

Informed consents vary by location and provider, and each state may have a different requirement of what needs to be stated in the consent. Below, is a state-by-state breakdown of informed consent requirements. The information provided was supplied by the Center For Connected Health Policy at cchpca.org. It was up-to-date at the time this article was published, but be sure to check for updated legislation pertaining to your state. Alabama- Written informed consent required for Medicaid patients. Alaska- The law does not specify any guidelines on informed consent. Arizona- Written or oral consent required for all patients. Oral consent should be documented in the patient record. Medicaid requires written consent if a recording is made. Arkansas- Providers are required to follow applicable state and federal laws, but there is no specific requirement for informed consent. California- Written or oral consent required for all patients. Oral consent should be documented in the patient record. Colorado- Providers are required to issue a written consent to the patient that explicitly states: "1) The patient may refuse telemedicine services at any time, without loss or withdrawal of treatment; 2) All applicable confidentiality protections shall apply to the services; 3) The patient shall have access to all medical information from the services, under state law." Connecticut- The provider should verbally disclose information to the patient regarding limitations of treatment and treatment information, and he or she should obtain verbal consent during the visit. Delaware- The law specifies that the provider must have informed consent to treat via telemedicine, but it does not require it be a written consent. Medicaid rules state that the patient must consent to telehealth, and this consent can be obtained by either the referring, consulting or distant site provider. Florida- The law does not specify any guidelines on informed consent. Georgia- Medicaid requires written informed consent prior to the telemedicine visit. Hawaii- The law does not specify any guidelines on informed consent. Idaho- State law specifies that consent must be obtained from the patient. The Medicaid program specifies that the written informed consent is required. Illinois- The law does not specify any guidelines on informed consent. Indiana- State law specifies that the provider is not required to maintain a separate informed consent, though Medicaid law requires that the spoke site must obtain consent and both sites must maintain it. Iowa-  State law does not specify any guidelines on informed consent. Kansas- State law does not specific any guidelines on informed consent, but the Medicaid program specifies that consent must be obtained for telehealth home services. Kentucky: State law specifies that informed consent must be obtained by physicians, chiropractors, nurses, dentists, dieticians, pharmacists, psychologists, occupational therapists, behavioral analysts, physical therapists, speech language pathologist/audiologists, social workers, and marriage and family therapists. The law does not specify how the consent should be obtained. Louisiana- Regulations indicate that the provider must inform the patient about the relationship of the patient and provider as well as any other providers who are involved in the care. The patient may decline telemedicine treatment. Maine- Maine regulation and Medicaid specify: "Providers must deliver written educational information to patients at their visit. This information should be written at a sixth-grade comprehension level, and include the following: Maryland- Informed consent requires that the provider, "inform patients and consultants of the following: Medicaid rules state that the originating site must obtain consent. Massachusetts- State law does not specify any guidelines on informed consent. Michigan- State law does not specify any guidelines on informed consent. Minnesota- State law does not specify any guidelines on informed consent. Mississippi- Regulations specify that the provider must receive informed consent, but there is no information on required modality. Missouri- State law requires that providers obtain patient consent, and consent is specifically required prior to asynchronous (store-and-forward) services to ensure confidentiality of medical records. Additionally, parents/guardians must provide consent for school-based health services. APRNs must also receive informed consent. The Medicaid program requires written informed consent. Montana- State law does not specify any guidelines on informed consent. Nebraska- Written patient consent is required prior to any service delivery. The Medicaid program states that consent can be written or emailed, and is only required before initial service delivery. The consent must include: Nevada- State law does not specify any guidelines on informed consent. New Hampshire- State law does not specify any guidelines on informed consent. New Jersey- Informed consent is required for telepsychiatry through the Medicaid program. New Mexico- State law does not specify any guidelines on informed consent. New York- Informed consent is required for telepsychiatry. North Carolina- State law does not specify any guidelines on informed consent. North Dakota- State law does not specify any guidelines on informed consent. Ohio- Regulations specify that the originating site is responsible for obtaining informed consent. The modality is not specified. Oklahoma- Regulations specify that written informed consent is required. Oregon- State law does not specify any guidelines on informed consent. Pennsylvania- Informed consent is required for telepsychiatry through the Medicaid program. Rhode Island- Regulations specify that informed consent is required for email or text-based communication. South Carolina- State law does not specify any guidelines on informed consent. South Dakota- State law does not specify any guidelines on informed consent. Tennessee- Medicaid requires that the patient be informed prior to the telehealth visit, and that the patient be given an option to opt for in-person care if preferred. The consent should be documented in the patient record. Texas- State law requires that consent be obtained for telehealth services, and it can be obtained at either the originating or distant site. Parental/guardian consent is required for school-based services. Medicaid requires signed and dated consent for telemedicine, written or oral consent to allow another individual to participate in the session, and a "good-faith attempt" at written acknowledgement of privacy practices for email or electronic communication. Utah- State law does not specify any guidelines on informed consent. Vermont- The health care provider must document written or oral informed consent. Informed consent is required at the originating site for tele-ophthalmology or tele-dermatology. Asynchronous (store-and-forward) tele-ophthalmology or tele-dermatology does not preclude the patient from receiving the same service via real-time telemedicine at a later time. Patients also have the right to receive a consult with a distance site provider and get the results of said consult. Virginia- State law specifies that informed consent is required. The modality is not specified. Washington- The law does not specify any guidelines on informed consent. Washington DC- Regulations indicate that written consent is required. West Virginia- State law specifies that informed consent is required. The modality is not specified. Wisconsin- State law specifies that informed consent is required. The modality is not specified. Wyoming- Regulations state that written or oral consent is required for physical therapy. A telehealth consent for is required for the Medicaid program, and the patient can indicate that they want to discontinue telehealth services at any time.

How Implementation of Telemedicine is Changing Healthcare

Provider shortages across the country have made innovation in care delivery a necessity. Without a change in how patients access care, treatment deserts will continue to grow and specialty care will become even more sparse. The Association of American Medical College estimated a national shortage of up to 104,000 physicians by 2030. As treatment technology evolves, care delivery has to change as well. Telemedicine is the most accessible form of innovation, and telehealth platforms like Mend have already made simple-to-use and easy-to-implement technology available throughout the world.

More Than Just Critical Consults

While one of the more valuable use cases of telehealth services is to deliver specialty services into areas where it is otherwise unavailable, the sheer convenience of telemedicine in Primary Care and Pediatrics has made it a game changer for patient retention and treatment of low-acuity complaints. Telemedicine makes treatment accessible and fast, and the visits usually take less time than in-person appointments. As primary care and pediatrics panels get larger, working with a telehealth platform offers an alternative to waiting days for an acute but non-emergent complaint. Virtual healthcare solutions can deliver treatment for rashes, upper respiratory infections, abrasions, colds, flus and other non-acute illnesses within minutes.

Triage Patients To The Right Care

The access provided by digital healthcare means that patients can avoid the emergency room for non-emergent complaints. The ER is often a last resort for patients who were unable to secure time with their primary care, and it's a much more expensive alternative that doesn't offer continuity of care with their established physician. By working with a telehealth platform, providers can connect with patients prior to ER presentation and still secure some form of reimbursement for those services. Digital healthcare can both reduce ER utilization and unpaid after hours phone calls.

Making Specialist Care Accessible

The physician shortage is most evident in medical and surgical specialties, and it is expected to grow at an astounding rate over the next 12 years. It's estimated that there will be a shortage of up to 62,000 providers as currently practicing physicians retire and fewer students enter medical school. Telehealth services can significantly bridge these gaps by encouraging specialty consults without travel for the patient or the physician. Transportation is a growing barrier to treatment as areas suffer from lack of specialty care and public transportation options shrink in many areas throughout the country. Using a platform like Mend, physicians and patients can connect regardless of location with just a few taps on low-cost technology like tablets and laptops. Virtual healthcare is a valuable asset that can be implemented with limited upfront technology costs for patients and providers. Hospitals are not required to purchase large, costly carts to engage in telemedicine, and solutions that were previously cost-prohibitive in an outpatient setting become entirely attainable. What previously required a $100,000 electronic set up can now be achieved with the combination of a 429 tablet, the appropriate telemedicine platform and an Internet connection.

Telemedicine Is The Key To Better Health In The Face of Provider Shortages

As the demand for care grows and the number of providers shrink, telehealth services can be the key to extending care to underserved populations and ensuring patients receive the complete continuum of care. Telemedicine reduces costs, extends the physician patient relationship and solves some of the largest dilemmas physicians and patients face in the years to come. Though there were once considerable barriers to telehealth including limited access to technology, poor proliferation of high-speed internet and low patient/provider buy-in, these barriers have largely disappeared. The technology can be inexpensive and the return is considerable for all stakeholders.

Benefits of Adding Telemedicine In Premier Primary Care Practices

The average primary care specialist treats approximately 19 patients per day, according to the American Academy of Family Physicians. On average, PCPs spend 22 minutes per patient. Even with this type of intense panel, there is daily pressure to increase patient load, identify more billable encounters and treat patients faster. Introducing telemedicine services as a method of treating your own patients is an excellent way to bolster those efforts without sacrificing quality of care.

No, you don't have to join a panel of physicians.

Solutions like Mend make it possible to connect with your own patients through telemedicine solutions that don't require you to contract with another physician organization. There are many agencies that hire physicians to treat patients who request services through that agency, but these patients would not become a part of your standing panel. In those arrangements, physicians and patients are connected at random, and there is limited (if any) follow-up or continuity of care beyond the single encounter. Through Mend, primary health care providers have access to simple technology that can be used remotely by both patient and provider. Primary care physicians can treat and follow-up with their own patients through telemedicine solutions as long as the treatment meets the standard of medicine and is delivered in accordance with state law.

How to Introduce Telemedicine

Telemedicine can be an interesting but overwhelming prospect. Physicians and practice managers are often receptive to the idea, but they become stymied when trying to figure out how to implement it and fill their virtual clinic. By working with an experienced platform partner, like Mend, who can help you navigate the implementation waterways, you can skip the stress of implementing a telemedicine solution and move right to the benefits.

Reduce no shows

Primary care telehealth company provides an alternative for late cancellations or no-shows, and it enables providers to capture the encounter without searching for another patient to fill the spot. By working directly with those responsible for managing cancellations and no-shows, your platform partner can assist in implementing a reschedule to telemedicine services policy that encourages patients who cannot make it to an in-person visit to use telemedicine as an alternative. By diverting even half of missed or cancelled visits to telemedicine, practices can recoup hundreds per day.

Divert low-acuity visits

Telemedicine visits tend to be faster, and low-acuity complaints can be treated in minutes. By diverting these patients to telemedicine, either during set hours or on an as-needed basis, providers can free up limited in-person time for more severe cases that require hands on care. Primary care specialists can divert simple prescription refills, routine follow up care and low-acuity complaints to telemedicine for faster visits without sacrificing quality of care. Mend's implementation specialists can educate on best practices, and our telemedicine triage ensures that only patients who are appropriate for telemedicine services receive those appointments. By working with the right partner, you have an expert on hand who can help develop these workflows.

Turn phone calls into billable encounters

Premier primary care physicians provide a considerable amount of free care to patients after hours and throughout the day. By turning quick phone calls into often-billable or fee-for-service telemedicine services, providers get paid for their after-hours effort. Your platform can collect copays or fees prior to the session, and the time you would have spent on the phone becomes a full visit.

When provider after hours care, phone calls also often go undocumented. Telemedicine is documented like a regular visit, and that ensures that patient records are complete regardless where the patient is located when the support is provided.

Most importantly, telemedicine is not your EMR.

Many providers and office managers are hesitant to embark on a telemedicine implementation because they have had arduous software implementations before. Telemedicine solutions require a small fraction of the effort to implement when you work with an experienced partner like Mend. You won't have to overhaul your daily workflow, and we can show you how to best work telemedicine into your regular day. Do you want to use a telemedicine time block? Is this a tool for strictly after-hours? Do you prefer to use it for nurse follow ups and to deliver lab results? Whatever the use case for your practice is, there is a workflow and implementation plan that is easy to implement when you're working with the right partner.

Next steps?

Think you're ready to get moving? Let us help! We can walk you through the process, get your implementation plan moving and start you on the road to realizing the benefits of introducing telehealth into your practice.

Common Request: Telemedicine Platform With Documentation Solutions

A telemedicine platform needs to be a lot of things like secure, simple-to-use, and easily accessible. It needs to have robust tools to simplify telemedicine encounters and make the information gathering process prior to the appointment easy. Visit documentation, however, is not meant for a telemedicine platform.

It's a Common Question, and A Valid Request

Having one system for documentation and telemedicine may seem convenient, and providers think that they can cut out an extra step out of a sometimes frustrating documentation process. One system would be the ideal, but it presents hurdles for providers who even see one single patient in person among their telemedicine appointments. Focusing on convenience is important for your telemedicine platform, but the requirements for a telemedicine platform and a patient EMR are vastly different. It's more difficult than you would imagine to get everything within the same portal, and that's why it's not easy to find a one-size-fits-all solution as much. Providers often don't consider how customized their patient medical records are, and how flexible their documentation program with a telemedicine platform would have to be in order to support that level of flexibility. In theory, it's an excellent idea, but in execution, it's much more difficult to make it a reality.

Where The Real Problem Comes In

Imagine that your charts were still on paper. Every time you took a note, you put it in the folder for the patient in the room where you saw him or her, and those charts were never merged. When you saw the patient in Exam Room 1, you would have the notes for only the times where he or she was treated in Exam Room 1. When you treated the patient in Exam Room 3, you wouldn't have any notes because he or she had never been seen in that room before. Chaos, right? That's similar to what would happen if you tried to keep documentation in a telemedicine program rather than in a single electronic medical record. Your telemedicine solution should work alongside your documentation software, but it should never replace it. This ensures that your patient records are always complete, and that HIPAA-sensitive information is not abandoned in a documentation program that you only access when the patient presents via telemedicine. While it seems convenient to chart in your telemedicine software, the result is fragmented records that have to be regularly compiled or, worse, that never get amassed into a single record. The solution is to find an EMR that meets your needs AND a telemedicine program that can work alongside it. That way, whether you see the patient in-person or virtually, the documentation is standardized and your records are always complete. What sounds like a good idea in theory can actually create a much bigger problem in the long run.

So How Does The Telemedicine Program Meet Your Need?

Your patient medical records won't be maintained in your telemedicine platform, but your telemedicine platform can introduce many other conveniences that you would not have otherwise. Your telemedicine platform should provide patient appointment reminders, information capture for patient demographics, intakes and forms, customized automated consents and unlimited technical support. It should help replicate the in-person experience by delivering high connection rates, unlimited (and free) technical support, and implementation specialists who make it a painless process. Have more questions about a telemedicine platform? Fill out our demo request form and we'll be happy to share.

9 Essential Features Your Telemedicine Platform Should Include

With the number of solutions on the market, it can be hard to narrow down your top needs and wants in a platform. Before you start interviewing software or finalizing the best telemedicine companies, you should identify your list of non-negotiable items.

1) HIPAA compliance

If you're going to be treating patients, the system must be HIPAA compliant. A lot of video-conferencing software can provide a video connection for telemedicine providers, but it's not a good idea. Skype and FaceTime are not encrypted or secure. Check with your telemedicine platform to ensure that it meets all the minimum standards for HIPAA, and verify with your state laws that there are no additional requirements that platforms must meet. Additionally, your telemedicine platform partner must be willing to sign a Business Associate Agreement

2) Business Associate Agreement

Though often overlooked, ensuring that your telemedicine platform will sign a Business Associate Agreement is an integral part of implementing a platform into your practice. The sessions may not be recorded, but your telemedicine platform is going to store information related to your patients on their server. The Business Associate Agreement specifies that the provider/organization and the telemedicine platform have agreed that this information can be stored on the platform servers, and it specifies how the information is stored and cared for. The BAA protects healthcare organizations should the telemedicine platform be negligent in protecting that data. Willingness to sign a BAA further indicates that the platform is designed with healthcare in mind.

3) Web-Based

Downloading software is cumbersome and presents additional steps into a process that may already be foreign to patients. Software downloads add several variables that can be difficult to overcome. The software on the computer may be out of date. The patient may be unfamiliar with how to launch a download. They could have limited space on their hard drives or not remember the password to allow the download to start. If the patient isn't technically savvy, the hurdles presented could be insurmountable. It is important to provide telemedicine guidelines to all.

4) Flexible Hardware Requirements

You don't have to buy an office full of new equipment to use telemedicine. The telemedicine platform you select should be able to run on any device with an internet connection, microphone and front-facing camera. That means you can connect with patients from a computer, tablet or phone. The flexibility and ease of implementation are imperative.

5) One Step Login

How many user names or passwords do you use to log into your accounts and devices every day? Do you know those passwords offhand? Does the account require a user name or an email address? Do you remember what email address you used to make the account? If you have these questions to log into systems that you use all the time, how often do you think these come up for patients who are trying to log in to speak to their provider? It's possible to have a HIPAA-compliant connection without requiring a user name and password, and it eliminates a massive barrier to effective and expedient treatment.

6) Telemedicine Triage

One of the most important things to consider is how you can ensure that telemedicine is reserved for the right patients. Telemedicine platforms should have a triage solution built-in that allows providers to specify who qualifies for telemedicine visits and who should be referred for in-person care. This keeps telemedicine safe, and it ensures that no one slips through the cracks when self-scheduling or being scheduled by office staff.

7) Instant, In-House Support With Low Utilization

The telemedicine platform you select should be supported by the people who built it, and their help should be available to you instantly if you need it. A support response longer a few seconds doesn't help when you're trying to connect with a patient who is waiting on the other end of the virtual visit. Your platform should have proactive support features like connection testing, appointment reminders and live help for patients, staff and providers. Full-service support that is rarely utilized indicates that the telemedicine platform is reliable but that help is available if necessary.

8) Information Capture

While treating patients at a distance is convenient, it does present hurdles as far as collecting medical histories, current complaints, intake forms, patient consents and demographic information. If you work with a platform with a paperwork automation solution, this information can be easily collected prior to the visit without emailing forms, scanning information or manual entry into your EMR.

9) Workflow Experts On Staff

Whether you're a telemedicine provider, rolling the platform out to a large group, or just switching platforms, the partner you select should be able to offer guidance on how to best implement telemedicine into your organization. They should be familiar with state law, understand best practices and help you establish a designated workflow to make the solution easy for both you and your staff. Telemedicine providers don't need a one-size-fits-all solution, and workflow and implementation experts are a good indicator that your telemedicine platform understands variability.

Telepsychiatry Basics

In many specialties, telemedicine is an emerging concept. In psychiatry, however, telemedicine is a well-established tool that allows providers to reach patients regardless of the location of either party. Per the American Psychiatric Association, telepsychiatry was first practiced in 1959 to coordinate group therapy, ongoing therapy, training and consultations. Since then, it has grown in many ways, and it is now considered to be as effective as in-person care in many instances.

What is telepsychiatry?

Telepsychiatry is exactly what is sounds like. It's the delivery of psychiatric treatment and therapy through live-video or store-and-forward connections. According to the American Psychiatric Association, "Telepsychiatry is equivalent to in-person care in diagnostic accuracy, treatment effectiveness, and patient satisfaction; it often saves time, money and other resources." Are there times that telepsychiatry is preferred over in-person care? Studies say yes! Research has shown that pediatric and adolescent populations may have better outcomes with treatment delivered via through telepsychiatry providers. Family interactions via telepsychiatry services may be more authentic, and children feel more comfortable in their own environment. Additionally, young people are confident when using technology. There is also information to support improved treatment in severe anxiety disorders and PTSD. Keeping these patients in their own environments and at a distance from someone who they are unfamiliar with bolsters treatment. Additionally, treatment adherence is frequently improved with telepsychiatry.

Do I still need to see patients in person?

Initially, that's determined by state laws and rules. Some states don't allow providers to establish care via telemedicine, and some require in-person care at certain intervals. You can get more information on establishing care from the AMA here: http://www.ama-assn.org/system/files/2018-10/ama-chart-telemedicine-patient-physician-relationship.pdf. If your state allows fully virtual care, then it's up to you or your physicians to determine if they're comfortable treating patients without in-person interview and follow-ups. We work with groups who are fully virtual and others who have chosen to retain some of the in-person care. Many psychiatrists and community mental health centers are confident in telepsychiatry for treatment delivery, and they have turned to telemedicine to reduce overhead and limit brick and mortar locations. Other physicians and groups prefer to retain the in-person evaluation for certain diagnoses, while still others require regular in-person care with supplemental telemedicine. Going fully virtual is entirely possible, but the feasibility will vary by the patient population, comfortability of the providers and the state laws and regulations. Mend can help you sort through the best option for your practice.

What do I need to get started?

All you need is an internet-connected device with a front-facing camera and microphone. When you work with the right platform, you don't need expensive technology or peripherals. Some providers opt to use multiple screens because that is how they have developed their workflow, but it isn't required. In fact, by working with a platform like Mend that allows you to shrink down the telemedicine screen and nest it on top of your EMR, you're able to maintain better eye contact with the patient while charting, which enhances the therapeutic relationship and mimics an in-person interaction.

How do I get paid for my services?

Reimbursement is the one of the few pieces of telepsychiatry that still has considerable variation by location. Some states have telemedicine parity laws that require payment for these services and others do not. More so, some states require that telepsychiatry services be reimbursable but exclude many other medical specialties. The best resource to find out where your state falls is the state-by-state guide from the Center For Connected Health Policy at www.cchpca.com. If billing insurance isn't part of your business plan, then you can skip those steps all together. Mend can process credit card payments based on your preferences.

What's next?

Have more questions about getting a telepsychiatry practice up and running? We work with mental health groups and practices across the country, and our workflow experts can help sort out your ideal implementation plan. Just ask! h/t: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662387/#B13 h/t: http://www.ptsd.va.gov/understand/index.asp

How Do My Patients Complete Forms?

Form submission is one of the simplest parts of what we do at Mend, and we get a lot of questions about how that works in our system. Mend is designed to be the easiest way to request and receive paperwork from patients, and it's also the simplest way for patients to complete new patient forms, patient registration forms, insurance updates, demographic details and more. Healthcare is one of the last industries in America to hold on to paper and the standard for information collection. Our industries as a whole have shifted to electronic signatures, digitization, text and email for communication. Due to HIPAA and other security requirements, there has been a considerable amount of red tape in the way of advancing healthcare past archaic methods like paper, faxes, scanners and wet signatures.

Patient Forms Can Be Simple

Practices have been trying to go paperless for years, but it seems that the stacks of paperwork just continue to grow. The patient forms continue to grow in length, and the cost of materials and human capital for maintaining manual processes gets higher. When people present to the office for a new patient appointment, they typically complete patient registration forms while sitting in the waiting room. If they aren't completed in time for the appointment, the schedule gets pushed back while staff waits for demographic information and medical histories. Patient information forms can create significant backlogs for practices, but it doesn't have to be that way. With a few taps, staff can send new patient forms to patients on their personal technology, to be completed by the time they present for the appointment. The patient can view the forms after completion on their patient online portal, and the staff can avid considerable backlog in the waiting room. There is no more scanning information or manual entry of data. Mend takes care of all of that for you.

So How Does It All Work

Once we customize and build new patient forms, patient education, demographic updates, consents, or any bit of important data that a practice wants to collect, these forms can be pushed out to patients in one of two ways. 1) Tied to appointment type- Any time you schedule a specific appointment type, forms will be pushed to your patient that are appropriate for that visit type. New patients can receive intake packets while returning patients can be sent demographic and insurance updates. The set up is fully customizable, so only the forms that you select or identify for certain appointment types will be pushed out. This is built to your specifications. 2) Manually- Forms can be pushed out to patients without an appointment type trigger or as part of the booking process. This enables practices to send as many as they like without a requisite appointment scheduled in Mend. Additionally, it enables them to send different forms depending on the patients, rather than the type of scheduled appointment. Once the customized forms are sent out, patients receive a text message and email with a link to the requested information. They click the link, enter a birthdate and are connected to their forms for completion. Upon completions, the forms are pushed back to the Mend portal, where they can be reviewed or automatically integrated with your EMR. That's it.

The Impact Of Mend

Mend a telehealth company reduces overhead, manual labor and materials costs. We make it easier to get information from patients, and we shift the burden from your staff to our servers. With Mend, administration is easy.

Paperwork Automation in Healthcare: What Does it Mean & How to Start?

Paperwork automation is easily the most flexible tool that Mend offers. Healthcare is one of the last industries to hang on to paper forms and snail mail. Some of this retention is due to laws and regulations. For instance, healthcare providers and allied health companies are required by law to send out two paper bills to any customer who owes money to the organization. While you can also provide electronic bills, the paper is required. That isn't the case for most information gathered in healthcare, however. The real barrier is that the industry hasn't found a simple, secure method for collecting information from patients. New patient forms don't have to be on paper, but it's been difficult to find a simple way to get electronic forms to patients without cumbersome portals that are unreliable and have high compliance rates. Mend- a telehealth company changes that. Mend's robust paperwork automation solution can collect information from ANY healthcare endpoint. The possibilities are endless, but don't get overwhelmed. When we work with new groups, we ask them to find a single piece of paper or one information request that, if the process of collecting it was improved, would save their office staff a considerable amount of time. Is it new patient paperwork? Insurance information collection? Patient education forms? One of our groups was desperate to get their intake and new patient paperwork automated. Their patients have to complete new patient paperwork, financial forms, consents and more. Often, patients would sit in the waiting room for 30-40 minutes just working on completing the information. It would then have to be manually entered into the EMR while their financial paperwork was scanned in. Then, they had to be sure to return the financial documents to the patient, but the probability of it all getting lost in the shuffle was high. It was an ineffective system, but they didn't have the technology to devise a better, less cumbersome way of supporting their patients. That's where we came in. Mend digitized all of their new patient paperwork exactly to their specifications. We didn't use templates or we didn't require them to fit the requests into the fields that already existed. We created their forms exactly as they were on paper, and we replaced scanning documents with image and PDF uploads. They send the forms out to new patients via text message and email prior to the new patient visit. They also send out regular demographic updates for patients who have not been seen recently or who need to complete updated consents. This information can then be pushed to the EMR with our proprietary integration system. So what can be digitized with Mend?. And, actually, ANY form or paperwork that you need to collect from a healthcare endpoint. What is your one pain point that, if streamlined, would save time and money for your organization? When you identify the most important area to streamline and make more efficient, we can work with your team to build it to your specifications, develop your customized workflow, implement into your practice and fully realize the impact of new technology. Workflow specialists are the key to a successful and painless implementation. With Mend, all of it is included in your paperwork roll out. So where would you like to start?

Implementing Telemedicine Into Schools Drives Health Outcome Improvements

Adding telemedicine technology to schools leads to improved health outcomes for students, according to recent studies. Many children in American public schools have limited access to medical treatment due to poor transportation, difficulty coordinating with parent schedules and lack of primary care. By adding a telemedicine kiosk in the school nurse's office, students miss less school for medical appointments and gain access to care that they may not have had otherwise. Richard Lampe, MD, Chairman of the Department of Pediatrics at Texas Tech University Health Science Center, reported to the Texas Tribune that "Ninety percent of what you would see in a general pediatric clinic, we could handle it by telemedicine."

Addressing Care Gaps

Access to care is strongly linked to location and socioeconomic status. Children in lower income areas often wait longer for care due to limited access, transportation difficulties or lack of availability of guardians. A program in Rochester, New York made telemedicine available to patients in 4 "inner-city" schools. Students were treated within an average of 23 minutes for ENT issues, physicals, dermatology consults and other use cases. 85 percent of patients were treated the same day, and a patients were afforded treatment that would otherwise be unavailable to them. School attendance increases when students are afforded the appropriate care. The outcomes are positive for acute but non-emergent complaints as well as physicals that are often required by the school board to participate in activities. When parents are not immediately available to pick a child up from school, telemedicine can address acute complaints and, in many cases, return kids without contagious illness to class rather than sending them home.

Chronic conditions

By providing care to students with chronic illnesses such as Type I Diabetes, care outcomes improved over in-person care, and patients missed less time in class. In a study of school telemedicine for Type 1 Diabetes published in The Journal of Pediatrics, A1cs were lower in the telemedicine follow-up group than in in-person treatment. Improvements were noted on the Pediatric Diabetes Qualities of Life questionnaire, and there were significantly fewer urgent diabetes-related calls in the telemedicine group. Additionally, patients with school-based telemedicine follow-up were hospitalized less. The access to specialist care without significantly disrupting the educational environment was a valuable addition. http://www.sciencedirect.com/science/article/pii/S0022347609002340

Parents Can Consent To Treatment From Anywhere

School-based telemedicine programs still require parental consent, but these forms can be provided electronically to parents and guardians regardless of where the custodial adult is located. By working with a solution like Mend, paperwork can be instantly pushed out to a parent's mobile phone or email for completion within seconds. This consent allows the patient to be treated without the parent present. Mend also enables parents to participate in the session from anywhere. Multiple parties can log in to the same session with a secure link. This means that the custodial adult or adults can take part with the treating provider, patient and school nurse. The parents don't have to leave work or find transportation to participate with their child.

Forward Treatment Information To Parents

When only the patient and provider participate in the session, parents often have questions regarding prescriptions, treatment plans or ongoing care. By working with Mend, providers can finish charting and forward treatment information or notes to parents through a secure message. Parents still have access to their child's treatment information, and the information is forwarded through a simple-to-use, HIPAA compliant channel.

Use Existing Technology

One of the largest barriers to school-based telemedicine up to this point has been the cost of the equipment. Large carts are no longer required to connect to a patient in a school setting, and the school may not need to be any extra equipment. Solutions like Mend can work on any phone, tablet or computer with a front-facing camera, microphone and Internet connection. Many schools utilize existing technology and offer telemedicine with limited out-of-pocket.

Improve Outcomes With Limited Overhead

There are considerable advantages to making care available where children are already located. By delivering medical services into schools, one provider is able to cover multiple locations without any travel. This provides for greater coverage, better attendance, improved chronic illness outcomes and high satisfaction for all participants. If you have questions about how telemedicine could be implemented in your district, let us know! Our workflow experts are happy to help.

Remember Your EMR launch? Implementing Telemedicine Is Much Easier!

One of the most common hesitations that we hear from practices and large organization is that software is too hard to implement and their last rollout was a nightmare. They don't want to put their staff through that again. It's easily the most frequent objection to technology from people who are interested but unsure. And you know what? That makes perfect sense. Historically, software implementations have been difficult on staff and providers. They are long, arduous processes that manage important patient records, and they have to be managed properly to ensure that patient records are accessible despite the huge shift in platforms. We know what a traditional software rollout is like. There are long training sessions with employees from all different departments. The software may be cumbersome or complicated to use, and it might have been difficult to get it off the ground to begin with. Often, tools don't work correctly the first time, or they have steep learning curves. The process is difficult and can throw an entire, well-organized staff into chaos. Oh, and the tools are expensive and frequently difficult to use? Mend is a totally different experience. Mend deals with fewer patient medical records than your EMR, so there is less involved in setting up. While the platform remains fully HIPAA compliant and secure, but the setup process is significantly less arduous. Mend was designed for ease of use. Our goal was to make a robust, secure, intuitive communication platform that can have staff trained in minutes with secure methods that still allow handling of limited patient records. By building a web-based solution, we eliminated the need for software installations. Unlike your patient EMR or portal, it's a simple addition to your daily routine. Our WebRTC architecture ensures the best connection on the least amount of bandwidth. The flexibility of our system guarantees that telehealth software will work on any device with an internet connection, camera and microphone. Form completion requires only an Internet connection. Those patient records are securely managed in Mend and then transferred to the EMR through a number of integration options. We work alongside your existing workflow, so you don't have to start from scratch. Our training team is available to show you how to use the system, answer any questions and support you through your roll out. We build your information collection system from the ground up, and by not having features of an EMR, your patient medical records are always retained in a single place. We have implementation specialists who will help you design your workflow and share best practices so you can skip the pitfalls. And we offer complimentary, unlimited in-house support to patients, staff and providers to ensure that questions get answered and help is offered when needed. No support contracts. No complicated software to learn No trying to provide technical support to your patients or staff. Mend is unlike any other software that you've implemented in your practice. Our approach, architecture and availability set us apart. Improved communication is the future of healthcare. The Mend experience is drastically different from your previous software implementations, and we can work with you to ensure that your patient EMR works with Mend is the most efficient and cost-effective way for your practice. Mend is the future of improved communication and the next generation of simplified medical software.

Telemedicine in Dermatology: The Dos, Don’ts and Best Practices

By adding telemedicine, dermatologists can extend access to care while increasing the number of encounters that they can complete in a single day. Dermatology telemedicine services offer reduced wait times, increased schedule flexibility and high patient satisfaction. According to the American Academy of Dermatology, "The technology has reached a point where, in many situations, health care providers can use IT to offer quality health care services remotely," and they support telemedicine as an additional treatment tool to supplement in-person services. "The Academy supports the appropriate use of telemedicine as a means of improving access to the expertise of Board certified dermatologists to provide high-quality, high-value care. Telemedicine can also serve to improve patient care coordination and communication between other specialties and dermatology."

Manage Chronic Conditions

Add convenience to routine follow-ups by offering dermatology telemedicine services to patients for medication refills, lab results, imaging reviews and chronic illness management. Telemedicine is valuable for patients who lack transportation, and it simplifies visits for prescription refills.

Store-And-Forward For Simplicity

For mild or non-acute issues, store-and-forward telemedicine enables patients and providers to share images back and forth for review by the provider when appropriate. Patients can share an image of their abrasion or skin illness, and the provider can make an assessment upon review. This can considerably reduce time for diagnosis and treatment. Consults are frequently provided via teledermatology where images are provided and reviewed at a later time.

Consult Without Leaving the Office

Dermatologists can consult almost instantly when requested by a referring provider. Patients can be evaluated using the best telemedicine software while still in the primary care office or while hospitalized. Dermatology telemedicine services make treatment by specialists more accessible to patients in rural areas, and patients without transportation or in underserved areas benefit considerably.

Get paid for after-hours work

By replacing after-hours phone calls with on-call telemedicine appointments, providers can create billable encounters from phone calls that are not considerable reimbursable.

Make Follow-Ups a Breeze

Patients who are on medication maintenance, who are following up on a recent illness, or who need lab results may not require an in-person examination. Telemedicine makes it possible to quickly see these patients in succession while offering considerable convenience for the patient.

Higher Patient Satisfaction

Telemedicine services have a 95 percent satisfaction rating overall, according to a study completed by the General Journal of Internal Medicine. Patients report that they enjoy the convenience and flexibility.

Improve Provider Flexibility

Providers can treat patients from anywhere using the telemedicine platforms, which offers an unprecedented level of flexibility for those who travel, see patients in multiple locations or manage frequent emergencies.

What Do I Need to Get Started?

It's possible to get started with dermatology telemedicine services without purchasing any new hardware. By working with a platform like Mend, providers and patients can connect using any device with a front-facing camera, microphone and Internet connection.

What diagnoses are appropriate for treatment via telemedicine?

There is no definitive answer to this question because it varies considerably by physician and specialty. Every provider will have a different list of diagnoses that he or she is comfortable treating virtually. According to an article in JAMA Dermatology, telemedicine is appropriate for treatment of Viral skin lesions Acne Skin cancer follow up Pigmented lesions Biopsy follow up Disease management Common diagnoses The American Telemedicine Association supports additional consults for: Preventative care Immunizations Smoking Cessation Diet Physical Activity Again, every provider will have a different standard, and it's only recommended that providers treat diagnoses that they feel most comfortable with treating through telemedicine. Telemedicine doesn't replace all in-person care, but it is an excellent supplement for the conditions that providers feel they can effectively treat virtually.

What shouldn't be treated via telemedicine?

This will also vary considerably per provider, but the American Telemedicine Association cautions against treating patients who require "aggressive intervention" and "protocol driven procedures" such as: Cognitive disorders Intoxication Severe language barriers Emergent rather than urgent complaints

What Sets Mend Apart for Dermatologists

Simplest-To-Use Technology Patients log in with just a birthdate. Fully HIPAA Compliant and Secure Mend surpasses the minimum requirements for the American Telemedicine Association and state recommendations. Unmatched Connection Rates Mend has a 99.85 percent successful connection rate. Complimentary, Unlimited Support Patients, staff and provider can receive instant, in-house support whenever they need it No User Names or Passwords Patients log in to their sessions with only a birthdate. Web-Based Platform Patients and providers can connect from any device with an internet connection, microphone and camera. There is no software to download. Flexible Scheduling Options Mend offers multiple solutions for scheduling including staff scheduling, patient-initiated scheduling via website link or a combination of both solutions. Telemedicine Triage Mend's customized telemedicine triage ensures that only patients who meet the practice's criteria for telemedicine can schedule appointments. This keeps telemedicine safe. Customized intake paperwork Automate your front office with fully customized intake paperwork, demographic updates, forms and consents that can be pushed out manually or automatically sent based on appointment type. Telemedicine is the future of healthcare. Mend is the future of telemedicine. Fill out our demo request form to see how Mend works. http://www.aad.org/Forms/Policies/Uploads/PS/PS-Teledermatology.pdf

Can I Just Use Skype or FaceTime for HIPAA-compliant telemedicine?

Just about every internet-connected device comes with some sort of video conferencing solution, and it can seem easy to connect with patients using the programs that are readily available and free. After all, they're probably already installed on the technology that you own, and accounts are simple to make. If your patient doesn't mind, should you? Skype and FaceTime, though great tools for connecting with family and friends, are not designed for medical use, are not a designated telemedicine platform and should not be used to treat patients. They are missing critical tools and security features, like HIPAA compliance, that are absolutely necessary to appropriately connect with patients via telemedicine, and they can cause major compliance issues for your practice in the long run.

Skype and Facetime Are NOT HIPAA Compliant

Most importantly, the common, free video conferencing solutions aren't HIPAA-compliant. This means that any information transferred across the platform is not secure, and your patient's information isn't being protected. Many insurance companies have minimum requirements that platforms must meet in order for providers to bill for telemedicine. HIPAA compliance is the number one concern, and the top of those lists. Insurers won't reimburse for services provided on platforms that are not designed for telemedicine and that do not provide the requisite protections for their members' data and medical information.

You Need A BAA

Aside from the security precautions and encryptions that are built into telemedicine systems, an organization that is designed for telemedicine will enter into an agreement with you called a Business Associate's Agreement (BAA). This is integral to the HIPAA compliance. The BAA enumerates how data is stored, where it is stored and what the procedures that the entity, in this case the telemedicine company, follows to ensure that data is protected. A BAA is required by the Federal Government for one healthcare entity to share HIPAA-sensitive data with another healthcare entity. The BAA is important because it shows that both entities comply with HIPAA, but it also provides remedies should the telemedicine solution you partner with have a breach or other HIPAA violation. It's an important protection for both parties.

They Don't Have Scheduling Tools

Consumer-grade video conferencing solutions don't give you or the patient options to schedule appointments. Instead, one endpoint makes a "call" to another endpoint. It may be scheduled elsewhere or by hand, but there is no simple way to link the telemedicine appointment to any other software that tracks the appointment, the connection time or the patient information. With consumer-grade tools, it is much easier to accidentally log into a "session" that is meant for a specific person, and there are no other built-in methods to verify who you're speaking to. With a telemedicine platform, the patient logs into a scheduled appointment that is tied to their patient account and protected with identifying information.

No Appointment Reminders

When you have a scheduler, the platform can also manage appointment reminders to help ensure that the patient presents for the appointment at the right time. A telemedicine platform automates these solutions so you don't have to hire additional staff or a service to manage appointment reminders. So the next time you are required for dermatology telemedicine services, you will know.

The Details Are Important

There are big differences between tools that are designed for telemedicine and platforms that are meant for consumer use. Aside from major HIPAA violations, they lack the convenience and intuitiveness of solutions that are designed for medical use. HIPAA compliant technology, appointment scheduling, reminders and more are the minimum requirements for an effective telemedicine platform, and without them, providers leave themselves open for both inconvenience and major compliance violations.

Part 4: Treating Patients In Multiple States

Telemedicine has opened up considerable opportunities to treat patients throughout the country regardless where the physician is located. While the technology offered by the best telemedicine companies and provider willingness are there, state licensing creates a barrier in some situations. It's definitely possible to practice over state lines, but there are a few things to consider. Some states offer reciprocal licenses and others require full licensure. If you're traveling between two or more areas and you want to treat regularly in all of them, you may need multiple medical licenses to do so. A handful of states also offer telemedicine only licenses, which allow providers from anywhere in the country to treat patients within that state as long as they have both a telemedicine license and a valid license from where they currently reside. Additionally 12 states participate in an Interstate Licensing Compact that streamlines the process considerably. Currently, Alabama Idaho Illinois Iowa Minnesota Montana Nevada South Dakota Utah West Virginia Wisconsin Wyoming have entered the Interstate Licensing Compact, which allows for practice of telemedicine over state lines when certain criteria are met. Additionally, providers in Maryland can be licensed to treat via telemedicine in Delaware, Pennsylvania, Virginia and West Virginia in some cases. The best place to start is by calling or going to the web site of the licensing board in the state where the patients who you want to treat are located. An administrator for the board can give you the precise information based on their rules and legislation.

Part 3: How to Market a Telemedicine Practice

How are patients going to find your virtual practice? There are literally thousands of things that you can do to drive traffic, but they break down into two primary groups: hire a marketing professional or try some small-scale solutions yourself. If you have the budget for a marketing team, defer to them for the nuts and bolts. If that's not an option right now, here are a few things to consider (and later check on Part 1 of this series, 10 Things to Know About Starting Your Telemedicine Practice). If you're sticking with a cash-pay model, which many virtual practices do, you won't have a consistent stream of referrals from insurance companies. Allow a fair amount of time for the patients to find you. Unless you are partnering with a large organization that can send a considerable volume, don't expect to have your schedule packed immediately. You can definitely find reputable sources for patients to fill your days, but you'll need some time after day one. Partner with local healthcare providers who need people to fill your niche. Psychiatrists can offer immediate evaluations to pediatricians and general practitioners with patients who need evaluation but not hospitalization. Physical therapists can provide remote evaluations for home-health agencies or orthopedists. What is your specialty and your niche? Primary care physicians and mid-levels can partner with local pharmacies and get the pharmacy to hand out business cards to people who come in for over-the-counter medications. Local parenting groups can be filled with people who don't have time to go to the doctor but occasionally need immediate care. Mental health professionals can work with local agencies who have extended wait lists. Often, couples who are looking for marriage counseling have difficulty coordinating their schedules. Local faith-based organizations also see potential patients in distress who come to them and look for assistance. There are many ways to reach out to potential clients, and many of them are inexpensive or free. A stack of business cards can do a long way. Find your niche and figure out how to meet the people on different telemedicine platforms, who can help fill it.

Do I Need Additional Malpractice Insurance For Telemedicine?

Protecting themselves from liability is one of the first things that doctors consider when they make a change to their practice or begin providing an additional service. Questions about malpractice coverage are common and often the first thing providers want to clarify. The Center For Connected Health Policy reports that there have been few noted malpractice suits related to telemedicine services, but they encourage providers to do their due diligence and carry the right coverage as they would for in-person services. The following guidelines come from recommendations made by The Center For Connected Health Policy, and they do not represent official guidance on malpractice coverage or the type of policy necessary. For definitive information and guidance, we recommend contacting your malpractice coverage or legal counsel.

Contact Your Carrier

Before adding telemedicine to your practice, reach out to your malpractice coverage and verify that your current policy covers telemedicine services. Many carriers have a list of technical requirements and telemedicine best practices that they provide to their insured. The Center For Connected Health Policy also recommends discussing whether the policy allows you to practice over state lines. Some policies may not extend outside the boundaries of the state where you are licensed, and you may need multiple policies if you're licensed in more than one state. If you were hoping to connect with patients while on vacation or in another location where you are not licensed, this is important information to have.

Why Does My Location Matter?

State laws vary considerably on malpractice judgments, and some insurers may not be able to cover services that are provided in states with laws the vary markedly from the state where the policy was bound. If you're licensed in multiple states or you travel frequently and hope to use telemedicine to bridge those gaps, you'll want to make this clear to your insurance carrier so the representative can verify that your coverage extends to these circumstances.

Will The Premium Go Up?

Not necessarily. Many malpractice insurance binders cover physicians regardless how they deliver services, and telemedicine may already be considered under your current policy. In situations where the policy is new and the provider has not been insured for some time, there may be an increase in premium if you're opening a virtual only practice. Every insurer will be different, however, and there is no one-size-fits-all response to that question. The best solution is to ask!

Do You Need Additional Coverage?

There are situations where a policy does not cover telemedicine services, but they're rare. In those instances, providers may have to purchase an additional rider to cover the telemedicine services. Your carrier should be able to explain this to you when you call.

Other Kinds of Coverage

The Center For Connected Health Policy recommends providers evaluate the need for policies that cover electronic security issues like data breaches-- if this is not already covered in your malpractice policy. These policies are not required to practice telemedicine, but they do add an additional layer of protection for the best telemedicine companies. In general, malpractice insurance is rarely a hurdle for providers who want to add telemedicine to their practices. Virtual-only practices may require additional coverage in some instances, but premium increases otherwise are rare. By working with a platform partner like Mend, you can ensure that you meet all of the technological requirements to satisfy your malpractice coverage's requirements, and you can quickly be on your way to a successful telemedicine implementation!

Part 2: Should You Restart or Add Telemedicine Services to Your Current Practice? The Pros and Cons

A fully virtual medical practice can be an exciting prospect. You have the freedom to work from anywhere, that too at a much lower overhead than a full-service operation. The feasibility of a virtual practice as you are aware varies by specialty. Another critical thing to remember at this point is that you don't have to go virtual "entirely" to enjoy the flexibility of telemedicine. That's right. Many practitioners enjoy fewer days in the office, more favorable scheduling and increased revenue by integrating telemedicine into an existing practice. There are advantages and drawbacks to both and this precisely what we shall be discussing right here - Our second post in the series "Starting Your Telemedicine Practice."

Here's how you can incorporate telemedicine into your existing practice

If you already have an office up-and-running, you can introduce telemedicine into your existing operation. Make sure whatever you set up is HIPAA compliant to secure your and your patients' information. This is beneficial for the fact that you can utilize your current staff and infrastructure in your newly set up telehealth company while still getting the flexibility of telemedicine.

1. You won't have to manage your own schedule

To take advantage of the low overhead of virtual practices, many practitioners schedule for themselves or allow patients to plan their appointments within the telemedicine platform. While this is an excellent option, it can get slightly challenging if you don't have a virtual office manager to handle this. By working with your existing staff, you have a team of people who can take care of scheduling for you.

2. Phone calls and questions are managed through your current practice

Again, if you're running a low-overhead operation, after hours call or post-visit questions will come to you directly. Yes, there's no need to have a separate email or phone number.

3. You can add flexibility, but you won't be able to hit the road quite as much

By keeping brick-and-mortar, you will likely have to be at the clinic on a regular basis and see in-person patients as well. While that probably isn't different from what you're doing now, it won't be quite as flexible as a fully virtual operation. Telemedicine is a better option for a doctor who wants to reduce travel between sites than a doctor who wants to be across the country for half of the month.

What happens when you decide to have a fully virtual practice?

1. You really can practice anywhere, as long as your medical license allows

Most state laws, medical licenses allow you to treat patients in the states where you are licensed as long as the patient is located in that state. There are a handful of states that are more restrictive than that, so you will want to check with the board to make sure that your license allows it. By going entirely virtual, you can maintain continuity of care regardless whether you're in the mountains or on the beach.

2. You have to be strict on protocols

Regardless of the specialty, virtual practices need to have very clearly stated and documented clinical protocols for who you do and do not treat, and how those diagnoses and treatments can be treated safety via telemedicine. You want to be clear about what you don't treat or prescribe, and you want to make that information available to patients, either through intake paperwork or a consent form. Also, don't forget to stay up to date with your state laws.

3. You won't have to hire staff if you don't want to

One of the most enticing parts of a virtual practice is incredibly low overhead. You can save lots of bucks. You don't have to hire staff as you will be automating a lot of the paperwork and managing many of the administrative tasks yourself. You will want to honestly look at your capabilities here. There are a lot of physicians who are better doctors when "managed" by an office manager who takes care of the administrative tasks. That's okay! There are others who appreciate the flexibility so much that they're able to shoulder all of it. A virtual office manager is a great way to offset some of that burden, but you can save the money if you think you'll be able to answer phones, manage your own schedule and address the technology.

4. You're going to have to do some marketing

We'll cover this more in our next post in this series, but if you're starting from scratch, you're going to need to get the word out about your practice with effective marketing. You won't have a big sign on the highway to drive patients to you. It will require a marketing budget and a professional who can launch a full campaign or, at a minimum, some creativity, and a little sweat equity. So which do you think is best for your practice? At Mend, we can help you launch either. We offer the simplest-to-use platform on the market that can be up-and-running with just a few clicks - once you decide how you want your new virtual practice to run.

Part 1: 10 Things to Know About Starting Your Telemedicine Practice

Starting a virtual or hybrid practice presents freedom and flexibility that can never be matched by a full-time brick-and-mortar operation. Virtual practices allow practitioners to travel, work from home and treat patients in several states with appropriate licensure. That being said, it's not as simple as downloading a telehealth company program and connecting with a large number of interested patients. To realize the full potential of working virtually, there are a few things that you need to consider beforehand. If you don't know where to begin to start a telemedicine practice, we can help. We provide insight on the benefits, hurdles and organizational requirements and help get your practice up and running. We'll explore some of the best practices, discuss telemedicine pros and cons, and share some helpful tips as well. Remember, this is a general overview of the process, and the information here does not constitute official advice.

In our first post, we will look at 10 things you need to know about starting a telemedicine practice.

Starting a telemedicine practice can feel overwhelming, but Mend is here to help. We help providers start their practice from the ground up every day. Plus, there are these best telehealth software, which can make your experience better.

1. If you don't have a business already set up, you'll need to start one.

We recommend contacting a local incorporation attorney, the Small Business Association or your local medical board to get more information on how to get incorporated. They can provide resources on incorporation, bank accounts, business licenses and more.

2. Telemedicine laws vary by state.

You'll want to familiarize yourself with whether your state has a parity law covering telemedicine. We recommend referencing the American Telemedicine Association's document on telemedicine coverage to familiarize yourself with what is permitted, i.e., what that law allows explicitly.

3. There are two types of video telemedicine.

Telemedicine laws are generally broken up into two delivery methods: hub-and-spoke and direct-to-consumer. Direct-to-consumer means that the state or payer allows the patient to be located at home when receiving telemedicine services. The patient doesn't need a medical staff member present. Patients will self-report vitals (when able), and they may be directed by the practitioner for an in-person follow-up when necessary. 03 Not all patients qualify for direct-to-consumer telemedicine, and that's up to the provider to determine a protocol that ensures that only appropriate patients are receiving treatment via telemedicine. Mend can help develop and implement this protocol for providers. Hub-And-Spoke means that the patient has to be located in an "originating site," i.e. "spoke," to speak to a provider who is at the "hub" or another location. The patient cannot be located at home. States and payers that restrict telemedicine to hub-and-spoke have different lists of facilities that qualify as spoke sites. In general, these sites are healthcare facilities, clinics, doctors' offices, hospitals, etc. In both cases, it's important to use HIPAA compliant video conferencing, which Mend offers.

4. Medicare payment for telemedicine isn't robust yet.

Medicare does pay for telemedicine visits in very limited instances. Medicare restricts the patient location to specific types of medical facilities, so the patient cannot be located at home. The medical establishment or "spoke" site has to be located in a CMS-designated rural area. You can find out if your clinic or facility qualifies as one by using the locator on the CMS website. There is some movement that indicates telemedicine coverage may change for Medicare patients, but there is no timeline at this present moment.

5. In many states, Medicaid is the best payer for telemedicine.

Many Medicaid plans are very forward thinking about telemedicine because most members have serious problems with access to care. Working with Medicaid can often be your best bet for getting paid for telemedicine services.

6. Some states don't let you establish care via telemedicine.

Just like insurance coverage, the state policy landscape/laws on whether you can treat a patient for the first time via telemedicine vary considerably. Some states only require face-to-face interaction, and telemedicine is considered face-to-face interaction. However, some states require that you meet the patient in-person, and telemedicine, unfortunately, does not qualify as an in-person visit. Check ATA or your local medical board to know more about your state's laws before starting your practice. 02

7. Prescribing varies by location and substance.

State laws vary considerably on who can prescribe medication via telemedicine. Some laws restrict all prescribing, and there are others that allow it for established patients. Some states limit controlled substance prescriptions to specific diagnoses. This is another important thing to follow up with your state medical board about.

8. You can practice across state lines, in some situations.

You most likely need to be licensed in every state where you want to practice. There aren't many states that allow you to treat patients without some form of license for the area. If you already hold multiple licenses, then, in many cases, you should be able to provide services to patients in all of those states regardless of where you are physically located.

9. If you want to bill insurance, you will need a physical address.

Insurances list doctors by their physical address and zip code. That's how patients find doctors through the physician locator. If you already have an office where you practice in-person, then use that address for your telemedicine practice. If you wish to continue with telemedicine practice exclusively, you may want to consider renting a virtual office or executive suite so you can provide a physical address that isn't your home address.

10. Billing telemedicine is almost as simple as billing in-person visits.

The codes for telemedicine are the same as the codes for in-person visits because the services that you're providing should be identical. Bill your office visit code as usual, then add either the GT modifier or the 95 modifier. This varies by payer. You will also change the place of service code from 11 (office) to 02 (telemedicine). If you still have questions, that's okay! Once you familiarize yourself with these 10 things, you are on your way to starting your telemedicine business. Mend offers to simplest-to-use telemedicine platform on the market, and we can get you up and running in no time.