Telemedicine was integral for much of the COVID-19 pandemic, ensuring that pediatricians could offer their services to patients without putting either at risk of infection. While progress towards herd immunity via vaccines means that practices will be welcoming more patients to the office for in person visits, for many families the convenience of the medium means telemedicine is here to stay. Here’s how to make sure your telemedicine vendor, workflows, and practices are doing you and your patients justice well into the future, with a look at AAP guidance, key requirements, billing and getting paid, and managing the practices and people behind the screen.
Telemedicine Requirements and Perks
Physicians and the American Academy of Pediatrics have known that telemedicine is important to the future of pediatrics for several years, but the COVID-19 pandemic made it a sudden and necessary component of most practices. Whether you already had workflows in place or needed to set up a vendor as quickly as possible, you’ll want to be sure your solution is hitting the right requirements for you, for your patients, and for HIPAA and other regulations. Here’s what to look for:
HIPAA and Security Requirements
A quality telehealth vendor should be HIPAA-compliant and ensure the privacy of your patients’ information and the data being exchanged during each visit. According to the Department of Health & Human Services, a vendor should both be HIPAA-compliant and be willing to enter into a business associate agreement (BAA) as part of your contract.
Each U.S. state will have its own regulations. You can check here for your state’s telemedicine requirements to learn what you’ll need in your vendor -- be sure to check in multiple states if you see patients across state borders.
PCC encourages pediatric practices to switch to qualified vendors as soon as possible because of non compliance penalties. In 2020, the Office for Civil Rights announced that they would not penalize HIPAA noncompliance for the use of unofficial video and audio applications such as Zoom or Skype if providers used them in good faith for telemedicine during the state of emergency in response to the COVID-19 pandemic.
Top Qualities to Look for in a Vendor
A high-quality vendor will partner with you to meet compliance requirements, provide ongoing support, and ideally be peer-supported by fellow pediatricians. Visit PCC’s list of recommended telehealth vendors here to learn which companies PCC practices think most highly of. Since a telemedicine visit is more than a simple video call, the tools offered matter to the needs of patients and providers, who may also need to send a message to the front desk, make an appointment reminder, or switch between devices. Here are some features to watch for:
- Appropriate technology for your practice: A mobile app or text message service is a great way to engage with patients and help them access the service reliably and on time. Bandwidth and internet speeds are crucial for video visits, while a “store and forward” video service may be useful for rural locations without reliable internet. Accessibility on multiple devices can help solve problems too, like poor video quality or lack of access to a computer.
- Easy user interface for providers and patients. While programs that are easy to use are important for your practice, it’s key for families too, who will often need to navigate your vendor’s system in just a few minutes.
- Easy links to the appointment or waiting room with no need to download programs or apps will be important for many users.
- Minimized chat window to allow physicians to view charts and navigate the EHR in real time while the patient remains on the same screen.
- Training and resources to allow you to solve problems and learn the software quickly. Training multiple people on a service that’s easy to navigate can make the switch easy.
- Workflows that enable you to customize the tool to meet the needs of your practice and patients, such as recording vitals before the visit or sharing demographics with the nurse at a virtual check in. The fewer headaches and workarounds at the start, the easier integration will be for everyone.
- EHR features. Some telemedicine vendors integrate into your EHR, while others like PCC allow seamless pairing with any vendor with features like telehealth appointment scheduling and broadcast messaging.
- Easy scheduling. As in the case of workflows, the vendor should have a scheduling feature that’s simple for front desk staff to use and works with, not against, existing scheduling workflows such as appointment reminders and sending patients a check in link.
To determine the features that matter most to you PCC’s EHR shopping list may be helpful as a step-by-step guide to choosing a vendor, as many of the things you care about, like price and features, overlap between online services like EHRs and telemedicine. You can also consult with your pediatric colleagues to guide your team’s decision, either personally or through forums such as AAP’s SOAPM forum or PCC Community. If you’d like some insight on how to translate a visit from in person to virtual, you might like this video on performing well visits via telemedicine from Dr. Joe Hagan of Lakeside Pediatrics.
Billing and Coding for a Telemedicine Service
A key component of a successful telemedicine service is ensuring that your practice will be compensated appropriately. Federal, state, and insurance policies for telemedicine payments are not yet fully formed at the time of this post’s writing, but parity between telehealth and in person visits will remain a crucial point as these policies develop post-pandemic.
For now, it’s important to be certain you’re billing and coding appropriately. In April 2021, the AMA reversed some policies that were put into place during the COVID-19 public health emergency (PHE). Please visit the AMA's telemedicine guides to find up to date coding and billing policies. Important topics to check are coding and billing procedures for audio-only as well as video calls. Don't forget to bill for portal messages, too. In April 2021, the AMA lobbied CMS to extend coverage of audio-only Medicare coverage beyond the PHE.
Don’t forget to bill for phone calls and portal messages, too -- these are underbilled in many practices but are important methods of service when patients can’t or are hesitant to come into the practice.
Finally, a key strategy in ensuring prompt and accurate payments is keeping an ongoing conversation going with your key payors. For example, keep tabs on which payors accept which modifiers, or when key dates for telemedicine during states-of-emergency expire.
Promotion of Telehealth Online and In-Person
Once you have a trusted telemedicine vendor, you’ve trained your staff, and you know exactly how to bill to be paid appropriately, it’s time to let your families know all about telemedicine, and especially the perks it has to offer for them. Here’s a possible scenario:
During an in-person visit, you tell the caregivers of your patient with a chronic condition that there’s an option to do follow up visits via telemedicine. They say they’ve heard about it through your practice’s social media and on your website, but they’re not sure they would know how to operate the program. You offer them a print-out explaining how to use the application, or a link to a video tutorial, and they agree to give it a try. After a few tries, the family loves the telemedicine option and tell their child’s school about it, opening the option to perform the same visit during the patient’s school hours at the school nurse’s office. This combination of promotion strategies not only helps expand your telemedicine practice to local schools but also makes accessing care easier for families.
Many parents enjoy the convenience of telemedicine, and as wonderful as promotion tools like social media, print outs, videos, and even advertising are, word of mouth promotion by the pediatrician and between families can help get families unaware or nervous of telemedicine to give it a try.
Have a list of your favorite telemedicine benefits to offer to families. You may decide to promote telemedicine for visits that offer increased convenience for families, such as visits for nutrition, controlled substance, or behavioral health visits, or to save time for families with small children or infants. If many caregivers in your community work outside the home, telemedicine may be attractive as a safe, no-contact option prior to their children receiving a COVID-19 vaccine. Telemedicine can even be an option for those visits that may be hard for the caregiver to justify otherwise, such as examining a baby’s fever or asking about sleep schedules.
You can promote telehealth services on social media, your website, and broadcast email or text messages. In person promotion in the office via posters, information sheets, and simple conversation might help families new to telemedicine take the leap.
Managing Your Telehealth Services
Virtual healthcare can add flexibility and convenience into your practice’s schedules for physicians and families. Scheduling and managing its operations can be a challenge you can tackle with a few proactive strategies.
An ideal telehealth schedule depends on the amount of demand for the service and integrating telemedicine into the practice’s existing scheduling needs. One key way to integrate virtual visits is to automatically offer a telehealth visit when an appropriate visit is triggered, such as a follow up, nutrition, or behavioral health visit. Telehealth may also be useful in patient recall projects, as an online visit may be an easier hurdle for some patients than making it to the office.
Front desk staff should train on workflows that ensure an appointment is clearly labelled as telehealth in the system to notify providers to prepare appropriately. The same visit needs to be ready in the telemedicine application too, including adjustments if a patient reschedules or needs help using the service for the first time. PCC EHR offers a handy checkmark to indicate to physicians which visits are telemedicine.
Staffing & Operations
For a practice taking on a significant number of virtual visits, it pays to have a staffing and operations plan ahead of time, perhaps outlined as a project or SMART goal with a clear deadline. For example, you can determine when to send appointment reminders, how long to wait before a visit is classified as a no-show, and what front desk staff and nurses are expected to do to record demographics and vitals before the pediatrician arrives.
Want to have patients new to telehealth complete a survey after the visit? Add that to your plan to take steps to improve the process after your project or SMART goal deadline arrives. If there are miscommunications or issues, you can revisit the plan to highlight where improvements make sense and communicate the changes to your staff.
Don’t forget visit protocols: a telemedicine sick or well visit protocol outlines the visit and removes components such as lab orders or strep tests, since those don’t make sense during a virtual visit. Check out how to create a telemedicine protocol in PCC EHR here.
While more flexible generally than an in person visit as it can be performed from multiple locations for patient and physician, a telehealth visit will still require a private room that is well-lit and quiet enough for the visit to proceed without interruption or distractions. Depending on your office space, this can give a maximum limit on the number of visits per day if appropriate space cannot be found or is occupied by other providers. Please note that some payors do not allow physicians to perform telehealth visits from any location other than their practice.
Some physicians may wish to take full days of telehealth visits. This may be preferable for several reasons, such as if they are working extra hours, semi-retired, have health concerns restricting their contact with sick children and adolescents, or simply for a straightforward schedule. This requires all telehealth visits to be scheduled on certain days, lowering the convenience for patients, so it is worth evaluating with your practice case by case.
How can you improve your telemedicine services over time? Along with the plans you make for how you’d like your staffing and operations to work, it’s worth checking back after a period of time to see how reality matches with your original intentions. Facts worth checking are how long visits took compared to how long they were scheduled for, the number of visits that were rescheduled due to errors, the number of no-shows, and patient survey responses to measure their engagement and satisfaction with the service and the “webside” manner of the physician.
Performance reviews can help your team identify and work on weaknesses, such as waiting times, technology literacy, or patient engagement during telehealth visits. Perhaps most significantly, you can survey patients formally or informally to see if they find their visits helpful, convenient, and reassuring, or whether they’d like to see changes. A change as small as having a toy or bright poster to draw a child’s attention back to the visit can help a physician complete a successful telemedicine visit.
Many practices introduced a telemedicine service or increased their use out of necessity, however, this necessity gives even more precedence to the ease, accessibility, and performance of your digital toolset. We mentioned telemedicine protocols as key tools for making a telehealth a successful and efficient visit. Learn how PCC clients can set up telemedicine protocols on PCC Learn, the database for all things PCC.