Telemedicine – When Patients Make the Call

by Marcia Simon, APR

Note: a version of this post originally appeared in Strategic Health Care Marketing.

Consumers want faster access to health care, providers want to improve the patient relationship, and reimbursement rates for telemedicine are getting better. Combine these factors and it becomes clear – telemedicine is going mainstream.

Telemedicine claims have increased 624% from 2014 to 2018, according to FAIR Health, a nonprofit healthcare data collection company. Most of these virtual doctor visits are with non-hospital physicians, but the landscape is evolving rapidly.

“Telehealth increases access to patients outside a hospital’s primary catchment area, but it’s not just about getting new patients. Nobody wants to lose patients either,” says Michael Farrell, senior vice president of Hospitals and Health Systems for MDLIVE, a supplier of 24/7/365 virtual medical, behavioral health and dermatology care through a HIPAA and PHI-compliant, secure, cloud-based digital platform. “Telehealth decreases leakage,” Farrell adds.

To expand the patient base and keep current patients from leaving one practice for another, MDLIVE provides each hospital or system with its customized digital front door, which is basically a branded landing place, consisting of a webpage, application or chatbot that engages with each patient and can integrate the patient’s electronic health record.

Telehealth can help to alleviate many challenges that systems face today. For Yale New Haven Health, telemedicine is part of a strategy to prevent physician burnout for a growing health system with multiple locations.

Telemedicine – Good For Physicians

Yale New Haven Health typifies the trend of healthcare mergers and acquisitions. Now with seven affiliated hospitals, a multitude of urgent care centers and clinics across three states to bring healthcare closer to home for a growing community of patients, doctors need to split their time between the metro base and suburban locations.

“When we think about ambulatory services and physician groups, post-acute and long-term care, and the fact that hospitals are under pressure to reduce cost, putting a specialist in a car for a few extra hours is not a good use of time,” says Lisa Stump, chief information officer for Yale New Haven Health.

“Telehealth alleviates the burnout,” adds Stump. “It can also be a good option for physicians who are edging toward retirement, but aren’t quite ready to leave their practice. This way they have flexibility to work remotely with some patients while a new doctor takes over the office visits.”

“Patients want to receive care from a doctor they know and trust, but it’s unrealistic for every doctor to be available around the clock,” explains Stump. “Partnering with a third party is very reasonable, especially for health systems getting started with telehealth. There’s a lot to learn.”

Some Doctors Still Skeptical

A 2019 survey reported by FAIR Health found that physician adoption of telehealth increased 340% in three years, from 5% reporting having used video visits to see patients in 2015 to 22% in 2018. There’s still uncertainty, though, on the part of many physicians about what telehealth is and how to build it into their daily schedules.

Some private physicians feel threatened that telemedicine will pull patients away from them, according to Stump, but others are big supporters. She says the Yale Transplant Center was the first specialty to use patient-provider telemedicine and one transplant surgeon explained it this way:

“We need to schedule a post-op visit with every transplant patient. Bringing those patients back into a hospital or clinic setting is unnecessary. A virtual visit from the patient’s home serves the same purpose and it’s easier, and likely safer, for the patient.”

The greatest stumbling block may be the difficulties navigating state and federal legislation and reimbursement from private payers.

A Holistic Approach to Reimbursement

CMS (Centers for Medicare & Medicaid Services) and payers continue to expand reimbursement for telehealth, but looking at reimbursement alone is not the entire answer for a health system. Many other factors such as access, quality, prevention and satisfaction play into a successful program, explains Farrell.

“Think about the delivery of care and long wait times for basic chief complaints. If you take the colds, sniffles and flu cases out of your Emergency Department or urgent care centers, it will open up space for more complex patients, which typically means higher revenues,” says Farrell. “There is typically a significant ROI for a system’s at-risk patients every time a low-acuity patient uses telemedicine instead of an in-person visit.”

Virtual Visits 101

Just like preparing a spokesperson for a media interview, physicians need coaching before their debut on the telemedicine small screen. From eye contact to body language to clothing, MDLIVE trainers help doctors fine-tune their “webside manner.” Some hospitals have dedicated “virtualists” who become extremely proficient at online communication and diagnosis; med schools are exploring Telehealth Virtualist as a new specialty.

One critical component of telemedicine is the incorporation of electronic medical records (EMR) and software that assures compliance with HIPAA and PHI (Protected Health Information) security.

Better Patient Relationships

An alarming number of Americans have iatrophobia, or fear of doctors. Yes, it’s a real thing. Where someone may hesitate to make an office appointment for a lingering condition, they may find it less scary to make the call from the comfort of their home, which gives a doctor the opportunity for an initial evaluation.

Stump recalls one patient who made a telemed appointment because she had blood in her urine. During the video chat, the doctor convinced the patient that she needed to go to the nearest Emergency Department, where the patient was diagnosed with a rare condition and received necessary treatment. In this way, telemedicine promotes self-care, encouraging individuals to be proactive about their health. Timeliness of care is critical to quality patient care, and patients may be less inclined to put off a doctor appointment if they can easily do it by video chat from home. Telehealth also provides a way for patients to stay in network with their insurance provider when traveling.

“The most common feedback we get is that virtual doctor visits save an incredible amount of time, especially for people with strict work schedules. Plus they feel like the doctor is paying more attention to them. It’s not rushed like it can be during an office visit,” says Stump, who talked about the array of technologies like kiosks, and pop-up rooms that can be set up in retail settings or even in large workplaces. This enables employees to schedule virtual doctor visits in a private location during a short work break and can be an important part of employer health services.

“Rule-based algorithms are built into our triage engine that runs the patient through an adaptive interview to ensure the patient is eligible for a virtual visit rather than a trip to the Emergency Department,” says Farrell. “The advanced rules in the system help identify when a patient should seek higher acuity of care.” Anyone who may be experiencing a life threatening condition such as a heart attack or stroke should seek immediate help by calling 911.

Hurdles to telemedicine include start-up cost and technical training, equipment investment and lack of parity in reimbursements. However, the benefits of digital doctor visits may outweigh the arguments against them, as patients continue to voice their desire for convenience and lower costs to health care when and where they want it.

Marcia Simon, APR, writes about health care, medical issues and wellness. As principal of MSE Public Relations, she manages content, strategic communication and media relations for hospitals and digital health clients. Connect at marcia@mseusa.com or LinkedIn.com/in/marciasimon.