Five Steps To Prepare for a Telehealth Service

Posted by Michael Greiwe, MD | May 19, 2018 |
Michael Greiwe, MD

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Any technology implementation requires planning and foresight to help with stakeholder buy-in, service delivery, and benchmarking to ensure continuous clinical improvement. How many EMR implementations have gone badly when the vendor, hospital, or medical practice failed to appropriately plan for go-live and post-live?

This article will walk you through five of the most important planning steps that must be accomplished before rolling out a telehealth service for your patients.

Telehealth – Do These Five Things First

As a baseline, we’ve come up with five crucial steps that could apply to any medical practice specialty or any hospital considering telehealth implementation. Keep in mind that additional specialty- or regionally-specific steps may need to be added, but what follows will serve as a solid baseline for planning purposes.

1) Step One: Conduct a needs assessment

"Any telehealth service should be matched to the needs of the client/patient population and individuals to be served. Not all potential clients/patients may be appropriate candidate for telehealth services.”
Washington State
Telehealth Implementation Guidebook

The first step in any technology implementation is to fully understand why you need it. Think about it from a user perspective. How could your patients benefit from the service? What gaps in coverage will telehealth fulfill? Could it improve the lives of your staff by streamlining tasks? Where in the orthopedic workflow would you actually offer the service and to what target audience?

Meet with your team to map rollout logistics for the telehealth service.

Some additional questions to ask include:

  • Which clinical staff will deliver the care?
  • How will it be documented?
  • How will your patients be scheduled?
  • Who is available to help patients struggling with technical glitches?
  • What training will be needed?
  • How will you market the new service?

Your telehealth provider may be a good resource for this exploration. As a standard part of the service, OrthoLive provides technical support, training, and consultation.

2) Review all federal, state, and local laws and policies

Call your state medical board to determine what laws govern this service and if there is any new legislation pending that could affect your planning and decision-making process down the road. OrthoLive can help provide this initial data and help your practice stay on top of what’s happening on the legislative front.

3) Develop protocols to fit the service

It’s important to plan out service delivery protocols for telehealth implementation to ensure that the consults are conducted appropriately and consistently by all clinical staff. Discuss and document how scheduling should occur, how the exam room or office should be organized, how the “visit” is documented, and what workflows will change.

Click here for some guidelines from the Telehealth Resource Center.

Work with your telehealth vendor to roadmap pre-training, go-live, and the program evaluation process. Assign a site-specific telehealth superuser, who can help troubleshoot issues. Determine the training for staff, doctors, and the patients themselves. Next, develop a project plan that includes a rollout and training schedule. Develop a marketing plan that will help create excitement and drive implementation in your patient base. Finally, develop a program evaluation process that is an ongoing, structured methodology for determining what’s working and what needs improvement.

5) Plan for reimbursement.

By 2017, 48 state Medicaid programs offer some form of reimbursement for telehealth. It probably won’t come as a surprise to know that each state differs in their definition of telehealth or telemedicine. Currently, there are four ways to deliver this service, and payers vary in what they will cover:

1. Live video conferencing, or synchronous video, is just what it sounds like; a two-way live feed between a healthcare provider and patient. It should be HIPAA compliant and therefore, not Skype.
2. An asynchronous video isn’t live; the patient video is cached and forwarded to the provider.
3. Remote patient monitoring, sometimes conducted via patient wearable devices that send data through the cloud to an on-site provider portal.
4. mHealth or mobile health, which could incorporate elements of other services. Basically, this is telehealth on a smartphone, tablet, or other digital device.

The Center for Connected Health Policy (CCHP) says that live video conferencing is the most commonly reimbursed form of telehealth service. Click here for the CMS rules governing telehealth reimbursement and the HCPCS/CPT codes you’ll need to capture.

On the private payer side, the state you live in may have passed laws requiring insurance companies to reimburse for this cost-effective service. According to the CCHP, sometimes these laws require parity in reimbursement between in-patient visits and telehealth as long as the same standards of care are met.

The good news is that the trend is for telehealth reimbursement to increase over the next decade, as more organizations realize the benefits of the technology. For example, Telemedicine magazine just shared the news that ACOs and Medicare Advantage Plans will be offering reimbursement for telehealth services by 2020.

Prepare for telehealth reimbursement by also researching the reimbursement rules under your current payer contracts. If you’re outsourcing reimbursement, check in with your vendor about their expertise related to new telehealth reimbursement rules.

But why add this layer of complexity to an already task-laden reimbursement process? The answer is because your customers demand it.

Telehealth is in Demand

"Although it's true that the fastest-growing telehealth services are for simple conditions, orthopedics is ripe for leveraging the technology to improve patient convenience. Imagine if patients who are in pain or wearing a cast didn't need to drive (or have someone drive them) to the office for what is often a 10-minute visit. The incision check or mobility assessment could be done on a tablet or mobile device in the comfort of the patient's home or workplace."

Telehealth at a Tipping Point
Betty A. Hovey & Cheryl Toth
American Academy of Orthopedic Surgeons

A new report from Business Insider says the majority of Americans are open to using telehealth services. The Employer Benefits Research Institute (ERISA) just conducted a study showing that 96% of large employers are getting ready to roll out telehealth programs for employees. ERISA’s CEO said, “Telemedicine is particularly good for identifying health issues earlier and avoiding complications later.”

In addition to the obvious cost-savings for employers, the influence of the millennials will virtually guarantee that the telehealth programs will reach their full potential; 74% would select a virtual visit over an in-office physician appointment.

Preparing for the orthopedic practice of the future means exploring telehealth in the cloud. Contact OrthoLive to find out how we can position your practice for future success by using affordable telehealth software-as-a-service to expand your reach and give your patients what they’ve been asking for.

Topics: Practice, "telehealth", "telemedicine", orthopedic practice