TeleHealth

What is TeleHealth?

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Telehealth is the ability for your physicians to provide services to patients remotely via electronic information and telecommunication technologies. It allows long distance patient/clinician contact and care, advice, reminders, education, intervention, monitoring and remote admissions.

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What Financial Benefits does TeleHealth offer?

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CMS has proposed three new code sets for services to be covered under specific conditions

1. Virtual Check-Ins, officially titled “Brief Communication Technology-Based Service"
2. Asynchronous Images and Video, officially titled “Remote Evaluation of Pre-Recorded Patient Information”
3. Peer-to-Peer Internet Consults, officially titled “Interprofessional Internet Consultation.

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Virtual Check-Ins / Brief Communication Technology-Based Service

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Virtual check-ins are defined by a physician (or other qualified health care professional who can report evaluation and management services) digitally interacting for 5-10 minutes (telephone interactions or audio interactions enhanced with video) with an established patient.

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How will Asynchronous Visits be Supported?

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Asynchronous telemedicine is efficient, patient-centered, and aligns with how many service providers deliver non-healthcare and online services today.

CMS’ coverage of these services sends a strong message, both to medical boards and commercial health plans, that asynchronous telemedicine is an important and clinically-valid tool through which providers can deliver healthcare services.

The new code, HCPCS GRAS1, for “Remote Evaluation of Pre-Recorded Patient Information,” which would reimburse for a provider’s asynchronous review of “recorded video and/or images captured by a patient in order to evaluate the patient’s condition” and determine whether or not an office visit is necessary.

This type of review is also referred to as “store-and-forward” communication technology.

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About Peer-to-Peer Internet Consults

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The third category of new virtual care codes is reimbursement for peer-to-peer internet consultations. Under the new CPT codes 994X6, 994X0, 99446, 99447, 99448, 94449, CMS will pay for: “Assessment and management services conducted through telephone, internet, or electronic health record consultations furnished when a patient’s treating physician or other qualified healthcare professional requests the opinion and/or treatment advice of a consulting physician or qualified healthcare professional with specific specialty expertise to assist with the diagnosis and/or management of the patient’s problem without the need for the patient’s face-to-face contact with the consulting physician or qualified healthcare professional.”

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Are there any Limitations?

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• Frequency Limitations - CMS did not propose to impose a frequency limit on the use of virtual check-ins by the same practitioner with the same patient.
  
  
• Timeframe Limitations - Under the proposed virtual check-in code, CMS would reimburse providers for “5-10 minutes of medical discussion” so long as an E/M was not provided within the previous seven days.
  
  Additionally, in order for the code to apply, the virtual check-in appointment must not lead to an E/M or procedure within 24 hours of the appointment or soonest available appointment.
  
  This is similar to how CMS views coverage of telephone consults, and the AMA has historically advocated for separate coverage and reimbursement for telephone consults.
  
  
• Other Limitations - None of these codes require the use of interactive audio-video technology, nor do they require the patient be located in a rural area or a specific qualifying originating site.
  
  Moreover, CMS’ proposal to cover asynchronous telemedicine and non-face-to-face services is a major recognition of the validity of asynchronous telemedicine (also known as store-and-forward medical care without the use of interactive audio-video or a face-to-face exam).

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PCP

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Provide Ongoing Care For patients suffering from chronic conditions like diabetes, hypertension, or heart disease, telehealth helps keep patients better engaged in their care. PCPs are able to monitor symptom progression, adjust medications, and modify treatment pace without requiring patients to return to the office. Offer Counseling Services PCPs dedicate a lot of time and energy to mapping out self-care plans for managing depression, weight loss, and smoking cessation. Telemedicine allows physicians to conveniently check in with patients, provide counseling, and ensure treament plans are still working well. Review Screenings and Lab Results Providers order multiple lab tests and screenings each day, whether it be CHCs, blood glucose levels, or other tests. For abnormal lab results, remote video allows PCPs to discuss results with their patients face-to-face without losing money on follow-up phone calls. Manage Medications Whether it's birth control, blood pressure medication, or antidipressents, remote video appointments are an ideal solution for adjusting patient medications. It's more efficient for both patients and providers without sacrificing physician reimbursement. Chronic Care Management Chronic condition patients often require multiple physician office visits each year. These are patients who have regimented treatment plans that are frequently adjusted and must be closely monitored by an existing provider. For patients with chronic conditions, video-based appointments often involve medication adjustments, monitoring of side effects, lab/imaging reviews, and overall treatment pain management. Chronic conditions commonly managed through telemedicine include:

• Diabetes
• Hypertension
• Coronary artery disease
• Cardiac arrhythmia
• End-stage renal disease
• Hepatitis
• Asthma / COPD
• Obesity
• Oncologic co-morbicities
• Neurodegenerative diseases

Wellness Exam Follow-Up Patients who receive yearly wellness exams are prime candidates for telemedicine follow-ups. While the wellness exam itself requires a head-to-toe physical exam, following up on blood work and other screenings is ideal for a remote telemedicine visit. These remote visits also give providers the opportunity to discuss how the patient can make smart lifestyle decisions in order to improve overall health - which is especially important when abnormal results are found. Common wellness screenings ideal for telemedicine follow-ups include:

• Colonoscopy / sigmoidoscopy results
• Mammogram results
• Cholesterol levels
• STD testing
• CBC results
• Blood glucose levels
• Liver function testing
• Pap smear results
• Blood electrolytes

Minor Urgent Care Patients with a broad range of minor urgent care issues are increasingly turning to telemedicine for convenient access to healthcare providers from home. Telehealth enables these patients to receive care from their existing providers, ensuring full access to their medical records and providing continuity that is not possible with urgent care centers and on-demand telehealth services. Common urgent care issues ideal for telemedicine include:

• Cold and flu
• Allergies
• Sinus/ear infections
• Sore throat
• UTIs
• Diarrhea and vomiting

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OBGYN

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Manage Medications Adjusting medications for things like depression and anxiety, blood pressure, and birth control - or simply refilling prescriptions - aren't reason enough to bring busy patients into the office. Instead, OB/GYNs can offer to manage any non-scheduled medications remotely. Provide Postoperative Care In order to ensure patient safety and provide the highest quality of care, OB/GYNs must provide high-touch postoperative care. Especially for women who have undergone a serious procedure, schedulingg remote appointments allows doctors to provide that level of care without placing a physical burden on the patient. Discussing Lab Results Discussing sensitive material, like STD-screening results, PAP smears, and biopsies, face-to-face conversation should always be prioritized. Telemedicine helps OB/GYNs provide that level of care at no inconvenience to th epatient. Observe Treatment Plans Especially for conditions like gestational diabetes and postpartum depression that require frequent monitoring remote video appointments are ideal. They allow you to keep close tabs on patient progress and you still get fully reimbursed for services rendered. Conditions OB/GYNs can manage using telemedicine:

• Postpartum Depression - Offering convenient access for women suffering postpartum depression is an essential part of providing perinatal care as an OB/GYN. Use telemedicine to frequently check in with patients suffering from depression and ease the burden of travel on these new mothers. Even for women who aren't suffering from postpartum right away, remote video appointments are an ideal way to monitor if such a condition develops during the weeks following childbirth.
  
• Gestational Diabetes - Once a woman is diagnosed with gestational diabetes, special meals plans, scheduled physical activity, and even daily insulin self-checks are essential for effectively managing the condition. Checking in with your patients, even as often as weekly, is necessary to understand the progression of diabetes and the effectiveness of the individual treatment plan. Instead of checking in with a non-reimbursable phone call, schedule weekly or semi-monthly telemedicine appointments to keep tabs on your patients suffering from gestational diabetes.
  
• Hypertension and PreeClampsia - Although in-person physical exams are often necessary to monitor the progression of hypertension to preeclampsia, frequent check-ups to discuss symptoms (such as headache, blurred vision, or sensitivity to light) can be done effectively over telemedicine. It also allows OB/GYNs to offer patients face-to-face interactions should sudden issues or concerns arise.
  
• Follow-up on Well Woman Exams - While annual Well Woman exams require a head-to-toe physical exam, following up on blood work and other screenings is ideal for a remote telemedicine visit. These remote visits also give OB/GYNs the opportunity to discuss how the patient can make smart lifestyle decisions in order to improve overall health – which is especially important when abnormal results are found.
  
• Family Planning and Preconception Care - Whether you’re managing birth control doses for patients not yet wanting to have children or assisting a couple that’s ready, telemedicine can be used for ongoing counseling, modifying lifestyle treatment plans, and adjusting hormone-based medications.

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Neurology

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Medication Management Many medications prescribed by neurologists have significant side-effects that must be closely monitored. Employing telemedicine for frequent med checks increases compliance and ensures that side-effects and drug interactions are managed appropriately. Lifestyle Counseling Many patients with neurological disorders require lifestyle counseling in order to slow the disease progression. Doing this over telemedicine is ideal in that a physical examination is not required. The ease of initiating a telemedicine appointment helps increase treatment adherence and promotes a closer doctor-patient relationship. Lab/Imaging Results Although patients suffering from neurological conditions need to be seen in-office for things like CT scans, MRIs and blood tests, bringing them back into the office to discuss results is often not necessary. In fact, it can be quite an inconvenience. Telemedicine allows neurologists to discuss these results face-to-face without asking patients to leave their home. Conditions Neurologists can Manage with Telemedicine:

• Neuropathy - Treating Neuropathy typically involves managing symptoms. Lifestyle counseling to help limit the disease progression and adjusting medications like antidepressants, antiepileptics and cannabis can all be done over telemedicine.
  
• Epilepsy - Although about 70% of cases can be controlled through medication, frequent in-office lab work is still necessary. Using telemedicine to adjust medications, discuss symptom progression, and the review of diagnostic imaging results and blood work helps minimize trips to the office for epileptic patients.
  
• Parkinson's Disease - Once someone is diagnosed with Parkinson’s disease, therapies involving the use of Levodopa or dopamine agonsists to help control motor function can be managed through telemedicine. Although in-person rehabilitation is required, neurologists can also use telemedicine to counsel patients on dietary changes, exercise adjustments, and palliative care.
  
• Multiple Sclerosis - Because many medications such as corticosteroids, interferons, and pro-/anti-inflammatory can cause serious side effects, frequently monitoring their progression is essential and can be done effectively over telemedicine. Additionally, reviewing liver and blood tests or offering emotional counseling can also be done through telemedicine without losing the face-to-face interaction patients desire.

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