"Genies out of The Bottle" - Which Top #Telemedicine Features to Keep Post #COVID19

#TelemedNow Twitter Chat Wednesday, May 6 – 8 PM ET Introduction & Welcome: Andrew Watson (@arwmd) -- Moderator "Genies out of The Bottle" - Which Top #Telemedicine Features to Keep Post #COVID19

Q1 Expanded billing helps #TelemedNow - expansion, engagement. How do we prevent a "rollback" to pre-Covid, how do we preserve billing?

A1 Notable Responses: Andrew Watson (@arwmd) How do we increase durable reimbursement? #TelemedNow. Not just a payer issue here. A lot has to do with value. Joe Babaian (@JoeBabbian) We have to look at several aspects, no? Political pressure is going to be major, right? #TelemedNow Helen Burstin (@HelenBurstin) Critical question. The fact that @CMSGov provided parity for telephone calls is a key factor. Gets docs and others ready. Need to get Medicaid and plans on board. Miss too many people if overly focused on Medicare. Ceci Connolly (@CeciConnolly) We have a blueprint for #telehealth reimbursement: #MedicareAdvantage. Value-based model rather than fee-for-service—no matter how care is delivered—frees up drs to use tools as they see fit. Should be standard for all coverage models. @_ACHP #TelemedNow Ceci Connolly (@CeciConnolly) Clinical teams focused on what's best for patient and money that flows in direction of value, not volume @_ACHP #TelemedNow Sandeep Pulim (@SPulim) Reducing barriers to care to support improved outcomes by keeping new points of virtual care delivery #TelemedNow Andrew Watson (@arwmd) Medicare advantage is probably the best place to show value for all of Telemedicine. Is such a good point Ceci. #TelemedNow. there is sufficient risk and challenges of access that should enable us to prove it here. #telemedicine Ritu Thamman (@iamritu) If we can show improved pt outcomes &pt convenience ie shorter wait times, ˅ readmissions, & time & money saved by eliminating travel, childcare, time off from work, & even cost:integrated workflows may coordinate care b/w care settings & providers & ˅ administration burden/$ Evan Kirstel (@evankirstel) If these regulations made us inflexible at a time of crisis, what sense is there in putting them back once the crisis passes? #telemednow Helen Burstin (@HelenBurstin) We also can't forget about those without coverage who need to access telemed. Loved @JuddHollander tweet today -- "More people are uninsured than "un-phoned." #TelemedNow Jorge A Rodriguez (@translatedmed) It will key to expand Medicaid coverage. This will take multistakeholder advocacy #TelemedNow Ritu Thamman (@iamritu) Perhaps #TelemedNow may also offer another solution: to give telemedicine services to low-wage, part-time employees who aren’t eligible for full medical benefits, which isn’t feasible under current law. Cory Simpson (@CorySimpsonMD) Agree it must be data-driven, but I don't know if now is a fair time to collect outcomes that represent normal #telemedicine. The #pandemic has been a great motivator to increase access/payment for #TelemedNow, but many providers are brand-new users, operating under stress. Cory Simpson (@CorySimpsonMD) I also think we MUST acknowlege a very inconvenient truth: #COVID19 will not be the last #pandemic. If we can leverage this current public health crisis as a "trial by fire," next time, #telemedicine will be old hat to the newbies. Using #TelemedNow prepares us for future crises. Ami Bhatt (AmiBhattMD) Agree! Technically the annual influenza deaths could be reduced by increased use of #TelemedNow especially in the winter season!! Jennifer Co-Vu (DrJenniferCo_Vu) If we can also prove improved patient outcomes, this would preserve billing. #TelemedNow Salim Saiyed (@SalimCMIO) Not just patients, but their families/ caregivers also. We had several dementia & elderly patients 100+ seen via #telemednow. It rattles their entire day to get them lifted up in transport, to bring to clinic, etc. & remain confused because of strange new clinic, etc Vahagn Nikolian (@VNikolian) We need to do research to understand what decisions can effectively be made using telemedicine. Reimbursement has traditionally incentivized unnecessary travel/wait times for patients by requiring in-person evaluation. #telemednow Stacy Hurt (@stacy_hurt) Demonstrable use for patients that insurance companies can’t combat in any way, shape, or form #TelemedNow Q2 How do we preserve the practice of #TelemedNow across state lines? #telemedicine? PA as an example - FSMB model law - A2 Notable Responses: Andrew Watson (@arwmd) #TelemedNow. I also don’t think the current model is sufficient to enable affordable and easy cross state licensing, but I could be wrong. There’s so many demands and doctors right now, this is one more aspect of paperwork that slows us down. I know many are trying Evan Kirstel (@evankirstel) Continue to Lobby CMS to relax more rules around telehealth, allowing care across state lines #telemednow Joe Babaian (@JoeBabbian) Study relating to the adoption of technology and our conversation tonight. #TelemedNow Health Literacy and Health Information Technology Adoption: The Potential for a New Digital Divide. Article: Health Literacy and Health Information Technology Adoption: The Potential for a New Digital Divide Ritu Thamman (@iamritu) One way states may see the value of #TelemedNow is that it may improve equity for patients who don’t speak English via built in translators & for those who don’t have access to smartphones or the internet -barriers are falling via @AjitPaiFCC rural initiatives @AmiBhattMD Helen Burstin (@HelenBurstin) Great new white paper today from @BrookingsInst on how to remove regulatory barriers to telehealth. Some have used Interstate Medical Licensure Compact @drturnerlee @jtkarsen @jordanrobertsnc #TelemedNow Jorge A Rodriguez (@translatedmed) Interesting, are you suggesting that patients may be able to access language concordant providers across state lines if they are not available locally? #TelemedNow Sandeep Pulim (@SPulim) Or provide access to medically trained interpreters via video remote interpreting (VRI) with providers & patients #TelemedNow Ami Bhatt (AmiBhattMD) Now it’s time to do large scale research demonstrating the efficacy and safety of #TelemedNow #Telemedicine during this #pandemic to drive the point home. Ami Bhatt (AmiBhattMD) Very easy to call in a video interpreter to video visits and such a great experience. Also important because it helps us solve for implicit bias in #Telemedicine #TelemedNow Q3 How do we maintain / increase provider adoption of #TelemedNow? #telemedicine TY @DonnaKLencki for this today - A3 Notable Responses: Joe Babaian (@JoeBabbian) Continue to educate providers and remove FEAR. Fear of lost connection with patients AND peers, fear of lost reimbursement, and more. #TelemedNow Jagdish Patel, MD (@jpkca) Agree. Unless front desk and staff byes in, it is difficult to carry out #Telemedicine #TelemedNow Sandeep Pulim (@SPulim) Mapping virtual care to clinical workflows 2) Patient intake and warm video hand-off to appreciate level of care 3) Ease of documentation #TelemedNow Ceci Connolly (@CeciConnolly) Think #COVID19 has proven to drs how effective #telemed can be. Need to make sure we are appropriately Andrew Watson (@arwmd) I also think the operational cost is still high, it’ll be curious to see volumes going into July and August. And when I say operational cost, I mean the time to actually do a visit. In other words, ease of use. #TelemedNow #telemedicine Ted Chan (@upwardmobility) The cat is out of the bag for #telehealth. Rework all patient acquisition and intake flows and care to include telehealth strategy or rapidly lose patients to digital health players and fast moving systems with huge budgets. Ami Bhatt (AmiBhattMD) to increase provider adoption of #Telemedicine we need to recognize that it needs to be part of the workflow. Admin assistants, nurses, case management all need to be part of the #TelemedNow solution ! Evan Kirstel (@evankirstel) Proper training needs to be provided for clinical staff as they change their way of working with #Telemedicine #telehealth #telemednow Jagdish Patel, MD (@jpkca) one of the limitation is CMS allowed Audio only as virtual visit has limited real A/V visit Ritu Thamman (@iamritu) Make the workflow streamlined, support physicians w technology by prepping the pt, including collecting patient demographics, insurance info, & consents for treatment, & integrated flow into EHR. All integrated -scheduling to final communication / billing #TelemedNow Jim St.Clair (@jstcliar1) I don't think we've defined the boundaries of the full range of #telehealth use cases #TelemedNow Jennifer Co-Vu (DrJenniferCo_Vu) Always make it available as an option for patients. There should also be parity in reimbursement for #Telemedicine vs office visits. This is important for RVU-based practices. #TelemedNow Cory Simpson (@CorySimpsonMD) Start early in the #pipeline. #TelemedNow should 100% be an essential part of #MedEd and #GME. If @acgmeand @AAMCtoday are not moving to make #telemedicine a required competency/milestone for students/residents, they are not properly preparing the next generation of physicians. Ami Bhatt (AmiBhattMD) Yes, There are many trainees interested in #Telemedicine .. our biggest challenge is engaging them in it and creating pathways to teach them, have them apprentice and do research. That falls to all the #TelemedNow tweeters today! Carrie Diulus (@cadiulus) Platform & pt ability to use needs to be simple & over stable wifi. Charting templates need to be straightforward. Prepping patient ahead and team updating meds, etc helps. Pt satisfaction is a big driver. The better the experience for the patient the more interested the provider Q4 How do we maintain or expand access to care? For patients, members, providers? #TelemedNow What will it take?

A4 Notable Responses: Ted Chan (@upwardmobility) Just ignore the EHR for most use cases. Insurance should be as easy as using a credit card. Don’t reinvent authentication, just use Google login. Make user experience a simple transaction. Ami Bhatt (AmiBhattMD) Local community centers, places or worship, health centers will be good locations for #Telehealth clinics, as not all individuals will have the #technology #data or #connectivity #TelemedNow Jim St.Clair (@jstcliar1) I reached out to the @PCHAlliance today to discuss working with @HIMSS on a "true" advocacy committee/task force. Docs, vendors, etc to develop guides/papers/etc to educate and advocate. Need to bend @AHIPCoverage's ear!#TelemedNow Joe Babaian (@JoeBabbian) Expanded access starting with group plans driving it. I/patient log on, first thing I see - a selection of #Telemedicine offerings, pricing, access information.... #TelemedNow Jagdish Patel, MD (@jpkca) one thing I learned in last six weeks is when I discharged Pt from hospital than I tell them what to expect from #telemedicine visit so there are no surprises #TelemedNow Ritu Thamman (@iamritu) we must help healthcare systems that treat poor, minority, & rural populations to participate in these data exchange & pooling efforts. “data quarantine “will disproportionately hurt these populations @rashmeeushah @CircOutcomes #TelemedNow Evan Kirstel (@evankirstel) We need to support those lawmakers looking to expand access to telehealth for Medicare beneficiaries like the ConnectAct #telemednow Jorge A Rodriguez (@translatedmed) Key to partner with community organizations. Essentially extending the barbershop + HTN management study, but with telehealth #TelemedNow Helen Burstin (HelenBurstin) Expanding access is key, but long way to equity. Recent study in @nejmcatalyst by @elainekhoong @sarahsnouri et al. Addressing equity in telemedicine for chronic disease management during COVID-19 h/t @jeffreylinder #TelemedNow

Jim St.Clair (@jstcliar1) "Equity" has to be driven by changing the cost model.. #telemednow Ceci Connolly (@CeciConnolly) Top of my list is broadband for so many pops currently w/out. @CMSGov recent flexibility allowing more services via phone is critical. Some issues can be handled with a simple call, and good to see greater awareness of this. @_ACHP #TelemedNow Cory Simpson (@CorySimpsonMD) Have to keep pressure on payors to continue to reimburse #TelemedNow to expand #AccessToCare. I imagine insurance adjusters factor in known barriers to care when setting rates. I hope #telemedicine brings down barriers, but do payors share that hope? Jim St.Clair (@jstcliar1) Why would they? Not being argumentative, just wondering their motivation #telemednow Ami Bhatt (AmiBhattMD) Take HTN and DM as examples: if we can have more continuous outpatient management of groups who classically don’t “need” in person visits but need more frequent monitoring and more education without stress, then we can improve care and payors will support us! #TelemedNow Jennifer Co-Vu (DrJenniferCo_Vu) One thought: Primary care offices (esp rural areas) can provide a place for patients to have access to subspecialists they refer them to via #Telemedicine #TelemedNow Stacy Hurt (@stacy_hurt) We need much more education and handholding for patients-like anything, we need to show them the benefits and applications in order to reduce their fear/anxiety of this new concept #TelemedNow Q5 How can platforms help maintain or expand #TelemedNow adoption? #telemedicine What role do platforms play? On the 3/20/20 SSA waiver 1135 -non-traditional platforms were included.

A5 Notable Responses: Jagdish Patel, MD (@jpkca) optimization of tele-platform with RPM and portability of solution will help #TelemedNow Sandeep Pulim (@SPulim) Definitely helped to expand adoption but HCPs are quickly realizing limitations as they are starting to think about long-term #TelemedNow Ami Bhatt (AmiBhattMD) connectivity is key. In #COVID19 times maybe people are willing to tolerate “glitches” but that patience will fade over time. #TelemedNow Jagdish Patel, MD (@jpkca) A5: #telemedicine covers the following issues Reduced travel time for working patients Access for the rural population Convenience Choice of the young generation Reduce no show in bad weather #TelemedNow Stacy Hurt (@stacy_hurt) Implementation should actively involve patients for adoption- if we educate patients about its advantages, it will reduce fear and increase usage- most #patients don’t understand #RPM #TelemedNow

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