Embracing Telehealth During COVID-19

How Can Your Dermatology Practice Effectively Move to and Embrace Telehealth Options?

An increase in the utilization of telemedicine and telehealth is one of the many ways medicine is changing because of the novel coronavirus. Many dermatology practices have begun making a hard pivot toward telemedicine. In fact, some practices are converting as much as thirty percent of their scheduled visits to telemedicine visits. If this isn’t something you’ve already embraced in your practice, perhaps we can help make it more obtainable. Let’s take a closer look.

What are telehealth and telemedicine?

Telehealth refers primarily to the distribution of health-related information and services via electronic information and telecommunication technologies. In particular, it has proven helpful for long-distance patient and clinician contact, care, advice, appointment (and other) reminders, education, intervention, monitoring, and even remote admissions. Telemedicine, in comparison, refers specifically to providing remote clinical services (whereas telehealth also applies to non-clinical services). Telemedicine may be more socially accepted in some circles. Still, both are heavily practiced now: A 2016 study found that telehealth would be a billion-dollar industry by 2018, with more recent reports showing even more tremendous growth: $40 billion by 2019, and $130 billion by 2025.

Why embrace telehealth options?

For starters, even beyond that huge market referenced above, telehealth offerings might be one of the best ways to help keep the lights on in your practice—with the added benefit that it may help position your practice at the forefront of a post-COVID future. Not only did the Department of Health and Human Services (in concert with the Centers for Medicare and Medicaid Services (CMS)) relax privacy and payment regulations to help encourage telemedicine visits, but telemedicine visits are also now reimbursed at the same level as office visits. So why embrace telehealth options? Let’s look at five of the best reasons your dermatology practice can embrace telemedicine right now:

  1. Your costs might be lower for telemedicine visits (depending on staffing and equipment, of course). Still, your reimbursement may be the same as for a regularly scheduled office visit, meaning you can make more per visit.
  2. Telemedicine allows you to provide care while still observing appropriate social distancing, meaning you can provide services you might not be able to offer in-office currently.
  3. Telemedicine helps ensure you can serve your patients right now. It also keeps revenue flowing to your practice, and can help your practice better position for the future, as some prospective patients may find connecting via telemedicine safer than an in-office visit.
  4. Many patients find telemedicine appointments more inviting than in-office appointments, as they can get care (or at the very least, consults) from the comforts of their own home—and that can continue to be the case even after social distancing.
  5. You can also drastically increase your potential patient pool, as telehealth might allow you to serve a much larger market, including rural and otherwise underserved populations.

How have other practices and companies used telehealth and telemedicine?

As you might imagine, other companies have steadily embraced telemedicine as a competitive advantage in recent years, chief among them Walgreens and First Derm. Walgreens introduced “Find Care Now” and the MDLive platform, a digital health service offering a mobile platform on which Walgreens customers can get access to medical professionals. While MDLive mainly offers access to online services such as telemental health and non-acute urgent care, Walgreens also partnered with large healthcare providers such as New York’s Presbyterian Hospital, Atlanta’s Piedmont Healthcare, and Chicago’s Advocate Health Care. Rite Aid similarly added kiosks and digital access for their own partnership with telehealth provider InTouch Health, and First Derm has positioned itself as a premier telehealth dermatology provider—noting proudly on their website that they already have “over 50,000 dermatology cases answered.” Walgreen’s MDLive platform and Rite Aid’s InTouch partnership both denote that skincare (including acne and rash treatments, for instance) are some of their most common applications. As a result, all three—Walgreen’s MDLive, Rite Aid’s InTouch partnership, and First Derm—take significant business away from dermatology practices, business that might otherwise go to your practice.

Perhaps your practice is among those feeling the disruption caused by other competitors expanding their telehealth options. Even if you are not, however, there are numerous reasons (as previously detailed) to embrace telehealth options, as well as a range of what those options might look like for your practice.

What might telehealth and telemedicine options look like for your dermatology practice?

Let’s look at some of the ways you might embrace telehealth and telemedicine in your dermatology practice:

  1. Managing chronic conditions. For patients you’ve seen previously and for whom you help them manage chronic conditions, telemedicine can help you with managing reviews, medication refills, and more.
  2. Store-and-forward for simplicity. When working with other care providers, and especially for mild and non-acute issues, telemedicine can help you with treatments. Patients can share images of their skin illness or abrasion, and you or another provider can offer an assessment upon review, thus reducing diagnosis time and simplifying treatment, especially in this era of social distancing. Similarly, consults can be simplified by telemedicine.
  3. Consult without requiring an office visit. When working with referring providers, telemedicine consults can help limit face-to-face interactions while still allowing you to provide care. They can similarly be a way in which your practice can help patients in underserved areas or rural areas observe stay-at-home orders and still get the care they need.
  4. Simplify follow-up processes. For patients who need lab results, require a follow-up after a recent illness, or who are on medication maintenance, an in-person examination may not have been necessary previously and certainly isn’t necessary now as we are all being asked to limit our travel. Instead, telemedicine can allow your practice to provide that care still.
  5. Improve patient satisfaction. A study found that telemedicine services may have a 95 percent satisfaction overall. Patients generally report enjoying both the convenience and flexibility telemedicine can offer.
  6. Remote access. Telemedicine has the added advantage of allowing your employees and care providers to work remotely, meaning you can use more of your staff during this distancing phase without worrying about needing them in the office.

What might be appropriate for telemedicine?

While you will need to determine what kind of care your dermatology practice is willing to provide via telemedicine, JAMA Dermatology and the American Telemedicine Association (ATA) generally support virtually treating conditions that are 1) non-acute or mild; 2) do not present physical danger to the patient; 3) require routine follow-ups. Such conditions might include acne (and other common diagnoses), viral skin lesions, pigmented lesions, biopsy or skin cancer follow-ups, and general disease management. The ATA also generally supports additional consults for preventative care.

Again, though, every provider will have a different standard, and you’ll need to determine what standards work best for your dermatology practice. While telemedicine cannot and will not wholly replace in-person care, it can be an excellent option for some kinds of appointments.

Interested in more information about how to best embrace telemedicine in your dermatology practice? The American Academy of Dermatology has a COVID-19 specific telemedicine toolkit and their Teledermatology and COVID-19 webinar may well be worth a watch as an hour chock-full of good data and implementation ideas.

Medicare-specific telemedicine guidance

As previously noted, the Centers for Medicare and Medicaid Services (CMS) released guidelines broadening access to Medicare telehealth services and including an 1135 waiver allowing Medicare to pay for office, hospital, and other visits furnished via telehealth. Let’s look at a few key takeaways for your dermatology practice and telemedicine:

  • The Office for Civil Rights (OCR) will use discretion in collecting penalties when it comes to “good faith use of telehealth.” This means that care providers may use popular (private) video chat applications such as FaceTime, Google Hangouts, or Skype to provide telehealth without risk that OCR may seek a penalty for HIPAA noncompliance. (This does not, however, mean that care providers should use public-facing communication services such as Facebook Live, Twitch, or TikTok, which still may constitute a violation of HIPAA rules.) You may still, however, wish to inform patients of the potential security risks as well as potentially enter into HIPAA business associate agreements (BAA).
  • Dermatologists can bill for telehealth visits for any patient in any location as those restrictions have been lifted on telemedicine billing.
  • Virtual E/M visits are now considered the same as in-person visits and are paid at the same rate as regular in-person visits. Virtual visits can also be based on medical decision-making or time rather than documentation of history or a physical exam in the medical record.
  • Physicians and non-physician clinicians can provide telehealth services from their home while continuing to bill from their currently identified practice location without needing to update this in their Medicare enrollment.
  • Dermatologists can provide supervision to non-physician clinicians virtually through real-time audio and video technology.

There’s a great deal more in the CMS guidelines, too, of course, so you may wish to read the full CMS FAQs here.

Questions?  Let one of our experts help. Contact us today.

 

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