The Win-Win of Today's Telemedicine Technology for Small Practices

Healthcare professionals have been talking about telehealth and its potential benefits almost as long as there have been phones. Over the last five years, adoption of telehealth programs has increased steadily, but for some practices, particularly smaller, independent offices, the questions loom larger. How disruptive will adopting telehealth be to office workflow? Will telehealth overburden office staff? What are the risks involved in trying it? How will they get reimbursed for the investment? And, most important, what benefits can telehealth bring to the individual practice that offset the impact of the learning curve?

Unlike even one or two years ago, today’s answers are mostly positive.

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Reimbursement Is Real

Let’s tackle the big question first – reimbursement. Starting at the simplest point, most practices today give away a lot of practitioner time in telephone consults that are not reimbursable. Finding a way to generate revenue on even some of those would be a boon to most practices. But the news is far more positive than that. Thirty-five states, plus eight more pending, have enacted telehealth parity requiring certain payers to pay for telehealth consultations just as they would reimburse face-to-face visits. Private payers have been at the forefront of telehealth adoption, likely recognizing telehealth as a highly cost-effective delivery system for healthcare.  At the same time, a recent bill (The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017), has relaxed the restriction on Medicare reimbursements for telehealth, and while Medicaid reimbursement varies substantially from state to state, there are places where the reimbursement practices go further than Medicare. All practices should carefully review the rules and regulations in their states. Parity doesn’t always mean parity. This is why it’s an advantage to have a telehealth visit option that’s built into the EHR and practice management system, not a separate application. This ensures a smooth reimbursement process. For example, in Kareo when a video appointment is scheduled, the system automatically verifies that the patient is covered for telehealth. This removes much of the burden from the office staff and greatly increases the chances that the telehealth program will provide a revenue stream for the office.

What’s In It For Practices?

Beyond the potential for reimbursing telehealth visits, how will telehealth impact the operation of offices? First, telehealth can increase the number of daily or weekly visits without increasing the practitioner’s work hours because visits conducted via most well-designed telehealth systems take less time than an in-person visit. For example, a practice with three providers who each add two video visits per day, at an average reimbursement of $72, will earn an extra $103,680 in revenue over the course of a year. Telehealth also greatly reduces the number of no-shows and cancellations. Patients with a telehealth appointment are less likely to cancel because of work issues, transportation, child care, or just plain forgetting. An office appointment that has to be cancelled at the last minute can even be changed to a video visit, keeping the patient on track and not wasting the practitioner’s time. Having telehealth available makes a practice more competitive against the rising number of “convenient” healthcare outlets like urgent care, walk-ins and on-demand care.

What’s In It For Patients?

Perhaps most important, telehealth has the potential to improve patient health and increase quality outcomes since it provides an easy way to stay in ongoing touch with patients. The best use cases are for routine follow-up care where the appointment does not require a physical examination. For example, ideal cases for video visits are ongoing care for chronic conditions, observing treatment plans, reviewing slightly abnormal lab results, providing prescription updates, and discussing lifestyle changes for weight loss, smoking cessation and much more. Better quality outcomes also mean better reimbursement under today’s quality-driven healthcare system. Some of the specialties regularly using telehealth are:

• Primary Care
• OB/GYN
• Neurology
• Nephrology
• Mental/Behavioral Health
• Gastroenterology
• Endocrinology
• Cardiology
• Dermatology
• Pulmonology
• Infectious Disease
• Urology
• Hematology/Oncology

How Much Impact on Staff?

Traditionally, many providers have offered separate applications for telehealth, which required additional steps and training for office staff, making it more difficult to implement, especially for small practices. However, telehealth is now more feasible for all practices because new technology from Kareo integrates telehealth seamlessly into the EHR platform. For example, our customers can schedule telehealth appointments directly in their practice management system, maintaining current office workflow for scheduling, charting and billing with no extra steps or training required. The automatic eligibility verification removes much of the financial burden and produces on average 10 times the provider’s cost per visit.  Patients can request appointments online and conduct the visit through a mobile device or desktop.

Removing the Risk

In busy practices, all changes can feel risky in terms of impact on staff, patients and investment costs. The integration of telehealth with popular EHR platforms removes much of the impact on staff. Since more than 64 percent of patients say they would be happy to have a telehealth video appointment, the offering to patients is far more positive than negative. Finally, the investment risk has dropped to minimal. EHR providers that offer software-as-a service, such as Kareo, are now giving practices a chance to pay per telehealth visit, thereby being charged only for what they use. These low per-visit fees reduce the start-up burden on small practices, so the financial risk drops to negligible. In this way the office can implement a telehealth practice at its own pace, allowing reimbursements to keep pace with usage.

Chances are good that even the overworked independent practice can use today’s telehealth technology as an opportunity to increase revenue, unburden staff, and enhance patient satisfaction with the most minimal of investments. After years of promise, telehealth has become a win-win.

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