Telehealth Toolkit for Physicians and Advanced Practice Providers

Although telehealth has been around for decades, the last few years have seen tremendous growth in the industry. By 2027, the industry is expected to reach 82 billion dollars, with a forecasted compounded annual growth of almost 18%. According to the American Telemedicine Association, the definition of telemedicine is the remote delivery of healthcare services and clinical information using telecommunications technology. This includes a wide array of clinical services using internet, wireless, satellite and telephone media. Thanks to advances in technology and legislation, the definition is continuously evolving and expanding.

Payers have also begun reimbursing for more services, and most importantly, patients have accepted and now expect telemedicine options from their medical providers and their practices. COVID-19 changed the healthcare landscape and shined a light on what others users have been reporting for years: patients are typically more satisfied after telehealth appointments than with in-office appointments because they save time commuting and skip the waiting room. Patients who do travel to healthcare facilities to receive specialty care via telemedicine report positive experiences too, including improved continuity of care and increased access to services. Maybe you have finally decided to dip a toe in the water. Providers are becoming more open to treating and monitoring patients through a variety of virtual options. Is it right for you and your practice? We hope this toolkit will help answer your basic questions, provide excellent resources and give you a solid introduction to telemedicine and the many benefits it brings.

What are the different types of teleheath?

The main types of telemedicine are synchronous, asynchronous, remote patient monitoring, and mHealth.

Synchronous

Synchronous means that the telemedicine encounter is happening live in real time, with a provider communicating and interacting with a patient via video with audio. Through synchronous sessions, patients can receive care in a variety of settings.

Asynchronous

Also called store-and-forward, this allows the provider to seek a second opinion or consultation from another provider by securely passing along the patient’s pertinent health information through a secure system for review.

Remote patient monitoring

Remote patient monitoring consists of technologies that allow clinicians to monitor certain aspects related to a patient’s health. Examples of remote patient monitoring technology include continuous glucose monitoring, pulse oximetry and blood pressure devices. The collected data can be electronically uploaded and reviewed to create a picture of patient progress over time.

mHealth

mHealth, or Mobile health, refers to encounters conducted or healthcare information disseminated through a patient’s mobile device such a smart phone, tablet or personal digital assistant and supported by a wireless infrastructure.

How is the licensing, credentialing and privileging done for telehealth?

For credentialing and privileging, each organization’s bylaws will have their own specific requirements, as will the payers who ultimately reimburse you for telemedicine services. The credentialing and privileging process will require the same paperwork that is required for practicing medicine in the physical setting.

According to the Federation of State Medical Boards, you must be licensed in the state where the patient resides, not where you reside. Twelve state boards issue a special purpose license, telehealth license or certificate, or license to practice medicine across state lines to allow for the practice of telemedicine, and six state boards require physicians to register if they wish to practice across state lines. For more licensing information, check out our Telemedicine Law Map.

*It’s important to note that COVID-19 prompted a tremendous amount of temporary legislative changes. These changes loosened licensing restrictions to help improve access to care, HIPAA laws for video chat and altered some prescribing methods for telehealth clinicians. Because these measures are temporary please keep up-to-date with changes by visiting our Legislative Updates for Coronavirus page.

How does reimbursement work for telemedicine?

Reimbursement measures for telemedicine have improved significantly, as more patients embrace it and more providers and payers see the efficiency and cost-improvements it can bring to healthcare delivery. Right now, 37 states and the District of Columbia have private payor parity laws, and more have pending legislation. Parity means you’ll be reimbursed for telemedicine encounters the same as you would for face-to-face encounters.

Because parity and reimbursement laws vary by state, it’s important to ensure you thoroughly understand each state’s specific legislation. You can find more detailed information by state by visiting the Center for Connected Health Policy.

What kind of technology should I expect?

The most basic equipment required for a telemedicine encounter is a laptop or desktop computer with camera and microphone capabilities. If you are building a large-scale program that requires mobile carts or robotic units then more research must be done for interoperability and scalability.  Just like cars, you can have the economy model up to the finest, state-of-the-art technology available.

Telehealth platforms and EHR integration are important factors, but not all programs require complex solutions. It is paramount that the firm you partner with helps you build a tailored program that will fit your practice and grow with you.

In addition, you will need access to support. LocumTenens.com provides 24/7/365 technology support should you or your patients run into any issues.

Is there training available?

Training options vary, depending on the specialty or who you partner with to provide virtual consultations. Almost all technology providers offer training and technical support to ensure that clinicians are comfortable with the equipment.

Although there is no mandated telehealth certification program or telehealth-specific license required to practice, certifications do exist. Ensure that any certification you choose to pursue is accredited by the American Telehealth Association.The American Telehealth Association also offers practice guidelines.

What does a virtual visit look like?

When it comes time to have that first virtual patient visit, what should you expect? Most physicians and advanced practice providers find that building a relationship with patients across the screen is just as easy as when they have to do this face-to-face. Some providers find that the virtual setting helps them focus even more on the patient, as the normal distractions of the office and hospital are removed.

When it comes to preparing for your first virtual consult, the most important part is having a clear understanding of the expectations of the facility in which you are working. A good analogy would be painting a room. Painting is easy itself. The prep work is the hard part. Prep work for a virtual visit takes place months to weeks before you are able to provide a proper encounter. Focus on EMR training, learning a facility’s policies, building workflows and familiarizing yourself with the staff.

Tips for ensuring a positive and meaningful encounter for you, the facility and the patient include:

• Make sure that you are in an environment where you aren’t going to be interrupted. 
• Think about how you will be presenting yourself and how you will look and sound to the patient.
• Make sure the patient is comfortable. Ask the patient if they’ve met a doctor virtually before. If they haven’t, discuss the basic process and procedures for having a tele visit.
• Test the technology before connecting with a patient by participating in training and conducting trial runs.