AMA STEPS Forward® Series Announcement: [00:00] Hello, and welcome to the AMA STEPS Forward® podcast series. We'll hear from health care leaders nationwide about real world solutions to the challenges that practices are confronting today. solutions that help put the joy back into medicine. AMA STEPS Forward® program is open access and free to all at STEPSForward.org.
Taylor Johnson: [00:22] Hello, and welcome back to the AMA STEPS Forward® Private Practice: Attending to Business podcast, a 10-episode series exploring the business side of private practice. In this series, we talk about how to navigate business operations and practice efficiency solutions to create and support a thriving and sustainable medical practice business. I'm your host Taylor Johnson, manager of physician practice development at the American Medical Association. And I'm joined by my colleague and co host Meghan Kwiatkoski, program manager of private practice sustainability, also at the AMA. Collectively, we have two decades of experience in private physician practice, and we continue to support physician practices and our current work at the AMA. Before we start, I want to emphasize that this episode is for general informational purposes and should not be relied on as medical, legal, or other professional advice. Listeners are always encouraged to consult a professional advisor for any such advice. So to start us off today, let's go back to the basics from a high level. What is telehealth?
Meghan Kwiatkowski: [01:28] The AMA Telehealth Implementation Playbook does a really great job at explaining this. Telehealth, telemedicine, and related terms generally refer to the exchange of medical information from one site to another through electronic communication. So it's not just remote clinical services like it has been in the past. Telehealth can include real time audio/video communication that connects physicians and patients in different locations. It can include real time audio and telephone communications, store and forward technologies that collect images and data to be transmitted and interpreted at a later date, as well as interprofessional internet consultations between care teams.
[02:14] Taylor, you were managing a private practice at the beginning of the COVID-19 pandemic. Did your practice have a telehealth solution at that point, or did you have to implement one? Can you tell us what that was like?
Johnson: [02:28] So to be blunt, yes, I was managing a practice at the beginning of COVID-19, and no, we did not have a telehealth solution at the time. We had to scramble to find something that worked for our office. You mentioned the AMA's Telehealth Implementation Playbook, and it really is such a fantastic resource when you're trying to implement a telehealth solution. The playbook has a great framework for the implementation process, which we followed at a somewhat rapid pace because of the urgency of our situation. Basically, to start, you need to identify a need, which we obviously had due to the pandemic because we could not see a lot of our patients in the office. We had to form our core team that worked on the implementation of this project. So some of the things that we needed to consider were who in the practice needs to be involved and when? When should we involve the clinical staff? And then when should we involve the front desk staff? Did we want their input during platform evaluation, or did we want to wait until we were designing the workflow to pull them in? We really needed to outline how we would define platform success. So some of the things that our listeners can think about for this step would be, what are you trying to achieve with the implementation of this new platform? In my situation, we needed a space to conduct virtual exams for our patients that could not come into the office. Every situation is different. So it's very important that our listeners spend time and make sure that they understand what success looks like in their specific situation and their specific platform.
Johnson: [04:25] Next would be evaluating potential vendors. There are hundreds of technology platforms out there for digital health. It's important to take the time to compare each vendor and technology against these success factors that we just talked about, to make sure that the correct vendor is selected. And during the evaluation process, make sure that you look at the contract provided by the vendor. Are they able to meet your desired implementation timeline? Are they within your budget? What project management and implementation support do they offer? Then once a vendor is selected, and once we selected a vendor in my specific case, we had to design the workflow, prepare the care team and patients, and run through a few practice rounds of the implementation plan before we really rolled this out fully to all of the patients and the entire practice.
[05:25] So we evaluated our current workflow, and we tried to keep things as close to in-person visits as possible when we were designing our digital workflow. So we pulled in the clinical and administrative staff for their input on the proposed workflow and made adjustments based off of their recommendations. Then once we had a final workflow, we moved into information that our patients needed to make this a success. Now, in my case, we were implementing this during the pandemic. So we had very few patients in the office, and we had to find a way to communicate the new workflow to our patients. And the way that we decided to do this was via phone calls, emails, text messages, and our website. We really got this information out in every avenue that we could. And we knew it was a risk that our patients could be upset with the influx of communication that they were receiving from us, but surprisingly, we did not get a lot of negative feedback and the patients actually were very happy that we did everything we could to communicate this new process to them. And surprisingly, they caught on very quickly, which I think is also a concern, is that it will take several visits and rounds for the patients to become acclimated to the new workflow. So that was a huge help.
[06:57] And then once everyone was aware of the new plan, we scheduled a few patients on the new telehealth platform to make sure that the new workflow worked in practice. We had to make a few adjustments during this time so that everyone was comfortable but overall, it went pretty smoothly. And then we opened virtual visits to all patients and evaluated the status of the platform via surveys that we distributed to the staff and to the patients. I think that scheduling just a few patients on the platform first and making sure it worked before we completely rolled it out to everyone was really important. It was kind of like, you know, a little trial period. And so this is all covered in detail in that Telehealth Implementation Playbook. So our listeners can go there to explore the process in more detail, and we can link that in the podcast description below for everyone.
Kwiatkowski: [07:55] I was just going to add real quick Taylor, I think one of the key points that I want to underscore with any new process that you implement in a practice, communication is so key. Making sure that you're almost bordering on over communication, even if it you know can seem a little annoying, just to ensure that like not only your staff is on board and understands, but then your patients as well, because things change rapidly. We've talked about this a lot in private practice, and I think that that's ensuring that you have consistent, clear communication on all fronts is so critical.
Johnson: [08:30] Right, and Meghan, just to get your input, because I know that you do have such a great background in quality and process improvement. So I want to go back when I mentioned that we kind of did a little trial period with a few patients on the platform. Would you suggest a wide variety of patients, you know, with their age, and you know, everything like that just so that you're getting the best feedback, or how would you suggest that the staff that the practices identify those patients to test out their new workflow with?
Kwiatkowski: [09:06] For me, I would say start with a really small cohort, like I would open it up to the patients that you think would have the most trouble with it actually. Like I know, that seems counterintuitive, but the patients that you think would be most confused or most frustrated by the new process, the new technology, what have you, and sort of like pressure tested there with that small set of patients first. Obviously, they have to be willing to sort of be the testers here, but those are the people that are going to tell you, you know, I can't figure out how to work this or this doesn't flow right, or this isn't working and I can't find this. They're going to, they're going to tell you what's not working so that you can adjust to make it a seamless transition for the rest of the patient population. And then once you've read really worked out those major bugs, so to speak, then you can open it up more broadly to a larger set of your patient population. Obviously, in your case, like with COVID, it was a real emergent need. So there wasn't probably a lot of time for practices who were in a situation like yours to sort of go through those rounds of process improvement and testing and sort of like shake out, some of the bugs. So there was probably a lot of practices who were just sort of running with it and figuring it out as they went. But I think in an ideal situation, when you're doing something like this, to test it in a really small cohort first with people who are going to help you identify those big major issues, and then opening it up to a slightly larger round, if you have the time and the capacity to do so, and then opening it up beyond that to the rest of your patients.
Johnson: [10:50] I think that's right. And I think, you know, we both said that communication through this process is so key. So the patients that may have the most difficulty with it, like you said, they may be the least willing, but if you can communicate to them what your goals are, and why you would like them to be a part of this process. I think communicating that in the right way is really important.
[11:15] So I want to transition a little bit and talk about the telehealth landscape. I think it's evolving so quickly. And so I want to touch on the technologies and the impact specifically around medical coding. One of the biggest challenges when I was implementing telehealth in practice was payment for these services. Meg, can you tell us a little bit about how practices get paid for their telehealth services?
Kwiatkowski: [11:46] Yeah. I mean, I think obviously, the most important thing is to ensure that you are providing services, telehealth services in accordance with your state laws and regulations. Like that is like top billing the first and most important thing. As an example, many states during the pandemic relaxed laws and regulations related to telehealth services. You want to make sure that your practice is paying close attention to the federal changes and the changes within your state so that as things begin to be updated, that you are continuing to offer those services in accordance with your local regulations and the federal regulations as well.
[12:28] It is also important to note that coverage and payment for telehealth services does differ between insurance payers. So you want to make sure that you are reviewing your payer contracts for specifics on billing and coding these services. For example, payers…certain payers may require specific places of service or different modifiers to be listed on the claim. There are also several different codes for telehealth services which include evaluation and management visits, online digital check in visits, remote patient monitoring, self-measured blood pressure testing, and telephone evaluation and management visits. All of those things that I've just talked about listed, the AMA does have several resources on payment for telehealth services, so while we won't go into the details here--because I think that's a little bit beyond, you know, what we want to talk about today--we will link those in the podcast description as well so that our listeners can go investigate and learn more if they're interested. We've referenced the Telehealth Implementation Playbook several times, and that was designed for all physicians. It's not just those in private practice, but can you, Taylor, sort of talk about how private practices can utilize that playbook in conjunction with some of the other resources that we have to be successful in the world of telehealth?
Johnson: [13:52] So I would recommend starting with the telehealth playbook in those sections, but we also developed a private practice playbook that aims to help independent practices create a more efficient workflow. So use the concepts presented in the Private Practice Playbook when developing your telehealth implementation plan to really help streamline your efforts. And I know that we have covered so much in this episode, but Meghan, do you have anything to add?
Kwiatkowski: [14:27] I think all that I'll add to what we've already covered is just that telehealth really can truly be an asset to your practice, but it is important to implement it in a way that works best for your practice. So what's best for practice A might not be best for practice B that's down the road and that's okay. The goal is really just to utilize telehealth in practice so that it is additive overall.
Johnson: [14:55] That's a great way to end this episode. Thanks, Meghan.
Kwiatkowski: [15:00] Thank you, Taylor.
Johnson: [15:01] The tools and resources mentioned in today's episode are linked in the podcast description and available on the AMA website. CME is also available for this episode on the AMA's Ed Hub and linked in the podcast description. I'm Taylor Johnson and this has been Private Practice: Attending to Business. Thank you for listening.
AMA STEPS Forward® Series Announcement: [15:21] Thank you for listening to this episode from the AMA STEPS Forward® podcast series. AMA STEPS Forward® program is open access and free to all at STEPSForward.org. STEPS Forward® can help put the joy back into medicine by offering real world solutions to the challenges that your practice is confronting today. We look forward to you joining us next time on the AMA STEPS Forward® podcast series, STEPSForward.org.
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