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Telehealth

Overview

Telehealth allows physicians to stay connected and provide care to patients without an in-person visit through the utilization of telecommunications.

Key Considerations

Why should I utilize telehealth in my practice?

Telehealth allows for the continuation of care in a way that reduces the likelihood of infection and transmission of disease and eases the strain on the delivery system.

For these reasons, the CDC has recommended care be delivered virtually during the COVID-19 crisis as the best way to protect patients, physicians and medical staff. Beyond COVID-19, telehealth grows practices and improves access to care by providing alternative points-of-care and appealing to the technology-enabled populations.

What should I consider when implementing telehealth into my practice?

  1. Select a telehealth platform (see platform selection considerations below)
  2. Set up needed technology and equipment
  3. Incorporate telehealth into your existing workflow
  4. Inform patients of new telehealth offering
  5. Inform medical liability insurer of new telehealth offering
  6. Consider the services and circumstances under which these services are being provided for reimbursement.
  7. Schedule visits with patients

  1. Keep webside manner in mind (wear white coat, conduct video in private setting, say “hello”, check audio and visual)
  2. Obtain patient consent for the service before or at the start of the visit
  3. Triage patient care
  4. Integrate devices (Apple HealthKit, Tytocare, etc.)
  5. Obtain patient payment at time of service

  1. Document patient care
  2. Billing and payment for telehealth ranges by payer. Most up-to-date information can be found on Telehealth Reimbursement and Privacy Laws, through CMA’s FAQs, or through CMA’s economic services groups at economicservices@cmadocs.org.
  3. Schedule follow-up care
 
What other things should I consider when selecting a telehealth platform?

There are a variety of telehealth solution options, with the most common being EHR-integrated options and standalone options.

  • EHR-Integrated Options: Offered through EHR system, permits integration with one or more telehealth solution platforms.
  • Standalone Options: Permits use of your own EHR system and practice management services, while offering a telehealth solution directly to a practice.
    • Note: During COVID-19, federal and state privacy rules are not being enforced, temporarily permitting nonpublic facing remote tools such as Skype and FaceTime.

  • Training Modules
  • Patient Forms – intake and consent
  • Scheduling assistance
  • Point-of-care patient payment collection
  • Patient engagement & marketing support (push notifications, emails, office flyers)
  • Device integration, allowing data to be pulled from at-home devices and used during the visits (Apple HealthKit, Tytocare)
  • Clinical decision-making support
  • Ability to use with existing patients and under existing payer contracts vs. joining a medical group

Consider barriers to access. The more platforms a telehealth solutions operates on – mobile application, desktop browsers, etc. – the more options your patients will have.

  • Time to get the platform up and running
  • Equipment, upload/download speeds, and operating system requirements
  • Technical support offered
  • Optimal browsers
  • Ability to upload and store files/photos
  • Support of chat, mobile health, live videoconferencing, and/or remote patient monitoring

Federal and state privacy and security (HIPAA, HITRUST certified).

  • Setup fees and monthly or yearly cost
  • Month-to-month contract or monthly termination
For more detail, refer to the CMA Webinar on Implementing Telehealth in Your Practice.
 

Frequently Asked Questions

Telehealth Implementation

Telehealth is a mode of remote care delivery using electronic information and communication technologies. Under California law, it is defined as “a mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient is at the originating site and health care provider is at the distant site.” Cal. Business and Professions Code 2290.5.

Some malpractice coverage does not draw a distinction between traditional care and telemedicine or telehealth. Other malpractice coverage may not cover telehealth and would require underwriting approval or change in coverage and premiums before telehealth services can be provided. However, most of these malpractice companies have relaxed those restrictions and will not require prior underwriting approval or a coverage and premium change for telehealth services provided during the state of emergency.

As such, you may want to reach out to your malpractice insurer to inform them you are practicing telehealth, if it is a new modality of your practice.

During the COVID-19 outbreak, please refer to CMA’s COVID-19 Telehealth Toolkit document for the most up-to-date information on telehealth considerations.

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