The AMA’s Telehealth Immersion Program is designed to guide physicians, practices, and health systems in optimizing and sustaining telehealth at their organizations through a series of webinars, interactive peer-to-peer learning sessions, virtual discussions, bootcamps and resources on-demand. We invite you to this forum to continue the conversation from our latest Immersion Program sessions as a way to connect with our presenters, panelists and program participants.
The AMA Digital Health Research surveyed 1,300 physicians in three regular intervals between 2016 and 2022 to investigate physician motivations and requirements for integrating digital health tools into their practices. According to the AMA survey, the following adoption trends among physicians are helping to propel the digital transformation of health care. Read the findings and ask questions of the team in tomorrow's discussion: https://www.ama-assn.org/system/files/ama-digital-health-study.pdf
We are questioning our understanding of the documentation requirements for billing 99212-99215 virtually. We use a real-time video call platform for these visits. Do we have to document the provider and patient locations, i.e. Patient located at home in Mesa AZ? Do we have to document the transmission start and end times of the video calls?
How might we better enable doctors to play their newly expected role of digital health advisor and better engage their patients in digital health?
A commonly cited regulatory barrier to telemedicine adoption is licensing and credentialing. What can be done to improve this process?
We really need to embrace a universal license, or at least more states to join the interstate medical licensure Compact. Credentialing by proxy is a much more streamlined process which can help decrease the barrier for health care workers to have multiple state licenses and credentialing in multiple sites.
I think there is a great deal that happened to improve this as a result of COVID-19 pandemic. With the stay at home orders and restricted travel, when health care clinics were closed and families were hesitant to expose their loved ones to crowded hospital where risk of infection was high, the need for Telehealth services skyrocketed. For this reason, licensing requirements, particularly, interstate practice license requirements were simplified and relaxed. With this in mind, it is important to have those who are given license to practice Telehealth, be properly trained and possess the correct expertise, so that licensing is just a matter of paperwork. One option would be that if a person is licensed and credentialed to provide in person care, that ability to do Telehealth practice should be included. Licensing reciprocity, interstate license, and transparency about the qualifications of Telehealth provider may help reduce barriers currently. Also, many states have temporary processes that allow Telehealth, which can be a good potential for being made permanent.
I found the article below to be helpful also.
Having federal credentialing and one license - since this seems unlikely to happen, having cross state agreements for telehealth can help also. This barrier makes it hard to improve access for rural and smaller hospitals to specialists.
How can telehealth be used more widely in low-income and rural communities? What are some of the unique barriers to adoption in safety net hospitals and in rural areas? What some ways to overcome these challenges?
One of the main barriers is connectivity. We saw during the pandemic that many rural areas children were left behind when their schools went online because they were much more likely to have inadequate connectivity. The same is true in health care. Many rural areas embrace the technology as it serves to help them to keep more patients local by bringing specialty consults to the bedside. When patients are safely admitted locally, this helps with revenue and keeps rural hospitals open to care for their communities.
Telehealth can be in important and valuable tool for rural and low resource areas where access to healthcare, particularly specialists is limited. The two major barriers are pre-arranged agreements with clinicians and healthcare system, so that this becomes part of the network that patients have access to. Another challenge, as mentioned by Dr. Rhone, is connectivity. This may be a bit more challenging to overcome, but it appears that the problem is becoming less widespread as it used to be. One great option would be mobile device apps such as patient portals, where a patient can communicate with their primary care provider and their specialty needs can be met through connecting with a specialist in the network.
The FCC was committed to improving connectivity although it is still a large problem. Some of the solutions were having centralized places for care in community centers etc. For provider to provider consults within hospitals, connectivity is less of a prob but needs to have providers trained and partnerships with hub hospitals to access specialists. It requires devices, connection, training, and engagement. Research demonstrates it works and improves patient outcomes.
We found adaptation onto health tech platforms a challenge in that populations are hesitant to adapt with privacy and technical literacy. We know it’s a new frontier on the innovator side and even more so on the patient/tech user side. I think what may help support adaptation is promoting self-empowerment tools / patient rights education so that populations feel empowered to self advocate and believe using these new tools will “work” as a new viable treatment option. I believe adaption to tech platforms is becoming more commonplace but for underserved communities and rural populations - the irony being tech enables to penetrate these communities more - and yet we also have the opportunity to address the distrust folks have when it comes to pursuing medical care - and also over a tech-enabled platform. Ultimately I think the opportunity lies in media advocacy and education.
What are the major lessons you’ve learned from COVID-19? How have the flexibilities granted during the pandemic helped you grow your programs?
The waivers that were introduced during the public health emergency relaxed the licensing and credentialing requirements for health care providers. Many patients could be seen at home, which allowed for us to provide continuity of care for our patients. We especially saw decreased no show rates in many of our behavioral health patients who liked being seen from home. In addition, we didn't see a backlash of un or underqualified providers engaging in dubious or malfeasant patient interactions as some had feared prior to the pandemic. We proved that telemedicine works in many settings and doesn't cause inferior care.
Please see my answer to the previous question on regulatory barriers.
We had a running program when the pandemic started so we had to scale - it was easier than starting from scratch and we recognize that it was a unique position. Using telehealth for other programs was aided by the waivers since it was easier to get more people on board and answered questions we had about how to expand our running programs. It was a huge change in perception. On a more personal side, I hadn't previously organized trainings and QA for telehealth and had to do it quickly - I hadn't predicted that I would need it. It's a lesson on formalizing processes rather than relying on any individual as you don't know when it will be necessary.
Welcome to a follow-up Q&A from our most recent Telehealth Immersion Program session co-hosted with the American College of Emergency Physicians (ACEP), Clinical Case Study: Telehealth for Emergency Medicine. We had such an engaging discussion and didn't have time to answer all the questions so are pulling in our speakers to answer additional questions over the next week. If you missed the session, you can watch the recording here: https://bit.ly/3LlpiEm
Jeffrey Davis, Director of Regulatory and External Affairs, ACEP
Aditi U Joshi, MD, Chair Emergency Telehealth Section, ACEP
Kelly Rhone, MD, Interim Chief Medical Officer and Vice President of Outreach and Innovation at Avel eCare
Mohsen Saidinejad, MD, Director of Pediatric Emergency Medicine, Ronald Regan UCLA Medical Center