Delivering care differently in the age of COVID-19, through virtual care

March 20, 2020 |  Patient Safety, C-level, Coronavirus

Attractive female doctor working on her laptop in her office-1The COVID-19 pandemic is likely to test modern healthcare in ways never seen before. Physicians and nurses worldwide are being called to service, risking their own well-being to help an alarming volume of ill and worried patients. How we manage this emergency depends largely upon the quality of tools available to help us improve safety for our patient and clinician communities.

These tools include technologies that can help slow the spread of this new, highly transmissible virus through social distancing, allowing us to work with patients to determine the most appropriate venue of care.

As essential as hospitals are during this time, it is critical that we continue to stretch the limits of medical care beyond traditional settings by testing the capacity of contemporary digital tools that can help us adapt to delivering care in a variety of new settings. While governments are either mandating or strongly suggesting the cancellation of elective procedures, how can we continue to serve those patients who still require hospital care, as a tidal wave of novel coronavirus infections threatens to drown our systems?

Virtual care is an important and necessary part of the solution. In the U.S., the Coronavirus Preparedness and Response Supplemental Appropriations Act is expanding Medicare’s telemedicine coverage beyond rural areas, to enable millions of seniors to access their providers without risking infection.

As part of the 1135 waiver, Medicare will pay for office, hospital, and other visits furnished via virtual care across the country and including in patients’ places of residence, starting retroactively on March 6, 2020. A fact sheet published by the CMS states that these virtual care visits will be considered the same as in-person visits for the duration of the pandemic, and will be paid at the same rates.

This means that older patient populations, who are at the highest risk of serious coronavirus complications, can now visit with their physicians remotely for any reason - whether they are having COVID-19 symptoms or just need follow-ups for their ongoing health issues. Remote screening through virtual visits enables providers to better direct all of their patients, regardless of COVID-19 symptoms to the most appropriate setting. Engaging these vulnerable patients through virtual visits could go a long way in helping to prevent infections in crowded public health spaces, while also protecting staff from exposure.

Another promising piece of legislation is a change to HIPAA Privacy Enforcement policies. The HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations during the pandemic, for providers serving patients in good faith using everyday communications technologies. This includes non-public facing video applications like Skype, Google Hangouts, and Facebook Messenger.

"More older Americans will be able to access healthcare they need from their home, without worrying about putting themselves or others at risk during the COVID-19 outbreak," said HHS Secretary Alex Azar, in a press release.

"Providers will be allowed to use everyday technologies to talk to telehealth patients. More telehealth services will be covered for millions more Medicare beneficiaries, and providers will be allowed to offer these telehealth benefits at a lower cost than traditional services."

Virtual visits will also enable providers to reduce the volume burden at their facilities, while vetting patients to determine which ones should be seen in person. This will be paramount to controlling the spread of illness to both the clinician staff and the community at large, as we continue to best serve the needs of all patients.

Here are a few best practices to keep in mind, as you get started with conducting virtual visits:

  • Obtain verbal consent from your patient at the beginning of each visit, and document it. A sample opening script for physicians would go something like this: “Hi ________. This is Dr. ________. Can you see and hear me okay? With recent concerns about the coronavirus, we are trying to minimize exposure to you by shifting to telehealth appointments whenever possible. It restricts me from performing an exam, but the trade-off is protecting you during this pandemic. Do you consent to this option? If not, I would be happy to see if we can reschedule your appointment in the future, when feasible.”
  • Document a start and end time for each visit. Each call should be at least 5 minutes in duration.
  • You cannot bill for a virtual visit/call under certain circumstances. These include: 1) if the visit relates to a service provided within the previous 7 days, or 2) if the visit leads to scheduling a service and/or procedure within the next 24 hours, or at our next soonest available appointment. In these cases, the visit would be considered a non-billable service.

The coronavirus is forcing all of us to live our lives differently. Social distancing may be the most important behavior we put into practice this year. The sooner healthcare can follow this trend and find new ways to serve our patients, the safer we will all be in the coming weeks.

We're all in this together. We're sharing our latest updates and strategies for managing the current COVID-19 pandemic, along with those from our customer community.

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Written by Steven Jones, MD, Lead Physician Informaticist, MEDITECH

Steven Jones, MD, MPH has been a Board-Certified Family Practitioner since 1999. His experience includes the full range of family practice — obstetrics, pediatrics, adolescent, adult, and geriatric medicine — whether delivered in the inpatient, outpatient, or nursing home setting. In late 2011, Dr. Jones joined MEDITECH as our lead informatics physician. In that role, he now is responsible for the development of the user experience for all of MEDITECH's physician-facing products. He also serves as the lead clinical adviser for MEDITECH's Patient Safety team, playing a central role in all quality reviews. He plays an active role on MEDITECH's Patient Safety Review Board, participates in multiple other clinical projects, and maintains his practice as a Family Practitioner in southern New Hampshire.