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    Chris Harrop
    Chris Harrop

    The phrase “telehealth is here to stay” has become cliché, but the core thought resonates: Nearly two-thirds (65%) of healthcare leaders say they expect telehealth utilization to increase or stay the same over the course of this year.

    But just because your practice’s providers and staff might be confident in your virtual care delivery is no reason to not put more thought into telehealth services, especially when it comes to patients.

    Ann Mond Johnson, MBA, MHA, chief executive officer of the American Telemedicine Association, recently told HealthLeaders, “You have to [remember the] whole mantra of meeting people where they are virtually, digitally or in person. However that plays out, you have to recognize where they are in their own journey.”1

    Andrew J. Barbash, MD, co-founder of The Apractis Clinic, recommends that medical practice leaders take a big-picture view on telehealth programs, focusing on problems to solve and the best workflow to support those solutions. Especially given varying degrees of comfort with certain apps and interfaces, Barbash said it’s important “to make the technology part of [telehealth] … seamless, brainless and simple.”2

    “Take off your crisis hat and just think of what you want to do,” Barbash said. In many cases, that might mean evaluating what platform you use and the vendor that provides it. “You want a partner that’s looking at how you work and how you communicate with each other, and with your patients and eventually with other colleagues,” Barbash said.

    Measuring patient satisfaction may reveal that scores might be influenced by issues outside of technological hiccups. Administrators can assess how well providers have made the transition to more virtual visits and the unique ways in which the interaction with the patient has evolved based on a physician’s “webside manner.”

    “Some people are better at reading body language than others, and some people are better at languages, and some people use interpreters better,” Barbash said.

    Patient telehealth satisfaction on the rise

    A Feb. 16 MGMA Stat poll asked healthcare leaders, “Does your practice measure telehealth patient satisfaction?” The majority (57%) said “no,” while 43% responded “yes.” Among those whose organizations track patient satisfaction, 61% say scores have improved in the past year, compared to 7% who report scores worsened, while 33% noted “no change.”3

    The poll had 690 applicable responses.

    Other studies in the industry point to positive experiences with telehealth. A major study by J.D. Power of more than 4,300 patients in late 2020 found great patient satisfaction with telehealth during the early months of the pandemic, with overall customer satisfaction rated 860 on a 1,000-point scale — higher than all other healthcare, insurance and financial services studies done by the group.4

    The J.D. Power study pointed to patients citing five key performance indicators (KPIs) for telehealth:

    1. Spending enough time to provide quality care
    2. Completely resolving medical concern(s) during visit
    3. Following up after visit
    4. Resolving question/problem on first contact (online)
    5. Resolving question/problem on first contact (via phone).5

    Why do your patients want telehealth?

    With more COVID-19 immunizations happening daily, patients may feel more comfortable returning for in-person care. That may fundamentally change what your patients who opt for telehealth want from a virtual visit.

    Research done by patient access technology firm Kyruus found that nearly three out of four (73%) patients who sought a telehealth service between February and May 2020 had a pre-existing appointment cancelled or postponed, and the virtual care appointments they had largely involved seeing their existing providers.6

    Among those patients in the Kyruus report:

    • 41% were wellness check-ins
    • 30% were for chronic conditions
    • 24% were for treatment of an acute need.7


    Practices looking to understand patient needs should capture what types of telehealth visits are being sought on a regular basis as part of an evolving approach to the organization’s overall KPIs. By August 2020, one-third of healthcare leaders in an MGMA Stat poll said their practices were changing KPIs/metrics in response to the pandemic.8

    “The voice of the telemedicine customer is louder than ever before”

    Right before the pandemic changed everything, Martin Wright, partner, strategic consulting, Press Ganey Associates LLC, managed to get an elective podiatry procedure in March 2020.

    By the time of his in-person follow-up appointment to remove stitches, the waiting room was empty. Two weeks later, a follow-up with his podiatrist was done via laptop. The physician’s medical assistant sent an email reminder for the virtual visit days in advance, including directions and a link to test the system.

    For the appointment itself, Wright’s doctor spent the first few minutes “establishing trust with me,” Wright said. “He started by asking me if I was OK with how the technology worked … and he asked me if I was doing OK and really set the stage for a nice, cordial conversation.”

    Even with a chat between the two about baseball, the visit was over not long after it started. “We were done far earlier than I could have ever imagined, and I just have to tell you, I loved it,” Wright noted. “From a patient perspective, what would have taken me an hour and a half to drive and park, register, sit in that now-empty waiting room, check in, do the visit, check out, all that stuff — instead, the whole experience was 12 total minutes, from log in to log out.”

    Virtual experiences such as Wright’s matter more than ever as telehealth volumes continue at a rate much higher than before the pandemic. “The voice of the telemedicine customer is louder than ever before,” Wright said. “Patients are overwhelmingly positive about their virtual interactions, in particular with their care providers, even when technical issues create challenges.”

    Measuring people and process

    Press Ganey’s May 2020 whitepaper, The Rapid Transition to Telemedicine: Insights and Early Trends, highlighted data from the people side and the process side of telehealth services:

    • On the people side, there are questions about the likelihood of recommending the care provider, how the provider explained a certain condition and discussed treatments, and how the staff worked together to care for the patient.
    • On the process side, questions focused on the ease of talking with the provider over video, the ease of scheduling appointments and the audio-visual connections during the visit.9


    Splitting these elements of a virtual visit into two separate aspects of patient satisfaction helps a practice quickly determine if one side of the equation or another is contributing to the most-concerning scores received.

    In particular, the Press Ganey whitepaper showed that the people scores were great, yet the process side lagged behind. “The technology-specific items and process-related measures highlight an opportunity for enhancing the patient and physician connection,” Wright said. “And it really boils down to addressing the technical barriers that impede the consistent and reliable communication piece of the experience.”

    Key drivers of recommendations

    There were three top drivers for patients to recommend specific providers to friends and family, Wright said:

    1. The provider showing concern for the patients’ questions or worries
    2. The provider including the patient and his or her family in decisions that impact their outcomes
    3. The provider giving a clear explanation of the illness or the treatment.


    “When we get all three of those things right, there’s a 98.7% chance that patients will recommend the provider,” Wright said. However, when patients felt their care provider did not show concerns for their questions and worries, the scores for likelihood to recommend that provider dropped more than 70%. “These are behaviors over which the clinicians have full control; it’s independent of the technology,” Wright said. “This tells me there should be a continued focus on the interpersonal side of the visit and that it needs to be prioritized.”

    On the process side, some of the human elements were still strong drivers of whether patients would recommend a practice. Specifically, patients’ perception of the video visit staff working together to care for them was as strong a determinant of a recommendation as the ease of talking with a provider over video and the quality of the video connection.

    “What this data indicates to me is that we need to start with the people side and make sure that we have the right people with the right skills in the right roles to deliver that exceptional experience, and then we need to move to the process side,” Wright said.

    Virtual care competency assessments

    Scott Mondore, vice president, workforce engagement, Press Ganey Associates LLC, noted that 180- and 360-degree feedback assessments that are focused on care providers’ needed competencies and skills for effective virtual visits can be one way to measure where your team needs improvement.

    The 360-degree model includes a self-assessment, a supervisor’s assessment and ratings from peers and direct reports (if applicable). While normally focused on executive leadership, this model can be helpful in beginning a conversation about opportunities for improvement, Mondore said, including beyond your physicians.

    “Instead of just assuming that everybody can quickly transition to this approach of delivering care, it would be great for … nurses who are delivering care to see where they may have skill gaps, opportunities for improvement [and] opportunities for training,” Mondore said.

    Don’t leave patients hanging

    As the Kyruus research noted, much of the process and physician-patient relationship are focused on the pre-visit workflows that bring a patient and provider together to discuss the patient’s care, so it’s wise not to overlook “closing the loop on next steps” for that patient following a virtual care visit, as:

    • Only 35% of patients reported follow-up communication from a primary care provider
    • Less than half of patients (45%) noted they left a visit knowing what the next steps were, or clearly understood how to access virtual care visits in the future.10


    With the right set of metrics and the ability to populate that data for your care team and technology, there’s a foundation for long-term telehealth service line improvement and, in time, data to take to payers to negotiate for better reimbursement.

    Join MGMA Stat

    Our ability at MGMA to provide great resources, education and advocacy depends on a strong feedback loop with healthcare leaders. To be part of this effort, sign up for MGMA Stat and make your voice heard in our weekly polls. Sign up by texting “STAT” to 33550 or visit mgma.com/stat. Polls will be sent to your phone via text message.

    Notes:

    1. Roth M. “3 actions health systems should take now to bolster telehealth.” HealthLeaders. Feb. 16, 2021. Available from: bit.ly/3bQEN6v.
    2. MGMA. “Optimizing telehealth: Focus on your goals and workflows first rather than the technology.” Aug. 19, 2020. Available from: mgma.com/telebarbash.
    3. MGMA. “Almost one year into COVID-19, patient satisfaction with telehealth growing.” Feb. 18, 2021. Available from: mgma.com/stat-telesatisfaction.
    4. J.D. Power. 2020 Telehealth Satisfaction Study. Oct. 1, 2020. Available from: bit.ly/302OJ7z.
    5. Ibid.
    6. Kyruus. Patient Perspectives on Virtual Care. 2020. Available from: bit.ly/3rj0in0.
    7. Ibid.
    8. Moore N. “The KPIs that matter most in medical practices’ COVID-19 recovery.” MGMA. Aug. 19, 2020. Available from: mgma.com/stat-2020kpis.
    9. Press Ganey. The Rapid Transition to Telemedicine: Insights and Early Trends. May 19, 2020. Available from: bit.ly/3sGwyki.
    10. Kyruus.

    Chris Harrop

    Written By

    Chris Harrop

    A veteran journalist, Chris Harrop serves as managing editor of MGMA Connection magazine, MGMA Insights newsletter, MGMA Stat and several other publications across MGMA. Email him.


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