Payer rules, patient ease of use top telehealth challenges for medical practices

The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders: “What is your greatest operational challenge in providing telehealth services moving forward?” A majority (39%) cited payer rules/reimbursement; 23% noted patients’ technological knowledge and access limitations; 15% reported technological issues (e.g., connectivity and support); 11% pointed to buy-in (by patients, providers and/or staff); and 10% noted workflow and scheduling as their greatest challenge. “Other” accounted for 4% of responses.

The poll was conducted June 2, 2020, and had 515 applicable responses.

Payer rules/reimbursement

Practice leaders frequently noted that payer inconsistency regarding rules for payment of claims was a top challenge, complicating the already difficult work of keeping pace with evolving federal regulatory waivers on allowed technologies/platforms, site of service rules and pay parity. These findings reflect the results of an April 28 MGMA Stat poll on practice leaders’ biggest coding/billing challenges amid COVID-19.

Patient education, awareness and tech savvy

While the newly adopted technologies used for telehealth during the public health emergency (PHE) are common in consumers’ everyday lives (e.g., Zoom, Google Meet, FaceTime), a significant number of respondents cited patients often having difficulty understanding the technology and/or facing hurdles related to lack of a smartphone or access to the bandwidth necessary for a video visit, be that a hardwired internet connection or mobile data. 

Buying into new workflows and technology

Provider buy-in for new telehealth platforms and workflows was frequently cited as a challenge. Many respondents noted that the comfort level of physicians with revised visit workflows was low, especially in specialties (e.g., orthopedics) in which the virtual visit made it more difficult to evaluate a patient via video. Some respondents also noted they struggled with how much time it took them to set up an appointment. Numerous respondents also said that uncertainty over how long regulatory waivers would last before reverting to pre-pandemic norms also gave them pause for investing more time and energy into optimizing telehealth.

MGMA resource: Commercial Health Plan COVID-19 Policies
MGMA resource: Medicare Telehealth/Telemedicine Waivers During the COVID-19 Public Health Emergency

Beyond federal regulatory changes — on reimbursement, originating sites and platforms via which telehealth services may be performed — and state-level rules regarding patient consent, a few operational elements should be top of mind for practice leaders to achieve efficiency and help improve patient experience:

• Optimize your pre-visit workflow: Ensure patient consent is obtained and that the patient can gauge if his or her device is supported by your platform’s technical specifications. 
• Educate and prepare patients: While many patients are accustomed to the technology used in many telehealth platforms, some barriers remain. When possible, designate a staff member to provide guidance to patients about what to expect and offer tips, such as being in an area with adequate WiFi or mobile coverage before a visit. Test visits with a staff member can help minimize the risk of technical issues at the time of the provider-patient visit.
• Market your new services: Use social media channels to help patients feel more connected to the practice and inform them about receiving care via telehealth to gain acceptance. Try to draw analogues to other technology patients currently use in their daily lives.
• Optimize your workspaces: Find a quiet space that ensures patient privacy, with appropriate lighting; consider blocking any light from windows and relying primarily on overhead lighting for consistency. Set cameras at eye level so providers and staff can maintain eye contact with a patient. When performing visits, close any unnecessary programs on the computer, and use wired internet connections whenever possible to avoid interruptions. 
• Have backup plans: When all else fails, make sure your support team’s contact information is easily available. If you experience technical issues but staff or providers can see a patient’s video, take a screenshot to highlight the attempt made at a video visit before shifting to an audio-only visit, and document that screenshot.

To help physician practices and medical groups continue toward best practices in telehealth, MGMA is set to release a Research & Analysis report later this month, Optimizing Telehealth During COVID-19 and Beyond. What follows is a case-study excerpt from the forthcoming report on the importance of selecting a vendor platform that can be quickly and effectively implemented with low barriers to adoption:

Optimization of telehealth starts with a good partner 

Mountain Area Health Education Center (MAHEC), Asheville, N.C., was established in 1974 and serves the state’s 16 westernmost counties. The family medicine, OB/GYN and behavioral health practice has approximately 170 providers. 

CHALLENGE 

Although MAHEC planned to implement telehealth in summer 2020, it was forced to expedite adoption due to COVID-19. The practice had already conducted research on telehealth vendors, narrowing it down to four service providers.  

SOLUTION 

MAHEC selected a vendor that met the organization’s needs. That vendor was amenable to feedback from the practice and responsive to any issues that arose. Two days after the vendor was selected, the practice’s telehealth platform was up and running. That day, all 22 of MAHEC’s behavioral health providers saw every patient virtually. During the following week, the rest of the practice’s providers began to offer telehealth visits. As soon as the telehealth platform was pushed out, the practice’s marketing team began sending messages through the practice’s patient portal, texting patients through the telehealth platform and running radio and television ads. In addition, each clinic reached out to patients regarding the availability of telehealth.  

RESULTS 

Prior to the pandemic, MAHEC was averaging around 1,000 encounters per day, but that dropped by about 50% in mid-March. However, thanks to the nimbleness of implementing the vendor platform and the willingness of staff and providers to get on board with telehealth, the practice was able to restore encounters close to their pre-pandemic levels in less than three weeks from the time it selected a vendor.   

LESSONS LEARNED 

Practices should be mindful when selecting a vendor. It’s also vital to have an infrastructure in place that makes it conducive to quickly pulling together teams from different departments. It’s also crucial to have champions from each part of the organization, particularly in areas in which it could be a bit more challenging to implement telehealth (e.g., OB/GYN and family medicine).

MGMA Stat

Would you like to join our polling panel to voice your opinion on important practice management topics? MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. Results of other polls and information on how to participate in MGMA Stat are available at: mgma.com/stat.

Additional resources

• MGMA COVID-19 Recovery Center — Operational tools and content
• MGMA COVID-19 Federal Assistance and Advocacy Center — Legislative and regulatory updates
• MGMA members enjoy exclusive access to the July issue of MGMA Connection magazine, which will include expert insights from MGMA Government Affairs’ Mollie Gelburd, JD, associate director, on the post-COVID-19 future of telehealth, as well as Marion Jenkins, PhD, FHMISS, partner, HealthSpaces, on action steps to ensure recently added telehealth systems fit into your practice’s overall technology strategy during and after the pandemic.