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Starting a telehealth program in your practice: Know the steps

Insight Article - November 6, 2018

Patient Care Technology

Policies & Procedures

Andrew Hajde CMPE
Chris Harrop
Computers, smartphones and tablets increasingly offer new and potentially effective channels for delivering healthcare services. However, as telecommunications has revolutionized society, have healthcare organizations kept pace with the ability to offer telehealth services?

Healthcare organizations that have adopted telehealth services have touted the relative ease of getting their patients to understand and accept telehealth. For some patients, these services can be as easy to use as the video-call features, such as FaceTime or Skype, on their phones or home computers.

A recent MGMA Research & Analysis report, Telehealth: Adoption and Best Practices, outlined strategies for starting up a telehealth program within a medical group practice. These are the key takeaways:

Reimbursement barriers, patient focus

In the MGMA 2017 Telehealth Survey, about 41% of practice leaders said their organizations don’t offer telehealth services. When asked why, they largely pointed to not knowing how to get paid for the services:

When it comes to identifying where they hope to see a return on investment (ROI) for implementing telehealth services, practice leaders most frequently pointed to patient satisfaction and a new revenue source.

It helps retain physicians

Improved patient access is often listed as a driving force for adding telehealth but maintaining access to quality providers is also a key consideration.

Chris Meyer, director of Marshfield Clinic Virtual Health, Marshfield, Wis., noted that a child psychologist working with Marshfield was moving out of state for family reasons. He said that this was “a huge blow” to the practice because it could take years to replace him while patients’ needs remained high. In addition, the remaining doctors already had large patient panels.

By incorporating telehealth, Marshfield was able to connect the child psychologist to the clinic’s patients from Utah, where the provider continued to deliver care.

Chris Gallagher, MD, FACC, president and co-founder, Access Physicians, Dallas, said the organization launched its first virtual care program in 2013 to address the lack of cost-efficiency in on-site work during nights and on weekends for internists or community pulmonary physicians. Shifting that work to remote physicians who did not need to be at the facility was as much a benefit to the doctors as it was for patients who didn’t have to wait as long to be seen.

“Working nights is hard. Patient care is a 24/7 business. There are more nights and weekends than there are weekdays. … [Working from home] makes the nights and weekends more tolerable,” Gallagher said. “If you’re a physician and you’re doing telemedicine out of a bunker, your quality of life is not improved.”

Take time to get your tech right

With 12 clinics in metro Denver, Colorado Allergy & Asthma Centers, PC, experimented with using telehealth services by sending one or two providers to rural communities each month to initiate patient outreach. But the organization wanted to do more.

John Milewski, MBA, FACMPE, chief operating officer, saw an opportunity to expand to a patient population in the Rocky Mountains near Frisco, Colo. A Rocky Mountain hospital had started a dermatology telehealth program, which spurred Milewski’s organization to consider a similar program to boost patient outreach in mountain hospitals without sacrificing providers’ time traveling to and from the hospital.

While the partner hospitals brought in computers and hardware as part of their shared expenses in the collaboration, bringing in new data lines to handle the secure transmission of the patient health data posed a serious challenge, Milewski said. That step took about six months as they also worked out scheduling and patient communication workflows.

Bradley Eshbaugh, MBA, FACMPE, FACHE, FHM, previously served as chief administrative officer for a hospital medicine group in Michigan that launched telehealth services to offer cost-effective night coverage within its programs across the state.

While the group purchased telehealth carts and related IT services from a company in Texas, he said the tricky part was helping partner hospitals incorporate the carts and service into their IT systems. In addition to relying on hospital Wi-Fi and IT infrastructure, the group used its own cellular hotspots as another backup.

With that structure, the group developed telehealth pods of one physician and one physician assistant (PA) to cover two to three hospitals, depending on call volume and the number of nightly admissions.

Know the law

Before considering how to implement telehealth services, healthcare organizations should review state-specific regulations about the requirements of an established physician-patient relationship.

While all states now allow for the physician-patient relationship to be established via a telehealth service (effectively allowing providers to see new patients remotely), many regulations must be adhered to based on varying standards of care, including verification of patient identity, performance of an appropriate exam before establishing a diagnosis or other evidence-based standards of practice.

LEARN MORE: The Center for Connected Health Policy (CCHP) in Sacramento, Calif., maintains an up-to-date, searchable database of current telehealth laws and policies, as well as pending legislation and regulations for all 50 states and the District of Columbia.

As with all protected health information (PHI), telehealth services must comply with HIPAA Privacy and Security regulations. To address data security during telehealth encounters, many practices have adopted encryption to ensure that no unauthorized PHI disclosure will occur during transmission or when the information is stored. Reputable telehealth providers have technology that ensures against unauthorized PHI sharing.

Though telehealth services are becoming more widely available, states do not have uniform laws and regulations that determine whether patients must provide informed consent about when they receive care via telehealth services. This is particularly concerning for telehealth services that operate across state lines, in which the practice, provider and patient could each be in a different state. Among states that require informed consent, written acknowledgment is required in some states while verbal consent is sufficient in others.

Licensing, credentialing and hiring

With physicians working from California, Florida, Kentucky, Oregon and other states, Eshbaugh said licensing was a major challenge since there was no reciprocity on licensing among states. For example, to perform a telemedicine service on a patient in California, the provider must have a medical license in California. Additionally, since physicians are hired as employees and not independent contractors, the group sets up paperwork and accounts for payroll in a number of states.

Eshbaugh also noted that credentialing telehealth providers as ICU-capable became more of a challenge than credentialing on-site physicians. Since many of his telehealth providers are no longer performing procedures, which is the traditional way to credential for ICU privileges, it is difficult to quantify what makes a remote telehealth internist ICU-capable. The group must work with hospitals on different privileging criteria so the physicians can be credentialed and renew their credentials.

Get your staff on board

MGMA qualitative research shows that resistance to telehealth adoption commonly starts with physicians.

Adding telehealth to practice operations may alter practice workflows and require physicians to adapt to a shift in how the patient-physician relationship is established. Here are tips to help get your staff on board with telehealth:
  • Start conversations early with clinical staff members to get their buy-in. Consider identifying a physician champion early adopter who can show the importance of the technology to the rest of the clinical staff.
  • Identify the value for all stakeholders (what’s in it for them?) and for the entire organization.
  • Point to the flexibility of telehealth, which may allow physicians to work remotely from their home.
  • Educate physicians on “webside” manner (maintain eye contact, dress professionally, etc.).
  • Provide formal training on technology and protocols to all affected staff.
  • Explain how telehealth can help with patient recruitment, engagement and retention.
  • If your compensation model allows for it, incentivize!
Telehealth services can evolve as quickly as both the healthcare and telecommunications industries. Each year brings new changes to coding and reimbursement opportunities on the revenue cycle side. The technological side sees frequent changes too.

Practice leaders who want to remain on the front line of meeting patient demand regarding telehealth services should regularly revisit the topics covered in the telehealth report. Reviewing these issues with physician stakeholders and other key organizational leaders to navigate to a telehealth solution will ensure the practice is not just sustainable but also rewarding for both consumers and providers. Download Now: MGMA Telehealth Startup Checklist

About the Authors

Andrew Hajde
Andrew Hajde CMPE
Director, Content & Consulting MGMA Englewood, Colorado

Chris Harrop
Chris Harrop
Senior Editorial Manager MGMA

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


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