Knowledge Expansion Coming full circle: Telehealth can help bring the focus back to the patient Insight Article Patient Access Patient Care Technology Sign in to save Christian Green MA Time is a precious commodity for providers, and finding ways to become more efficient and spend more time with patients is a priority. In turn, patients want better access and to take part in their care, which has opened the door for telehealth, as Keith Dressler, MSD, DDS, founder and chief executive officer, Rhinogram, Chattanooga, Tenn., points out. “With value-based care, there’s motivation to keep patients healthier and happier and engaged. … There’s proof of how telehealth can really make a difference.” However, Dressler contends that proponents of telehealth often have to dispel several myths, which can impede adoption. According to Ann Mond Johnson, chief executive officer, American Telemedicine Association, these myths include: Only for rural areas — Telehealth technology can improve access to healthcare in less populated areas of the country, but there are also many urban areas where people have limited access to healthcare as well. Too expensive — This may have been the case at one time, but now there are inexpensive platforms such as smartphones to help reduce costs. Moreover, connected care technology has helped reduce inefficiencies, particularly in remote patient monitoring programs and skilled nursing facilities. Low quality of care — High-definition video and connected devices now make it possible to closely replicate in-person visits. In addition, telehealth has made it easier for patients and providers to collaborate more often, which can also improve those relationships. Impersonal — Virtual visits, particularly telemental health visits, often necessitate eye contact. They can also make conversation easier for patients who are apprehensive about seeing a physician in person. Providers prescribe more drugs than those treating patients in person — Despite a recent study by Pediatrics,1 which found that pediatricians are more apt to prescribe antibiotics to patients during virtual visits, Johnson believes that individual providers are responsible. Accordingly, prescriptions could be monitored by telehealth platforms with audit capabilities. Threat to providers — For some experienced providers, new technology and workflows might not be of interest. However, Johnson believes this can be addressed via organizations doing a better job of making providers more aware and educating them on using telehealth technology. “You can’t just drop people in the middle of this and say, ‘Good luck,’” she says. Only synchronous communication — Telehealth goes above and beyond synchronous communication (audio-visual platforms); it can include wearable and smart devices that send data back and forth, online portals, secure messaging platforms and personalized questionnaires, to name a few. Dressler believes group practices can use telehealth to separate themselves in regard to patient acquisition, patient retention, and staff efficiency and cost savings. Patient acquisition Patients are used to clicking a button and getting something in return within an expected amount of time. Dressler compares it to purchasing an item online or using a rideshare app. Patients expect this convenience to carry over to every service they use, including healthcare, so by providing direct access to their favorite technology — for example, texting or instant messaging — group practices can see a 10% to 30% increase in new patients. As more patients prefer texting over voice communication, practices need to provide what patients demand. “Allowing them to do what they want to do will make things much better for them and you,” Dressler adds. Offering these options is particularly important for millennials and millennial parents of patients. Millennials (anyone born 1980 to 1996) make up the largest population of consumers in the United States at 80 million. As Dressler asserts, millennials “grew up with a cell phone … texting and social media messaging. They know no other world but that.” Dressler suggests doing the following to help with patient acquisition: Inform patients regarding ways they can contact you. Ensure that your office phone number is textable while being HIPAA compliant. Give patients a way to contact you outside office hours. Make sure your practice is social media friendly and ask patients to provide reviews to help potential patients find you. Patient retention Much like patient acquisition, patient retention is predicated on giving patients what they want, which in this day and age is convenience. Dressler refers to this as “meeting people where they live.” “Lots of patients say, ‘You’ve given me back my life by being able to do this,’ because they haven’t had to take time off from work, or take kids out of school, or wait in a waiting room 30 minutes to only be told you’re healing fine,” Dressler maintains. “You have eliminated all of that. And patients are incredibly appreciative of that, give you awesome reviews and tell their friends about your services.” In this age of consumerism, Dressler notes that patients are most focused on direct access and a great experience and will return to providers who furnish that. Furthermore, patients stay with providers due to convenient factors such as: In-office visits being set aside for new and higher acuity patients Patients having the option to receive virtual care. Providing high levels of access — including allowing patients to message the practice on Facebook, text the practice via its website and text the office’s number — can mean all the difference in making a practice more appealing. “If a contemporary of mine says the only way you can get a hold of me is by phone during my office hours, then you would have to understand that my practice will be [much] busier than the other practice,” Dressler emphasizes. Staff efficiency and cost savings The benefits of telehealth go beyond patient acquisition and retention. Per Dressler, group practices can streamline their workflows while also saving and making money. Oftentimes, the end result for physicians and staff is getting one to two hours back a day, thanks to patient data. “You’re going to receive lots of information about where your patients are communicating from,” Dressler says. Telehealth platforms “can also tell you when your highest text volume is” to determine when you need to staff differently. “That will allow you to maximize people, maximize time and allow you to improve efficiencies as an overall performance of your practice,” Dressler notes. In addition, owing to the convenience of technology, staff members can become more efficient in their work, while also better connecting the office. “These platforms provide the ability to never have to leave your desk to physically locate a teammate or doctor,” Dressler says. “They have internal messaging capabilities.” For group practices, the cost savings can be quite beneficial. According to a 2017 survey, 29% of practices that tracked ROI reported more than 20% savings from their telehealth services and more than 50% reported savings of 10% or more.2 It’s also important to understand how much practices spend on patients as soon as they walk through the door. “On average, telehealth visits save practices $100 per visit,” Dressler says. “You have front desk time, sterilization of chair or room, gloves, nurse time, doctor time, etc. Understand that all of these things add up. … If you can keep those people out and still deliver quality care, then your ROI is going up; you’ve decreased the expense structure of your practice.” With the potential to increase patient engagement and drive positive patient outcomes, while also freeing up administrative time and increasing ROI, Dressler believes it’s time for group practices to take a long look at telehealth adoption. “We are pioneering the future,” Dressler says. “The more who can participate and help in the pioneering, the better that end result will be for all of us.” Dig deeper: Sweetgrass Pediatrics With 22 pediatricians, seven nurse practitioners and six offices in the greater Charleston, S.C., area, Sweetgrass Pediatrics is one of the largest pediatric Medicaid providers in the state. The practice implemented telehealth to help address the following challenges: An NCQA Level 3 Patient-Centered Medical Home practice has to provide a high level of patient access, which it was not. Needed a centralized process for scheduling, prescription refills, etc. Patients sometimes waited several hours for return phone calls. Results Sick children received care at home and did not get other patients sick in the waiting room. Parents received responses in minutes rather than hours. Set up a central number for messaging, which could be routed appropriately. Streamlined workflow for scheduling and patient inquiries, using templated responses for common care instructions. “For their large Medicaid population, they tripled the engagement with that population,” Dressler says of Sweetgrass’ implementation of telehealth. “They were also able to decrease the number of phone calls coming into the practice by 30%.” Dig deeper: Virginia Center for Women Virginia Center for Women is a five-provider OB/GYN practice with six locations in the Chesapeake, Va., area. The practice implemented telehealth to help address the following challenges: Inefficient processes and staff not getting work done. Patients not pleased with long wait times for test results. Physician did not feel as though she had enough time with patients. Results Unnecessary visits replaced by virtual consults. Physician’s personal nurse got back two hours a day. Patient test results sent as soon as they arrived, often by the physician. Patient satisfaction increased, which helped improve Google reviews. Because the physician enjoys spending time with her patients, telehealth helped significantly in that regard. As Dressler relates, “She got back time as well so that she could have the relationship she wanted with patients.” Notes: Ray KN, Shi Z, Gidengil CA, Poon SJ, Uscher-Pines L, Mehrotra A. “Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits.” Pediatrics. May 2019; 143(5). Available from: bit.ly/2u0OFsq. 2017 Telemedicine & Digital Health Survey. Foley and Lardner, LLP, November 15, 2017. Available from: bit.ly/2UnvqEg.