By Mark Dwyer
Video-based doctor visits (e-visits) have received renewed interest to address the shortages of primary care physicians nationwide, especially in rural areas. The healthcare industry is ripe for a strategy to address what many believe to be one of the greatest challenges of the Affordable Care Act (ACA)—providing government subsidized insurance coverage to thirty million Americans while struggling with a major shortage of primary care physicians throughout much of the country.
Providing insurance to uninsured individuals was seen by many as a vital component of a successful ACA. Unfortunately, most individuals initially receiving government subsidized healthcare were without a primary care provider. These early enrollees were also those with serious health issues related to the costliest health conditions. Consequently, the already over-crowded emergency departments across the country became even more congested only now with newly insured individuals who had nowhere else to go to receive the healthcare they needed.
The demand for healthcare has further increased due to our aging population, along with a declining supply of primary care physicians. According to the Association of American Medical Colleges, by 2030, the United States will have a shortage of as many as 43,100 primary care physicians.
What does this have to do with call centers?
Since their inception, healthcare call centers’ mantra has been to get patients “the right care—at the right time—at the right place.” Video-based doctor visits are a logical source for patients to be served as an extension of the call center. The most successful organizations that offer healthcare triage call center services may be those who devise a strategy to integrate video-based physician visits as a triage end-point for immediate, real-time appointments.
According to the American Telemedicine Association, “as the US healthcare environment continues to evolve due to changes in reimbursement, legal issues, and shrinking healthcare resources, the expanding role of telehealth nurses will continue to evolve.” In distant, rural, small, and sparsely populated areas, telephone triage nursing can remove time and distance barriers between providers and patients. Video-based doctor visits are a prime example of how patients can connect with providers to make better use of shrinking healthcare resources.
It is clear there are not enough primary care physicians to handle patients physically able to be seen in the office setting. But that is not the only concern resulting from the shortage. There are an estimated two to four million people who need doctors, nurses, and healthcare providers to make house calls. Unfortunately, the number of physicians and health practitioners who make house calls has also greatly decreased over the years.
In an August 8, 2017 article by Elizabeth Whitman titled “When patients need house calls, there may be no doctors nearby,” the author referenced a study by Aaron Yao, an assistant professor at the University of Virginia School of Medicine. Yao’s study cited findings that showed more than half of Americans live over thirty miles away from full-time providers of home-based medical care. These centers limit how far they send doctors, nurses, physician assistants, or other primary care providers. Consequently, the healthcare system needs to expand ways to get care to these homebound patients, many of whom suffer from chronic diseases.
“These are the high-cost, high-need people,” Yao said. “We live longer, but we also suffer for longer years,” he added, noting that if doctors can get to patients’ homes and manage their symptoms, they could help prevent emergency room visits and hospitalizations.
Despite the study’s limitations, Yao said his findings drove home crucial points about the need for more, and more widely available, home-based medical care providers in the US. That said, Yao admits, “It’s not a high-paying job,” and comes with related challenges making it less appealing to many healthcare providers. This challenge also lends itself to the use of video-based doctor visits.
So how do e-visits work in conjunction with triage call centers? First, it is important to understand that not all e-visit programs are the same. Like any system that uses patient data, e-visit programs need to be HIPAA compliant. Strong e-visit programs are designed around optimal provider workflows with simple to navigate virtual waiting rooms. E-visit technology allows a physician to connect with a patient via secure, high-resolution video. These connections can be used for a remote visit, to share medical images, to send text messages or online chats in real-time, and to submit prescriptions to the patient’s pharmacy. E-visits help keep patient flow moving with flexible, on-demand virtual visits. When the triage disposition calls for an urgent care referral or to see one’s doctor immediately, patients can get quick “walk-in” care without leaving their house, eliminating long wait times at the urgent care facility.
In addition, a strong e-visit program can increase patient satisfaction by quickly addressing patients’ needs. With e-visits, you can quickly offer patients 24/7 care without the commute or long wait at the clinic. Access to high-quality, convenient care keeps patients happy. According to survey data, 37 percent of parents would choose a virtual care option for their child in the event of a minor illness. That percentage more than doubles for parents in rural areas with minimal access to pediatric specialty care.
How does one monetize the e-visit? Many insurance companies now allow reimbursement for telemedicine services, especially remote visits done via two-way video. As of January 2017 Cigna, Aetna, United Healthcare, and thirty other payors put telemedicine in plans nationwide. In order to be reimbursed, each telemedicine visit needs to be well-documented. Whether stored in the call center software’s triage transaction notes or in the patient’s EHR, everything must be saved in one place and be up-to-date. Some e-visit programs may also integrate with an EHR system for seamless record-keeping. The top telemedicine software solutions allow healthcare providers to easily document the patient encounter and then submit the record for reimbursement.
In addition, through use of e-visit programs, unbilled work also gets reimbursed. From refilling a prescription to treating an illness, some e-visit programs can collect payment from patients and provide a detailed medical chart to submit for reimbursement. E-visits also help to reduce costly no-shows. Missed appointments can cost a provider’s practice thousands in lost revenue. When the visit is real-time via an e-visit program, the service is paid for at the time of care. This creates a more profitable practice further aligning the provider to the facility hosting the call center to which the e-visit program is associated.
Telemedicine solutions come in various configurations. The sophistication of the technology, equipment, training, set-up, and number of users required will all affect the cost of a telemedicine service. Healthcare providers should evaluate their budget for an e-visit program and make sure they consider how much training and staff resources they will need to implement the telemedicine software. Since telemedicine providers offer solutions for single-provider practices all the way to huge health systems, it is imperative to do your homework.
E-visit solutions have the power to change the way we provide and receive healthcare for the better.
Mark Dwyer is a thirty-year veteran of the healthcare call center industry and the COO at LVM Systems, which provides healthcare call center software.