In response to the rapid spread of COVID-19 across the United States, many ambulatory practices are recognizing video visits as a crucial method to protect health care providers and patients and to flatten the curve of community infection. For community-based practices, a few key issues should be considered in deploying a video visit strategy.
What protocols and workflows will staff need to appropriately triage patients to video care versus in-clinic care?
Commonly, video visits have been used for low-risk medical needs such as managing cold symptoms, seasonal allergies, pink eye, urinary tract infections, minor skin issues and upset stomach. Given the potential need to screen symptomatic or at-risk patients for COVID-19, providers will want to work with State and regional public health authorities to review guidelines and establish screening protocols to determine the need for COVID-19 testing. For the duration of the public health emergency, providers will also want to look at the common care needs of patients in their practice population and prioritize video visits for low-risk conditions which should be addressed in the short term but do not require an in-office visit.
What technologies should be used to facilitate video visits?
Many practices have the technological solutions in place to conduct video visits already, as they have recognized the utility of video visits to help reduce the cost of care as well as improve patient access and experience. For those that do not, it is important to consider how EHR and practice management systems will integrate with the video visit tool; or be used concurrently to facilitate clinical documentation and billing needs. While state and federal programs temporarily may lighten HIPAA requirements regarding web-based commercial tools such as FaceTime or Skype; in the longer term these tools do not have the privacy safeguards to be HIPAA compliant and are not integrated with health record and billing systems. Integrated, HIPAA compliant tools will lessen the challenges practices may face with changes regarding workflow and will align with the movement to value-based care while maintaining patient privacy protections. NextGen Healthcare offers a highly capable video visit tool, further details may be found here.
What services will commercial insurers and CMS cover from a reimbursement perspective?
State Departments of Health are working with commercial insurers and health plans to provide guidance to healthcare providers on what services will be covered. Congress and the Centers for Medicare and Medicaid Service (CMS) are doing their part to promote the use of virtual visits for Medicare Beneficiaries.
Under the Coronavirus Preparedness and Response Supplemental Appropriations Act (H.R. 6074) passed by Congress on March 6, 2020, the CMS has expanded the breadth of the 1135 waiver to help promote three types of virtual visits by physicians and other professionals for the duration of the COVID-19 Public Health Emergency.
- Medicare telehealth visits: using telecommunication technology for office, hospital and other services which usually take place in person. Under the waiver, patients may receive these services from any licensed Medicare provider, not solely those with whom they have an established relationship. Further, providers will be given the flexibility to waive or limit co-insurance or deductibles.
- Virtual check-ins: For patients with an established relationship with their provider, a virtual check-in allows for a brief visit between the patient and their provider so as to avoid travel and the need for office-based, routine care during the Emergency.
- E-visits: In all types of locations including the patient’s home, and in all areas (not just rural), established Medicare patients may use online patient portals to have non-face-to-face communications with their doctors. Here the waiver provisions are not quite as broad as these services can only be reported when the billing practice has an established relationship with the patient; it is the patient who must generate the initial inquiry and communications covered occur over a 7-day period.
For more information on the services, billing codes and provider types covered by the waiver, review the CMS fact sheet on this topic located here.