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Hello ,

It is Easter Sunday 2020 and we are nearing the peak (hopefully the first and only) of the Coronavirus Health Crisis.

Over the past weeks, thousands of healthcare organizations have rapidly stood up telemedicine while thousands of physician practices have closed their doors for at least six weeks. Yet, according to our own polling of 350 participants during a national webinar hosted by the MGMA on April 7, while 97% of respondents indicated that they had launched telemedicine, 50% saw less than 25% of the pre-covid volume. For almost 80% their volume was still less than 50%.

The consequences of this statistic are staggering. This means that there are thousands of physician practices that are laying off staff, potentially risking going out of business and denying their patients access to care. For most patients this may be fine for a couple of weeks, but the longer this lasts, the worse the situation for patients with chronic conditions (including those with canceled surgeries) will become.

While we may not know until research papers are published 3 years from now, I would not be surprised if the indirect, secondary death toll as a result of the coronavirus health crisis far exceeds the currently predicted deaths of 60,000 as a result of coronavirus infection.
But that does not have to be the case. It is possible to deliver great care and practice medicine at a distance.

On March 18 it took us 36 hours to stand up 5 primary care practices with 20+ providers. Within a week, they were back at 85% of pre-covid volume 75% of their visits via telemedicine, while physicians were ranking the clinical quality of the visits at an average of 4.3 on 5-point Likert scale.

The secret to success does not lie in the technology used (it was actually quite clunky). Nor were the providers in any way more prepared to switch to telemedicine. No, the secret was in the clear leadership by the CEO and the focus on workflow, training and support that put the providers in and center so they could take care of their patients.

While the health crisis continues, we need to not only optimize our existing telemedicine services, we need to also think ahead start shifting toward a "remote care management" model and mindset, including for those soon to be discharged from the hospital after their coronavirus-related admission.

This week’s article describes the six hallmarks of launching and optimizing telehealth services that patients love and that physicians like doing.


With kind regards,
P.P.S.: Do you know a colleague who might enjoy reading this newsletter? Please send them this link to see an archive of past newsletters and an opportunity to subscribe:

Many healthcare providers are now well into the full-blown delivery of care through telehealth. Yet questions remain:  What are the next steps for practices to create and maintain sustainable telehealth services, clinically, and financially sound, and responsive to the health crisis? 

Join this session as part of MGMA's Virtual Operations Conference to learn how to optimize telehealth services through improved technical and operational support and vigorous monitoring of performance and clinical outcomes. Christian Milaster and Kathy Letendre will share pragmatic advice on optimizing workflows, staffing, billing, policies, and telehealth technology for the next waves in this unprecedented health crisis.

For the full schedule and description of our session at 2:55 PM, see here:
https://www.mgma.com/events/the-operations-conference/schedule-and-sessions/session-details/thursday-sessions
Free Resources
Telehealth and Covid-19



Weekly Open Forums: Access to Ingenium’s Telehealth Experts
Initiated by a German engineer who spent 12 years at the Mayo Clinic improving healthcare delivery, Ingenium Healthcare Advisors is a consortium of 11 pragmatic advisors each with decades of experience in healthcare delivery, particularly the implementation of telehealth solutions. We bring the deep and broad expertise in telemedicine, remote patient monitoring, eICU, telehealth technology, regulatory, legislative, billing, marketing, change management, etc.

As a service to our colleagues in the industry, we are offering free Open Forums for healthcare practitioners and leaders to get their questions about telehealth answered and receive pragmatic advice on best practices when standing up a new telemedicine service quickly.

You can register here:
http://tiny.cc/ing-th-cov19-sessions

MGMA Webinar: Rapidly Launching, then Optimizing Telehealth
As practices respond to new telehealth legislation amidst #COVID19, effective implementation processes, while crucial, can prove overwhelming.

In this 1-hour webinar, hosted by the MGMA, now available on demand, Christian Milaster and Kathy Letendre of Ingenium Digital Health will share key steps for rapid launch, as well as optimization strategies to ensure that your services are clinically and financially sound in this quickly evolving healthcare climate:

Register here for free access to this webinar:
https://www.mgma.com/resources/continuing-education/products/standing-up-a-telehealth-practice-in-the-covid-(2)  

MGMA Podcast:
COVID19: What Healthcare Leaders Need To Know About Telehealth and the CMS Policy Changes
Listen to an interview of Christian Milaster and Kathy Letendre recorded by the MGMA, published on March 20 (our part starts at 14:45 minutes).

Contact Us
To schedule a complimentary Zoom call to find out how we can best help you and your organization, email Christian at christian.cv@ingeniumdigitalhealth.com  or call 657-464-3648.
 
The Six Hallmarks of Excellent Telemedicine Services
Before COVID-19 it would take most organizations many months to launch a new telemedicine service. Interest or demand was not very high and the individuals assigned to getting the new service up and running were only doing so part-time.

In my consulting practice, by distilling my years of experience into a few key hallmarks, I shortened this process to a few weeks - if the key resources were available to engage in the design and implementation of the new services.

In the middle of the coronavirus health crisis I was able to launch a new telemedicine service in just 36 hours, rolling it out to two dozen providers across 5 locations, bringing the number of visits up to 400 within a week, quite close to pre-covid-19 volumes.

Many other healthcare organizations scrambled in March 2020 to quickly launch telemedicine and many did succeed in making telehealth technology available to providers to connect with patient’s at a distance.

While it was important to act quickly and to simply "stand something up", now is the time to go back and make sure to retroactively apply the six hallmarks of telehealth success.

1. New Clinical Service Mindset
One of the most critical hallmarks of telehealth success is when everyone involved in telehealth, especially leadership, realizes that the launch of telehealth is not simply a Health IT deployment project, but rather the launch of a new clinical service offering. Imagine in your mind the steps you would undertake to ensure the new clinical service is ready and that patients are asking for it.

The same principles and actions apply to the launch of a new telemedicine service. Once you realize what you would have done if you had treated this as a new clinical service offering, you can go back and do those things that should have been done.

2. Remote Care is NOT Telemedicine
One of the most helpful distinctions is the notion that what most physician practices are doing these days is to "connect with patients at a distance", our definition of "remote care".

But it is in many cases not telemedicine, i.e., "practicing medicine at a distance". Too big are often the problems, too low the tolerance for non-performing technology. And the lack of just the basic vital signs or the absence of organizational clinical guidelines, can quickly render a remote care visit ineffective.

To get the listening of the staff and the providers, calling it "remote care" with the intent to evolve into "practicing medicine" is one way to get the initial interest and buy-in.


3. Focus on Quality

Given the ad-hoc nature of most remote care service launched in response to the healthcare crisis, you cannot allow yourself to "fly blind", even for a single day. In addition to volume stats, you need to collect and act on data on clinical quality, patient & clinician acceptance, technical performance and financial performance.

Next, you need to designate an individual to monitor and analyze the data on a daily basis. Associated with the agreed-on metrics to collect, the executive decision team must then continuously define the key actions to take once a metric goes above or below the desired threshold - and put those actions in place when needed.

4. Consistent Internal Pre-Authorization
The rules and regulations around telehealth reimbursement have and will continue to change frequently. In order to prevent the delivery of care that is either unknowingly non- reimbursable or even illegal, you need to establish a process by which every scheduled telehealth appointment will be reviewed before the visit by a central decision authority.

While initially each and every visit may get the "go ahead", there will quickly come a time when lifted regulations are rolled back. It is thus important that everyone at least notify the central pre-authorization team to make sure that the telehealth visit should proceed.

5. Pre-Visit Patient TechCheck
One of our key desired hallmarks for telehealth is to enable physicians to "practice on top of their license", enabling them to "only do what only they can do". For the workflow design this includes removing any administrative, legal, or operational tasks on the physicians’ workflow.
Especially when a provider has to troubleshoot the patient’s audio, video, or connection options, their productivity sinks enormously, and with it their tolerance for making telemedicine work for them.

The best practice is to truly dedicate the time to ensure that each patient, at the time when the appointment is scheduled, can conduct a quick TechCheck: Does the patient have the adequate technology (smartphone, tablet, PC) and adequate, reliable connectivity, and the ability to operate the technology well?

6. User Training
For the final of the six hallmarks, we are focusing on two separate audiences: training for the providers and training for the supporting staff.

Provider Training: All providers offering telemedicine need to be trained on a variety of aspects of telemedicine. This training should be delivered just-in-time on an as-needed basis. It can be conducted in person or remotely or via a pre-recorded video/ presentation. This training should cover clinical guidelines (inclusion and exclusion criteria), policies (licensure, consent, emergency contact, privacy, etc.), billing rules, webiquette/webside manners, use of the telemedicine technology, the process for e-prescribing, post-visit documentation and follow-up visit scheduling as well as access to support.

Staff Training: Similarly, training materials (documents, presentations, etc.) should be developed for the various audiences affected by telemedicine, including, but not limited to schedulers, patient service representatives, medical billing staff/coders, MAs & RNs, providers and leadership.

Resources: In addition to live, interpersonal training, the creation of short explainer videos and single-page cheat-sheets will go a long way to reminding people of the key basics.

Summary
Launching telehealth rapidly and quickly was exactly what was needed in the early weeks of the Covid-19 health crisis. But before things get too much out of control, it is important to retroactively reapply the key hallmarks of telehealth success as laid out above.

Send me your comments by replying to this email.

Christian Milaster is the Founder and CEO of Ingenium Digital Health where he and his expert advisors partner with healthcare leaders to optimize the delivery of care.
To discuss how you can use telehealth to optimize the delivery of care, contact Christian by phone or text (657-464-3648), email, or video chat.

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This edition of Telehealth Tuesday was sent to _t.e.s.t_@example.com.
Ingenium Consulting Group, Inc., 1173 Bayview Vis, Annapolis, MD 21409, United States
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