Telehealth

[air bud]

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Is anyone employing telehealth? Could you see keeping it after all this does down? Specifically for more rural outreach clinics where you don't go very often?

 

[CutsWithFury]

Is anyone employing telehealth? Could you see keeping it after all this does down? Specifically for more rural outreach clinics where you don't go very often?

My hospital is making everyone try to transition to as much telehealth as possible. It makes sense of medicine and medicine subspecialties but makes little sense for ortho/podiatry/general surgery especially when it comes to new patients. It will have utility for surgical specialities mostly for post-op visits.

We were never set up for it prior to COVID 19. I can see the hospital keeping it once its over as it can create new opportunities to reach patients in different territories. It would be mostly beneficial for medicine in that respect though.

 

[DYK343]

I like it for routine stuff and hope it stays.
Patients dont have to miss work. They can just take a 10min break and "see the doctor" and it reimburses the same (at least for now).
I could definitely see this staying.
It's a win win for patient/doctor.

 

[air bud]

I like it for routine stuff and hope it stays.
Patients dont have to miss work. They can just take a 10min break and "see the doctor" and it reimburses the same (at least for now).
I could definitely see this staying.
It's a win win for patient/doctor.

That may be circumstances for now my understanding is prior to this was mostly for rural locations and the patient has to be located at a specific originating site like a local clinic or something.

 

[DYK343]

That may be circumstances for now my understanding is prior to this was mostly for rural locations and the patient has to be located at a specific originating site like a local clinic or something.

Hopefully it changes! We had some telehealth through our clinic prior but im not sure how it all worked out as I wasnt involved. I know the reimbursements were much less.

 

[air bud]

Also I could see it modified for physical exam. There is an assistant there and whether you use the doll that you normally ask where the bad man touched you or a foot model, you could have someone else do a pretty good exam. Like Achilles pain. Show them and have them push on insertion. Does it hurt? Boom there you boot and and medrol dose pack.

 

[air bud]

again do you really need x-ray for a lot of things if there's swelling and you they say they have pain on the top of their foot it's not that hard to show somebody how to push On the base of the metatarsals pain? Stress fracture surgical shoe in vitamin d that's all you have to do.

 

[heybrother]

If the established follow-ups are done via telephone with the one of the G codes ie. like G2012 or G2020 (something like that) - the visits are worth next to nothing. Like $10-15. That said - for some of my patients I was just calling them and saying - look, we are cancelling your visit, but how are you doing. Yeah, I'll refill your naproxen, keep stretching. You might actually be getting paid for something you were already doing.

The thing about the telehealth visits is to charge them as a visit you have to use video - ie. skype/facetime/etc (HIPAA rules are relaxed at present). So it needs to be something as described above - a classic MSK pain that the person can point to. Plantar fasciitis is probably the best example. Is it focal at the medial heel? Are you still able to walk? Its been going on for 3 months? K.

That's my understanding from trying to read the Medicare documentation. Theoretically the video visits are supposed to be for established patients, but they aren't going to audit so you could do new patients in the mean time.

 

[air bud]

do you really need x-ray for a bunion?. Why can't you just look at their foot give them can some conservative options. When that's exhausted tell him to come in and make a visit take some X-rays and you can talk surgery. That bunion patient all you are going to tell him to do is get some wider shoes and try some over-the-counter orthotics that aren't going to fix the problem but may make the pain better.

 

[air bud]

If the established follow-ups are done via telephone with the one of the G codes ie. like G2012 or G2020 (something like that) - the visits are worth next to nothing. Like $10-15. That said - for some of my patients I was just calling them and saying - look, we are cancelling your visit, but how are you doing. Yeah, I'll refill your naproxen, keep stretching. You might actually be getting paid for something you were already doing.

The thing about the telehealth visits is to charge them as a visit you have to use video - ie. skype/facetime/etc (HIPAA rules are relaxed at present). So it needs to be something as described above - a classic MSK pain that the person can point to. Plantar fasciitis is probably the best example. Is it focal at the medial heel? Are you still able to walk? Its been going on for 3 months? K.

That's my understanding from trying to read the Medicare documentation. Theoretically the video visits are supposed to be for established patients, but they aren't going to audit so you could do new patients in the mean time.

Yes video has to be done in order to actually make it worth your time to get full reimbursement. There is an APM a webinar that was just done on this but again that's talkin about things in terms of the waivers being made for current situation and not what was eligible to be done prior to this.

 

[DYK343]

The main issue is when telehealth fails and they have to come in for a real exam to diagnose a neuroma or PTTD etc, etc.
That would lead to 2 visits and the insurance companies dont want that.
But for real simple stuff like a rash or someone wants to start terbinafine I think its great.

 

[josebiwasabi]

The main issue is when telehealth fails and they have to come in for a real exam to diagnose a neuroma or PTTD etc, etc.
That would lead to 2 visits and the insurance companies dont want that.
But for real simple stuff like a rash or someone wants to start terbinafine I think its great.

That's why they can't be new patients and there's a 7 day global for telehealth.

In our office we are using it for our wound pts, we take a look at the wound and if it looks suspicious/concerning we tell them to come in for in-person eval asap. Since it's in the 7 day global, we can't bill both visits, but it's good patient care. These people are immunosuppressed so if they have a stable/improving wound there's no need to come in to the office for a wound check.