Weitzman COVID-19 ECHO

1. www.himss.org
Sustaining Telehealth: Balancing
Telehealth & In-Person Care from the
Operations Perspective
April 13, 2022

2. 80,449,398 cases on 4/12/22 with 985,826 deaths
https://coronavirus.jhu.edu/us-map
COVID-19 in the United States: TOTAL

3. https://www.nytimes.com/interactive/2021/us/covid-cases.html
COVID-19 Hot Spots

4. Philadelphia re-instates indoor masking

5. https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

6. Are the numbers going up?
• Less testing now…
– Using at-home rapid tests
– Not reported
• Several states, including AZ, HI,
NV and OH stopped reporting
daily Covid data to the CDC
– “Their alarm bells won’t go off
until we see a rise in
hospitalizations and deaths, which
are lagging indicators”
» Gregg Gonsalves, an ID doc at
Yale’s School of Public Health
The information we are
getting from the CDC is
going to be less reliable,
more spotty, and lose
momentum,” Dr. Bright –
Rockefeller Institute

7. What is circulating?
covid.cdc.gov/covid-data-tracker/
#variant-proportions

8. Practical advice for the HCW:
• Trust your knowledge, instincts
– What’s going on locally?
• Increase in visits?
– Trajectory of case numbers?
• rate of increase 5% a week vs 50%?
• how long cases have been rising?
Case counts lag transmission
• Know risk profiles of patients
– High risk?
– Vaccine status?

9. Practical advice for the HCW:
• Continue with the ‘team approach’
– What can my colleague help with?
www.confermed.com

10. Trusted Resources
• Johns Hopkins
https://coronavirus.jhu.edu/map.html
• CDC
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://emergency.cdc.gov/coca/calls/2020/
• WHO:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
• Others
https://www.nytimes.com/interactive/2021/us/covid-cases.html
https://www.thelancet.com/coronavirus
https://covidactnow.org/

11. Sustaining Telehealth: Balancing
Telehealth & In-Person Care from
the Operations Perspective
April 13, 2022
Sydney Kennedy (he/him)
Jen Stewart Barrett (she/her)

12. Spread of Care & Visit Types
• In-person care
– Medical providers
– Specialist providers (with the exception of dietitians)
• Telehealth care
– Behavioral health – very few providers are on-site
– MATs (Medically Assisted Therapies)
• MATs (i.e., Suboxone treatment)
– Limited group of providers can do MAT
– Telehealth is used to manage the distance and availability of MAT sessions
– MAT providers can treat across the state, as opposed to treating at a specific site
• Benefits of Telehealth Visit Types
– 1 BH provider can provide care to multiple schools per day
– Holding visits outside of school hours
• Rooms available for patients on-site who lack equipment for telehealth
appointments

14. Telehealth Changes for Providers
• Not one size fits all for visit type
• Telehealth vs. in-person reviews are
completed case-by-case to analyze
provider utilization
• Providers prefer blocks of time with
telehealth or in-person visits
• Communication with patients & actual
appointment start time
– Patients have different expectations for
telehealth visits
– Virtual waiting room enhancements help
providers ease patients

15. Patient Communication
• Distinguishing the need for a telehealth vs
in-person visit
– Distinction made based on nature and
clinical need of the visit
– Patients may struggle to understand the
difference, or hesitant to attend in-person
• Limited access for in-person visits
– Restrictions in place for number of
individuals allowed in-person
– Spouses/parents with children cannot come
in together, unless needed for assistance
• COVID-19 testing
– Patients presenting COVID symptoms
require virtual visit with a provider prior to
testing

16. Impact of Telehealth for Patients
• Convenience & accessibility
– Telehealth reliable for patients with
transportation issues
– Requires less travel and wait time from
a patient’s day
– Ability to provide alternative hours for
Behavioral Health visits
• Creating ease of access with
telehealth technology
– Automated link sent prior to visit
– One-click Zoom link to join visit
– App install requirements removed
– Waiting room videos and enhancements

17. Waiting Room Video Clip

18. Ongoing Telehealth Challenges
• Reimbursement guidelines for duration of visit:
– Video: Once all clinical measures are met, time is not a consideration
– Phone: Regardless of clinical measures being met, set length of time must be met
• Location for virtual (phone or video) visit must be in-state only in CT
• Changes to legislation always evolving
• Behavioral Health group sessions cannot use phone visits
• Overall confidence in e-Consults
– The next COVID-19 variant may not impact our visit types
– Pandemic conditions are monitored daily

19. Provider Lessons Learned
• Billing department had to change billing process, increasing time to bill
claims due to review of encounter note requirements
• Chart auditing is completed regularly
– Video/phone/in-person reports are monitored to understand what our utilization is
– Provides insight into continuous operational improvement
• Communicating changes to holding phone or video visits with teams
– Employees must understand the importance and intention behind changes
• For example, understanding changes to duration of phone and video visits
• Telehealth doesn’t always work for providers
• Slow internet speed when connected to VPN (virtual private network)
– VPN is needed to secure health records

20. Patient Lessons Learned
• Phone calls rejected or marked as spam by companies
– If possible, use clinic phone number instead of any individualized, wholesale IP lines
– Staff must communicate with patients to expect a phone call during visit time
• Medical needs cannot be physically shown during a phone visit
– Patients must send images through secure medical records process
• Lack of integration between our telehealth system and our health records
– Micromanagement required to ensure our systems align
• Ensure that your patient engagement platforms are up to the challenge
going forward