Telehealth communications have exploded in the wake of COVID-19, and for good reason. We all want to do as much as we can to “flatten the curve” so we can get back to life as we previously knew it.
I think we all had a feeling that telehealth would be the future of medicine (or at least a good chunk of it); but no one could have predicted we would all suddenly be trying desperately to incorporate this function. En masse. In real time. Doctors, hospitals, insurance carriers, software companies are all trying to add this seemingly simple (but complex) line of service to those who rely upon us. But like many things, the devil is in the details.
The reality is that telemedicine is not new. It has been used in rural areas by hospitals ERs for years. It is new for most outpatient medical practices.
So what can be done by way of telehealth? What are the “rules”? It seems fine to use telehealth for basic, less complicated conditions. But now, we find ourselves in the position of handling much more complex cases by this route. Here are the facts.
Telehealth cannot be used for new patient visits (at least not yet). When it comes to visits with a specialist (such as myself), when seeing someone for the first time I need to actually perform an exam to assist in determining what diagnosis is the most likely, and to reduce ordering unnecessary tests. For example, if someone comes to me complaining of leg numbness; hyperactive reflexes tell me to look at the brain or spinal cord. If reflexes are absent or reduced, it tells me to look at the peripheral nerves. The neurological exam remains very important to making an accurate diagnosis. Hyperactive reflexes: get MRI; absent or reduced reflexes: get an EMG/NCS.
Additionally, if a new patient is not evaluated in person by the doctor billing for the service, it is possible that the doctor will be left without legal protection should something go awry. Presently, SVMIC (the main insurance company for medical malpractice in Tennessee) does not cover telehealth visits for new patients.
What are the back-end details of adding telehealth services? Well, it’s not as simple as using facetime or Duo (despite what you hear on the news). Vetting the many software platforms out there takes time (time we don’t have), not to mention developing new workflows and training staff to maintain HIPAA standards. Billing is an altogether different issue. How can we collect copays when most platforms have no option for this? Will insurance carriers pay more than $15 for a virtual visit? To date, in Tennessee only Medicare and Blue Cross Blue Shield of Tennessee (BCBST) have detailed written policies stating that reimbursement for telehealth will be the same as in person visits. Regardless of your political persuasion, everyone should get paid by their employer for their hard work. Medical professionals such as the staff at KCA are no exception to this rule. Put simply, if a carrier doesn’t step up to the plate and help during these trying times and commit to proper payment, we won’t be able to take care of any of you for very long. So no, it’s not as simple as calling in for a controlled substance refill to last you for 3 months. Medically, it’s inappropriate; and financially it is not sustainable if every patient tried to do this.
So what are we doing at KCA? We have 3 options for patients currently on the schedule.
1) Keep your regularly scheduled visit if you pass the COVID-19 screening questions. Certain businesses are exempt from the “shelter in place” rule, such as KCA Neurology. These include “life sustaining businesses” such as certain doctor visits, pharmacies, grocery stores. So, if you can go to Publix, you can come to your doctor’s appointment.
2) Contact us to convert your office visit to a virtual visit. If you have BCBST or MDC, co-payment will be taken over the phone, and our MA will get an update from you prior to your virtual visit with the MD or PA.
3) If you do not have BCBST or MDC, you may still have a virtual visit through Southern Practice Consultants. I work for them part time, but they do not take insurance. A visit receipt will be provided for you to submit to your insurance carrier so you can be reimbursed for your payment per their rules. Just be aware, they may not reimburse you the full amount. If this does not appeal to you, see #1.
Like all things, this too shall pass. We just have to work together. This pandemic is like nothing anyone alive has ever seen, and we are all trying to figure it out as we go. But once we get through this, we will be stronger.