If your LTPAC organization seeks to utilize telehealth in 2021, consider some best practices at the outset of your efforts.
Technology and Infrastructure
As mentioned in earlier articles, telehealth is a fairly straightforward proposition in terms of what’s required to get it up and running—and keep it running smoothly.
From a technology and infrastructure standpoint, you’ll need to make sure you have the following:
Electronic devices – ideally we recommend large tablets that are mounted on a portable stand/portable cart and can be wheeled in and out of resident rooms. Tablets are the preferred option over computers with embedded keyboards, since germs and other substances can penetrate the nooks and crannies of keyboards. Other viable options also include wall-mount stations and kiosks—but with any solution, infection prevention and control is essential (see below).
All necessary medical equipment and devices (e.g., stethoscope, electrocardiogram, pulse oximeter) located near the resident for use by nurses and/or aides during telehealth visits.
Strong and reliable broadband connectivity on both ends of the spectrum – physician and resident – as well as a backup plan and associated resources for emergencies. It’s important to have the requisite bandwidth to support the technology at both ends.
A solid firewall to shield computers and other devices from malicious and/or unnecessary traffic.
Strong password protection.
An “interactive audio and video telecommunications system” (e.g., Zoom, Skype, Teams), as per CMS guidelines, that permits real-time communication between resident and caregiver.
Electronic notices, including reminders and step-by-step login instructions and links, to help both parties gain access to the telehealth visit.
From a cost standpoint, we recommend exploring grant opportunities through rural health grants and other initiatives that can help offset some related costs.
Like anything related to care delivery, your telehealth efforts should be guided by established processes and procedures. How you decide to construct those is dependent on your unique organization, but some initial questions to help you get started include:
Is there a limit to how many consults per month can be conducted, either resident- or organization-based?
Are there certain residents who the providers will not visit for any reason?
Who will be conducting the telehealth visits? Will there be a specific team for my organization or facilities?
Who is to sign the orders given via telehealth visits? Do those orders integrate with your EHR system? If not, could they?
Does the solution integrate with the organization’s current EHR? If so, what information is transmitted through the integration?
Who can request the telehealth visit (RNs/LPNs/residents)?
Infection Prevention and Control
Tablets and other devices used repeatedly for telehealth visits must be disinfected after each use. Additionally, there are infection control products like antimicrobial covers for tablets and other medical-grade equipment that can help keep telehealth visits safe for all parties.
You’ll want your physicians and staff who assist residents to understand the technology, why, when and where it should be used, the meeting platform and the protocols around telehealth visits. To an extent, this includes bedside manner; while physicians aren’t physically present in a room with residents, they should maintain eye contact whenever possible by looking into the camera. It’s essentially the same approach taken during a face-to-face visit, albeit in a virtual setting.
As part of any rigorous telehealth training program, time should be set aside for overall training and run-throughs. Physicians and staff who will use telehealth technology should be comfortable with it—and that entails giving them opportunities to use it in different scenarios, from history and physical appointments to emergency care.
Staffing and Workflows
Before deploying telehealth as a large-scale tool, make sure your organization has the staff available to facilitate and manage it.
If you do utilize telehealth, document visits accurately and thoroughly. Other than physician visits, other types of telehealth visits (e.g., follow-up appointments) are not currently reimbursable; but that doesn’t mean they won’t be in the future. For home health agencies, documentation is critical because telehealth visits are included in the care plan—specifically, listed among the total number of visits and subject to review during an audit.
As mentioned earlier, it’s important to determine what, if any, EHR integrations exist so that physicians could potentially type orders and other information directly into your EHR system. In this regard, you may want to check with your EHR provider to see what integrations already exist in your current package—and what add-ons could be available.
Make sure at the outset that your organization meets all CMS regulations around telehealth/telemedicine, as well as state regulations, which differ from state to state. The Center for Connected Health Policy maintains useful policy tracker and state actions update pages that your organization can utilize to better understand regulations that impact you.
Telehealth has gained widespread traction among primary healthcare providers—particularly as the COVID-19 pandemic has evolved. Through it all, telehealth has proven to be an efficient and highly effective means to delivering care and enhancing outcomes.
We encourage you to explore possibilities for integrating telehealth into the fabric of your operation. In this regard, the consulting consultants at Richter are available to assist you with any needs you may have related to the clinical, financial, implementation and accounting aspects of telehealth.