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3. Preparethepatientbefore the appointment.
Talk to your patients about whether it is in their best interests to pursue care by remote or virtual visit. This obviously depends on your specialty and the patient’s presenting concerns. When using this modality, as with any other, let patients know that they have a right to stop or refuse treatment.
Consider not only your technology, but also what equip- ment patients are using. Have your staff review technol- ogy needs with patients before you begin.
Receive informed consent from the patient for tele- health treatment. This conversation does not take long.
A telehealth-specific informed consent form may already exist within your electronic health record system. As an alternative, The Doctors Company has created a sample informed consent that you can adapt to your practice. But at a minimum, get your patient’s verbal consent to consult by telehealth—and document that approval in the patient’s record—before forging ahead.
Agree with your patient about what you will do if a tech- nology malfunction occurs, whether you will resume by phone or have the patient come to the office in person.
You also want to talk to the patient about what tele- health means for billing. You may tell the patient, here’s what your insurance company says about it or we don’t know what your insurance company is going to say about it. States and insurers have made a variety of exceptions to their usual rules during COVID-19, but the exceptions keep changing—with some reverting to a prior rule and others changing permanently—so check with each insurer frequently. The Centers for Medicare and Medicaid Ser- vices continue to periodically post payment updates.
First and foremost, do what you think is in your patient’s best interest as guided by good clinical judgment. Pro- viders need to be able to support their practices, but the payment has to come secondary to doing the best for your patient in whatever environment we
are in.
4. Developyourweb-sidemanner.
Consider your surroundings as you prepare for
video visits. You may realize that the brightly colored and patterned wall hanging behind you could be distracting and choose a plainer background. For
video consulting, imagine the visit from the patient’s point of view, and create a professional tone.
With newer patients, consider donning your white coat (if you weren’t wearing it already), and make sure that your badge is visible. Clothing looks different on camera than it does in person so, when possible, choose solid colors over multicolored patterns that can create a rainbow effect. Good colors for video include earth tones, like deep blues, purples, and teal green.
A little common sense will go a long way in removing distractions and maintaining a professional tone during telehealth visits.
5. Calloncreativityto“examine” patients remotely.
It is true that some symptoms and conditions simply must be evaluated in person and are not appropriate for care by telehealth. A virtual exam may, however, be more informative than you would think. For instance, peritoni- tis can be assessed by asking the patient to jump up and down. Musculoskeletal injuries may be assessed using the Ottawa knee and ankle rules. For more information about remote evaluation tools, start with the April 2020 article in NEJM Catalyst, “The Transition from Reimagining to Rec- reating Health Care Is Now” and “Strategies for Effective Patient-Assisted Telehealth Assessments.”
6. Consideradditionalinsuranceneeds.
In the last year, a number of institutions, including healthcare, have been affected by cybercrime. Most experts believe that this situation is unlikely to improve, so you should consider seeking increased cybersecurity coverage.
This is also a good opportunity to review your busi- ness associate agreements with technology providers to understand who will be liable in case of a breach. Privacy liability is critical.
Business interruption insurance should also be reviewed. For providers with a significant portion of the practice delivered via telehealth, any interruption in communication technology can be considered business interruption. Consider adding or increasing your coverage in this area.
7. Acknowledge when telehealth is not appropriate.
A practitioner using best judgment can say to a patient, it’s hard for me to fully evaluate your symptoms using this kind of encounter, and I need you to come in. It’s easier to miss things with telehealth, so when you have that second sense you are missing something, act on it.
Of the telehealth-related claims received by The Doc- tors Company, nearly 70 percent have alleged diagnostic errors, and most of those involved cancer. The risk of missing a cancer diagnosis by telehealth depends in part on your practice specialty.
If, in your best judgment, you believe that an in-person visit is called for, and you think that the risk of the patient coming to your office is less than the risk of not seeing them, then you should have the patient come to your office.
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For assistance, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or patientsafety@thedoctors.com.