Update on My Experience with Telemedicine
By Charles Papp, MD
Last year, I wrote an article about my early experiences with telemedicine. Back then the lockdown was restrictive, patients were afraid, and physicians were struggling to find protective gear, meet guidelines, and keep their practices afloat. To help deal with these difficulties, we began offering telemedicine services. Federal and state governments eased restrictions,
allowing physicians easier access, and simplified billing for these services. At one point, I was offering telemedicine services one to two days a week. Now the lockdown restrictions are easing, a large and growing proportion of the population is getting vaccinated, and patients and doctors alike are starting to breathe a sigh of relief. Many of us are finding that our offices are
brimming and the pent-up demand is starting to show up on our doorsteps. The temptation, especially for certain specialties, is to drop the telemedicine option. I would strongly encourage reconsideration of that decision.
We are a rural state and many of our patients live several hours away. Some encounter suboptimal travel conditions, especially in bad weather. In addition, Kentucky’s population is
older and sicker than many other states. Travel can become a significant hardship sometimes to
the point of delaying or canceling a doctor visit. A telemedicine option may make the difference
between timely intervention and complications due to delayed care.
Some of our rural patients have poor or nonexistent internet access which can hinder video
conferencing. This can be difficult for Medicare patients since physicians cannot bill for a
telemedicine visit without video. Fortunately, this largely does not apply to Medicaid and private
patients. Kentucky House Bill 140, sponsored by Rep. Deanna Frazier, expands the definition of
telehealth to allow audio-only encounters. The bill also continues payment parity unless the
telehealth provider and the commercial health plan or Medicaid MCO negotiate a lower rate.
If you already are using telemedicine, I recommend you keep the service active. Be creative and think of new uses in your practice where it can benefit your patients. If you have not started using it, give it a try. Telemedicine is a growing alternative that deserves a place in most practices. It is convenient and sometimes essential for patients, and currently the regulations are relaxed. It is not hard to set up. Once you have, I believe you will find it a valuable addition to your practice.
Here are some pointers I have learned. They are not all inclusive, but hopefully they will be
helpful:
● Pick a HIPAA-compliant, easy-to-use telemedicine software. We use Doxy.me which is
cloud based, HIPAA compliant, and free.
● Test your software before you use it. Get the bugs worked out before you have a
frustrated patient waiting for a connection. Make sure you have the right hardware with
the appropriate software plugins as well as a secure wifi connection with good
bandwidth.
● Adjust your website so that patients can enter your virtual waiting room.
● Have a person familiar with IT at your side when you start. You likely will encounter
some glitches in the beginning, and an expert at your side will be like a lifeguard nearby
when you are learning to swim.
● Train key staff to do the initial contact and load the medical history. This will save you
time and help you anticipate unexpected issues.
● Load a template for a telemedicine physical exam. That way you can simply modify it
rather than typing it in every time.
● Have a way to keep track of the time you spend with each visit because this affects your
billing.
● Lastly, dress like a doctor for the interviews. Put on your white coat and resist the
temptation to show up overly casual. You will show respect for your patients, and they
will have more confidence in what you say.