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Caitlin Whyte: MetaStar Health IT Radio is a podcast series that features consulting content experts and covers topics regarding the Wisconsin Medicaid EHR incentive program, promoting interoperability, formerly meaningful use as well as a behavior health technical assistance initiative. Episodes covered will guide your practice clinic, hospital or hospital system through the complex federal or state requirements of the promoting interoperability programs. MetaStar has helped more than 2000 providers attest to promoting interoperability as Wisconsin's regional extension center since 2010 and continues to provide adaptation assistance and audit preparation as a consulting service. We are joined by Lanette Hesse, a Project Specialist at MetaStar. Where she supports practices and providers participating in the Medicaid promoting interoperability as well as Medicaid's behavior health initiative program. Today. She sharing with us information about telehealth and the recent changes to policy. This is MetaStar Health IT Radio. I'm your host, Caitlin Whyte. Lanette, tell us what is telehealth exactly?

Lanette Hesse: Thanks for having me today, Caitlin. We are really hearing a lot about telehealth. Every time I turn on the TV, I hear that term. For this podcast, I will use Wisconsin Medicaid DHS definition that says telehealth or telemedicine enables a provider who is located at a distance site to render the service remotely to a member located at an originating site, using a combination of interactive video, audio and externally acquired images through a networking environment. There are other terms that you might hear and those include virtual visits, ehealth, mhealth or telepsychiatry. Telemedicine in some circles is used interchangeably with telehealth and then others it means a peer to peer coaching, consulting or learning. So really telehealth is an umbrella term and there are many different types.

Host: There has been a lot of information regarding telehealth. What would be some examples of different types of telehealth?

Lanette Hesse: Some examples of telehealth are the remote patient monitoring or RPM. And that's an opportunity to store data on a device such as an Apple Watch and sending it to be reviewed. An example of this might include remote glucose or blood pressure monitoring from home. Other types of telehealth that we might not think about are virtual check-ins and these are really brief five to 10 minute check-ins with the patient and provider that can be done via telephone or other telecommunication devices to decide whether maybe an office visit is warranted or maybe another service is needed. A virtual visit might entail a remote evaluation of a recorded video or image sent by a patient. Another type of telehealth that people don't think about are what we call either visits. This is a communication between patient and provider that happens via your patient portal, but really the most common type of telehealth visit is the one we think about as a virtual visit and this is when a patient and provider telecommunicate via a real-time audio video for an appointment. So really the bottom line is that telehealth encompasses more than a video call to your provider. It really includes peer to peer coaching and learning portal use and telephone calls to name just a few. It's really important to point out that telehealth is healthcare utilizing a different modality.

Host: You mentioned we're hearing so much more about telehealth these days. Why is it such a hot topic during the COVID-19 pandemic?

Lanette Hesse: Yeah, that's really a great question because telehealth has really been around for decades. As a matter of fact, about nine years ago, I was scheduled for a telehealth appointment, but however, during this current COVID-19 public health emergency, the transformation of telehealth is really via policy changes. This has been the main driver for remote access to patient care, so some of those policies are temporary and some are permanent. So in early March, the CMS or the Centers for Medicare and Medicaid services, they released guidelines around telehealth policy changes in response to our current COVID-19 pandemic. These policy changes really had a lot of components, but in my mind, the three biggest Medicare changes included, number one, allowing all Medicare patients regardless of their geographic location to be seen via live video conferencing in their homes. This took out the requirement of being at an originating site.

Another big change was they changed the Medicare reimbursement for telehealth. And thirdly, they changed the guidelines to allow for a greater range of technology that some people would be familiar with, such as maybe face-time and zoom. Many commercial carriers followed suit. There were some permanent changes in policy that happened locally here in Wisconsin. Last November a bill went into effect here in Wisconsin that changed Medicaid policy and that expanded telehealth and reimbursement to improve some of the access to healthcare professionals including behavioral health care professionals. This allowed for patients to connect remotely with providers from home school or other nonclinical locations. And that ended the restrictions and payment based on where the patient was located. So again, that happened long before the public health emergency. So really in my opinion, the pandemic was a catalyst for changing the paradigm of healthcare delivery and has in so many cases normalized telehealth by encouraging the use of this technology.

Host: Now what does all of this mean for a patient?

Lanette Hesse: Really in the end it means more access to healthcare. As a patient, you'd really want to contact your provider to see if telehealth is available. And appropriate for your scenario. Also many commercial as well as Medicare and Medicaid plans cover telehealth visits. So you would want to reach out to your individual plan to inquire about that reimbursement. They're really still going to be certain visits that require a face to face setting, but determining if telehealth is appropriate for your visit really should be done between the patient and the provider or healthcare organization. I really want to call out patient advocacy here and say that recognizing that telehealth could be a great opportunity for easy access to healthcare for everyone.

Host: Now on the other side, what are some strategies for providers during this time?

Lanette Hesse: There's a lot of information out there regarding telehealth changes for providers, so really one of the most important things in our mind is to make a strategic plan for telehealth in your medical setting that really looks beyond the COVID-19 public health emergency. Some of those might include your telehealth technology as part of your security risk assessment. Also, understanding what applications or technologies would really be appropriate for your use as a provider. They're really a lot of technologies and application and vendors that have been doing this for a really long time. So some of the things you might want to take into consideration are perhaps your budget, what's your strategic long-term planning around telehealth? And really any special requirements, being mindful of HIPAA and consent protocols, and you might want to check with your national local as well as your malpractice coverage guidelines and policy.

Host: You mentioned earlier about certain technologies that can be utilized during this public health emergencies. Can you tell us more about that?

Lanette Hesse: During this time, the Office of Civil Rights or the OCR gave some guidance regarding acceptable technologies to be used only during the COVID-19 crisis and they really broke these down into three categories. The first is technology that's considered HIPAA noncompliant and that's technologies that should only be used during the health emergency. These are ones that the public are pretty familiar with, like Apple's FaceTime and Skype. The second category is technologies that are HIPAA compliant and some examples of these include zoom for healthcare and also doxy.me. The third category included technologies that really aren't recommended at all during this pandemic or beyond. And those included Facebook live, Twitch, and Tick Toc. There are so many strategies for providers and organizations at this time and really we recommend practices looking into tip sheets that are time sensitive, as many items change rapidly.

Host: What are some tips or best practices regarding telehealth?

Lanette Hesse: Some of the tips sheets that we have reviewed and recommend and have noticed, different items include information that might be applicable for say a telephone medicine appointment. And some of those tips and tricks are things like calling the patient by name, making sure that you have a smile in your voice while you're on a phone conversation and know the limits of your media. If you're using a phone, they wouldn't be able to point to any items. And another one I found was interesting as they recommend providers on those phone visits, never hang up first. Make sure that is left up to the patient. Some best practices that we have noticed for those virtual visits via audio visual modality is really developing frequently asked questions around the telehealth visits. For instance, sending out to the patient how to complete a visit in instructions. This really helps reduce anxiety around the new technology being used for the first time. Also, make sure you use a similar familiar flow with your patients just like you would for a face to face visit.

Also, some best practices include having a neutral background including not being in front of a bright window or light as you're doing your video appointment. You'd also want to document your appointment in your office note just as you would a face to face visit. There are so many resources, like I mentioned earlier that you'd really want to make sure you're being cognizant of the dates that were issued. We are recommending that providers and professional organizations utilize toolkits recommended from different organizations such as the AMA, which is the American Medical Association, the American Academy of Family Physicians, as well as the American Psychiatric Association all have tool kits that are available on their websites. We also want to call out Wisconsin's DHS Forward Health Portal. They have great resources as well as cms.gov or looking at each individual commercial payer.

Host: We hear lots of positives about telehealth, but what are some of the barriers?

Lanette Hesse: There are really a lot of challenges surrounding telehealth, including equity for all patients for this technology. There can also be barriers around broadband limitations, confidentiality or maybe the fear of using technology, but in my opinion, telehealth utilization in conjunction with face to face visits is really here to stay and we need to work together on education, equity and advocacy.

Host: Wrapping up here, Lanette, where can listeners go for more information or assistance on telehealth?

Lanette Hesse: Right. There are really so many resources available and we can help at MetaStar to curate some of those resources. So really good place to start is with our website and that's metastar.com/podcast, that's M E T A S T A R .com/podcast.

Host: Thank you for your time, Lanette and for the information on what has become a popular alternative to in-person doctor's visits during this unprecedented time. That was Lanette Hesse, a project specialist at MetaStar. For more information on this topic and to access the resources mentioned, please visit MetaStar.com/podcast that's M E T Astar.com/podcast. If you enjoyed this episode, you could find more like it in our podcast library and be sure to share it with others on your social channels. This is MetaStar Health IT Radio. I'm your host, Caitlin Whyte. We'll see you next time.