05/19/2020

As always, we are incredibly grateful to serve each and every one of you. We are also grateful to have so many wonderful members willing to volunteer their time for the benefit of all. TIOPA hosted a “Think Tank” on Thursday March 14^th to compile experience and examples of how practices are reopening, and re-engaging with patients. Members of the May 14^th Think Tank were:

Viji Krishnan	PPG Health
Ivette Gamblin	PPG Health   Via Phone Call
Tammara Franklin	GeriNation Medical Centers
Kymberly Lewis	Primary care Associates
Darla Shelley	Attigo Infusion Inc
Angie Cruz	PPG healthcare
Kathy McGuire	Granbury Eye Clinic
Barbara Wester	Uptown Physicians Group
Ginger Lento	TIOPA
Tim Paquette	TIOPA
Scott Bullington	Integrated Medical Services

*Please note, the following information is not meant to address disinfecting guidelines or use of PPE.

Based on TIOPA’s previous survey and informal patient questioning, our “Think Tank” was posed the following two challenges.

1. What can practices do to increase access to care for patients that are at risk, pose risk, or otherwise will delay seeking care due to safety concerns.
2. What can practices do to proactively re-engage patients to stay on track with their healthcare needs.   

Two points of discussion:

• Patient Access
  • Based on our survey and feedback from our panel, a high number of practices have adopted some form of virtual encounters during the PHE and expect to maintain its use in varying degrees even afterwards. The level of adoption was heavily dependent upon specialty and existing disease levels within the patient population.
  • For example, a nephrology practice sharing the same location with family practice patients led to the decision for all visits to be virtual. Physicians rounding in a hospital and then coming to the office added to the level of safety concerns as well.
  • Differentiating between chronic and acute patients led some practices to see only chronic/refill patients in-office and all acute virtually. Others reversed and saw only acute illness patients in-office and all chronic/refill patients virtually. Separating the two appears to be a universal thought and one might also consider the health and susceptibility of the medical provider and staff as well.
  • Also, when considering which patients will be in the office, consider the paths they will take to and from different internal locations. Do acutely ill patients cross paths with non-acutely ill patients? Are the paths acutely ill patients take easy to sanitize more often?  
  • Most offices have adopted a different triage protocol, making sure patients are not symptomatic before entering into general areas. For instance, setting up a location outside the door, or having patients triaged first at a side door.  
  • The above examples are mainly practice driven but be mindful that patients will have varying degrees of trust for their safety when re-entering practices. The decision to continue virtual visits should also be patient driven.
  • It is unknown at this time what policies will resume once the PHE is lifted and require face to face encounters at certain intervals for virtually treated patients.

• Patient Scheduling to increase in-office availability
  • Our panel discussed varying schedule options but the overriding theme was to accomplish less crowding in the waiting room and time for deeper cleaning between patient visits in-office.
    • Schedule all in-office visits for first half of day, and virtual visits for second half of the day. In-office visits are spaced to allow for quick cleaning and the virtual visit time allows for a deeper cleaning to set while patients aren’t present.
    • Alternate or plug in virtual visits between in-office visits. This allows staff to deeper clean more often throughout the day.
    • Clinical staff have been involved with scheduling to help determine which health conditions, and complicating factors, should be prioritized within either mode of access, virtual or in-office.
    • To limit office capacity of in-office visits, some patients are being asked to wait in their cars and then taken directly to a room when ready.
    • Patients needing to have labs drawn or leave UAs, etc. may also go back to their car and have a virtual visit while on-site. This may provide easier logistics should the patient need additional diagnostics either on-site or off-site.
• Billing
  • Very few instances of virtual visits being denied have been noted. Many appear to have determined the correct code/modifier combinations and primary discussion centered around patient responsibility versus practice responsibility. Many carriers have announced that practices can waive patient cost-shares causing much confusion. While some carriers are stating they will cover virtual visits at 100%, others are implying the provider can waive the patient cost-share and it will not be deemed as incentivizing the patient. What you deem necessary with your practice is your business, but here are a few tips.  
    • You may already be experiencing a reduction in patient encounters and revenue. It is not your obligation to waive copays and deductibles, just because the carriers say it is your right.
    • If a patient states her insurance covers virtual visits 100%, but you can not verify the benefit, let the patient know you will gladly issue a refund should the carrier pay as such.
    • If the carrier processes the claim with a patient responsibility and the patient states her insurance should have paid 100% thus she has no responsibility, have the patient contact her insurance for clarification. The policy is bought and paid for by the patient based on what the patient is willing to contribute financially. You did not buy the policy, therefore you are not obligated to argue against its established benefits.
    • It was also noted that some carriers are now automatically reprocessing claims to include the patient portion in their payment. Keeping in mind it is not all carriers intent to do so.   
    • Consider collecting the patients cost responsibility at the time the appointment is scheduled. Otherwise, all virtual visits should start with a check-in call by the front desk as if the patient would similarly do in the office. By collecting the patient’s cost portion at the time of scheduling, adherence to the visit is much more likely.

• Patient Engagement and Outreach
  • Regardless of one’s own opinion of the virus, patient emotions and expectations may differ. Some patients have expressed a desire for varying visit options, a need to understand the practice’s protocol for sanitation, and a proactive interest to prepare their own health against outbreaks. Practices should consider initiating communications with patients rather than wait and see approach.
    • Consider turning off automatic appointment reminders so that staff can speak directly with patients, answer any questions, and explain office protocols.
    • Use the messaging feature within the patient portals to regularly update and inform patients about visit options, cleaning protocols, and health tips. One practice mentioned seeing an increase in patients they’ve not seen for years.
    • Have staff provide follow up calls to check on patients that presented with previous acute symptoms.
    • Use reports to identify patients that are overdue for annual well exams or have gaps in specific services based on their conditions.
    • Use social media to communicate your ongoing process to re-open. Create posts announcing available office hours, virtual visit options, “how to” do a virtual visit, staying healthly topics, smiling staff in your sparkling clean office.
    • Research and communicate ways patients can proactively improve their own body’s immune system for these type circumstances. Our TIOPA Community partner, Evexipel, has provided a prerecorded webinar on the subject, located on our provider resource page. Click Here

The workflows discussed likely don’t cover all of the variables a practice may encounter while re-opening. However, we hope that the ideas presented spur inspiration in a way to help you design a plan for yourself. We are extremely grateful for those that participated in our Think Tank and are equally grateful for the many more that volunteered to participate. Lastly, we welcome any of your suggestions and experiences as well. Please reply to our emails with your comments and we’ll make your suggestions available through our website.