TELEHEALTHA D O P T I O N + B E S T P R A C T I C E S

F E B R U A R Y 2 0 1 8

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C O N T E N T S

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Defining telehealth and telemedicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Types of telehealth services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Telehealth service adoption trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Resources: Telehealth background and overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Challenges and requirements in implementing

telehealth services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11How telehealth fits within a practice’s mission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Colorado Allergy & Asthma Centers, PC: Building the infrastructure . . . . . . . 1110 tips for implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13iNDIGO Health Partners: The night shift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Tips to get your staff on board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Considerations when choosing a telehealth vendor . . . . . . . . . . . . . . . . . . . . . . . . 15 Resources: Requirement and vendor selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Billing and reimbursement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Telemedicine and Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Medicare billing and reimbursement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Telehealth and Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Telehealth and commercial payers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Resources: Reimbursement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Case studies/best practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Kaiser Permanente: Virtual outpacing in person . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Blue Sky Neurology: Adding community through consults . . . . . . . . . . . . . . . . . 25UC Davis Health: From early adoption to rapid expansion . . . . . . . . . . . . . . . . . 26Access Physicians: “Easy math” for adding telehealth . . . . . . . . . . . . . . . . . . . . . . . 27Resources: Additional considerations for telehealth usage . . . . . . . . . . . . . . . . 29

Looking ahead . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30MGMA Telehealth Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31MGMA Telehealth Interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Click on the sections below to navigate directly to each part of the report.

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© 2018 MGMA. All rights reserved.2

Introduction

Computers, smartphones and mobile devices increasingly

offer new and potentially effective channels for delivering

healthcare services. However, as telecommunications has

revolutionized society, have healthcare organizations kept

pace with the ability to offer telehealth services?

More than 40% of medical groups stated they are or are

planning to offer telehealth services this year, while another

20% had not yet decided, according to a Jan. 9, 2018

MGMA Stat poll. Check out the results from the 2017

and 2018 MGMA Stat polls.

Healthcare organizations that have adopted telehealth services have touted the relative ease of

getting their patients to understand and accept telehealth. For some patients, these services can be

as easy to use as the video-call features, such as FaceTime or Skype, on their phones or home computers.

70% That has prompted many practices to rethink the care delivery process. In recent years, researchers have noted that approximately 70% of all patient visits do not require face-to-face interaction and could be done safely via virtual encounter.The benefits of telehealth — boosting access to physicians, lowering costs for the practice and payers,

and adding convenience for the patient — all make sense for medical practices shifting to value-based care

only if the services can be implemented, maintained and reimbursed sustainably.

This report outlines numerous models that can help medical practices plan, implement and operate telehealth

services. Understanding the drivers of telehealth services, as well as the operating requirements, and billing

and reimbursement guidelines will help ensure successful adoption of the services.

Equally important, however, is understanding how healthcare consumers embrace telehealth services.

According to a recent American Well/Harris Poll survey, nearly two-thirds of patients would like their primary

care provider (PCP) to offer telehealth, and one out of five consumers said they would switch providers

to one that offers video visits.

MGMA Data Solutions has conducted new surveys and qualitative interviews to identify why many practices

add telehealth services. We also explored how the expectations of doing so were met or shifted once

operationalized, and how leaders navigated the staffing, technological and financial realities.

50%

40%

30%

20%

10%

0%Currently

doPlanning

toUnsureNo

26%

15%

39%

20%

Will you offer telehealth services in 2018?

3©MGMA. All rights reserved.

https://www.mgma.com/data/data-stories/slight-increase-in-the-number-of-practices-offerinhttps://www.mgma.com/data/data-stories/slight-increase-in-the-number-of-practices-offerinhttps://www.mgma.com/data/data-stories/slight-increase-in-the-number-of-practices-offerinhttps://www.mgma.com/data/data-stories/slight-increase-in-the-number-of-practices-offerinhttps://www.ncbi.nlm.nih.gov/pubmed/24765740https://www.ncbi.nlm.nih.gov/pubmed/24765740http://go.americanwell.com/2017ConsumerSurvey.html

TEN TIPS FOR IMPLEMENTING TELEHEALTH SERVICES

Set clear goals and tie them to your strategic plan. Telehealth works best when it is part

of your program. The fewer changes that you need to make, the easier adoption will be

(read more on page 21).

Understand your patients’ wants and needs (read an effective strategy on page 26).

Determine how telehealth supports your value-based care initiatives.

Research reimbursement and licensure options and requirements in your area.

Engage and educate your staff.

Research telehealth vendors and platforms (read our tips on page 14).

Reach out to colleagues in your specialty who have already adopted telehealth

so you can learn from their implementation experience.

Discuss liability issues with your medical malpractice carrier.

Be patient, mindful and realistic with the timeline. It may take more than a year between

idea and implementation.*

Include the new services in your marketing plan.

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* As noted by respondents in the Jan . 9, 2018, MGMA Stat poll, on average, telehealth program implementation took about one year,

with the time frame ranging from as brief as a couple of months to as long as a couple of years .

© 2018 MGMA. All rights reserved.4

https://www.mgma.com/data/data-stories/slight-increase-in-the-number-of-practices-offerin

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10 tips for implementation 12