Author’s note: Today’s article marks the 200th edition of Telehealth Tuesday. Launched well before Covid in 2018, Telehealth Tuesday has helped me to capture the many lessons we’ve learned in helping organizations to launch, optimize, or grow their telehealth services across dozens of organizations. I hope you continue to find the insights and guidance useful.
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The longer I’m in telehealth, the more I become present to the vast opportunities that lie before us once our traditional health system (and antiquated reimbursement systems) truly embraces the possibilities offered by virtual care.
Challenged by one of our clients, I was asked to share my thoughts on how virtual care could be used to increase clinics’ capacity to provide care to more patients. While virtual care cannot magically create new clinicians, it can be used as a strategic tool to optimize the utilization of the existing providers and to decrease demand for visits.
Reduce unfilled appointment slots
The obvious place to start increasing capacity is to fully utilize the capacity that is already there. It’s in the nature of today’s clinical practices, that inevitably providers will have holes in their schedule throughout the day – the slot might have been never filled, a patient had to cancel on short notice, or a patient simply did not show.
There are multiple tactics to fill those holes with good patients.
The most obvious tactic is to make sure that there are never any appointment slots that are not filled – either through diligent scheduling, or by immediately filling cancellations with patients from a waiting list.
Speaking about cancellations – actually the best way to “recover” from a cancellation is to offer the patient a video visit as an alternative for their in-person visit. Sometimes when patients cancel, it’s more about the overall time investment, transportation, or both that prevents patients from seeing their doctor. As we’ve all experienced, a 10-minute doctor’s visit can easily take an hour and a half, if you take transportation, parking, and waiting into an account.
Sometimes patients could make themselves available for a 10 minute video call in a secure location with good connectivity – but may not be able to come into the office. By offering to convert the pre-scheduled in-person appointment with a video visit we create a win-win-win: we ensure continuity of care for the patients, we fill an appointment slot, and we can create a billable visit.
If a cancellation is short notice, patients on the waiting list could also be offered a virtual appointment, as they may not be able to make it to the clinic on time.
A similar approach also exists for in-person no-shows: when patients are given a time of 10, 15 minutes before the actual appointment time, then patients that don’t show within 10 minutes of their indicated time can be contacted and offered a telehealth visit, if they truly simply forgot about the scheduled appointment.
A final technique is what I call “load balancing”, i.e., to spread additional provider capacity across the various sites of a health system or health center, by instituting site-to-site visits. I.e., if one clinic is running short on providers, they can offer patients a virtual appointment – either directly to the patient’s home, or in a designated telehealth room at the clinic. While the visit would typically not be conducted by the clinician at that clinic, this configuration utilizes another clinician’s availability.
Reduce the need for video visits
If the goal is to see more patients, i.e., to increase an organization’s patient panel, another key win-win-win strategy is to invest in making sure that the condition of patients with chronic diseases does not deteriorate to the point where they need an appointment.
This can be accomplished through a multitude of ways, all first and foremost focused on ensuring that the patient is “activated” to participate in their care, to support executing the care plan.
One highly underutilized but demonstrably valuable virtual care modality is secure messaging. With the introduction of smartphones, our communication style has dramatically changed over the last 2 decades. Most communication between friends and family members these days occurs via text messaging and only rarely over phone calls.
The main reason this way of providing care — checking in on the patient, or being accessible for a quick question here and there — is not utilized more often, is that our current care delivery system is still mired in (and hampered by) the fee-for-service mindset – and thus far, there’s no reimbursement code for sending a text message, so clinicians don’t think about.
Besides, most clinicians are not set up to easily send secure messages while protecting their “identity” (namely their personal cell phone number).
What secure messaging does for patients, though, is to send a message that someone is caring about their condition and is available when they need help or have questions.
A second, increasingly popular way to improve a patients management of their chronic disease is an enrollment of a remote physiological monitoring service. Here, patients are provided with a digitally connected scale, blood pressure cuff and/or glucometer and are prompted to measure and send their vital signs on at least a daily basis, which is then reviewed by a monitoring nurse and escalated to the primary care physician as needed.
By being enrolled in RPM, the patient can feel empowered to make the changes they need to make to offset or reverse their chronic disease. Just knowing that someone cares and knowing that somebody, somewhere is paying attention can do wonders for the patient’s motivation to follow the clinicians’ care plan.
A third way to ensure that the patient’s condition is well managed so that visits are limited to the regularly occurring check ups is to arrange for virtual access to specialty and subspecialty services. This can be most easily achieved through a partnership with the nearest academic medical center with the patient being scheduled to appear at the clinic to conduct their telehealth visit with the specialist.
This also allows for great collaboration and warm handoffs from the primary care clinicians to the specialists, further ensuring that the patient is in good hands with their local clinic.
Creating More Clinicians out of Thin Air
Last but not least, an increased embracing of using video visits whenever clinically feasible and acceptable to the patients can increase your organization’s clinical capacity.
First off, virtual care (especially if the providers are working from home) can add additionally capacity, e.g., after hours or weekends if that is desirable by the clinicians (many people would love to be able to “go” to the doctor after a day’s work).
By offering “work-hour” flexibility and “work-location” flexibility, more clinicians may be willing to see more patients virtually from the comfort of their home or their vacation cabin.
This also means that your organization should explore hiring virtual only providers or mostly virtual providers, as an extension of the “brick & mortar” team. As long as the clinician is licensed in the state where the patient is located, in most states the location of the provider does not matter.
If you are trying to recruit into a rural area, it can be difficult to attract younger talent who tend to prefer the more urban areas. With a virtual only position, this may be very attractive for a new clinician to build their experience and their patient panel.
Virtual Care as a Magic Wand
Over the past decades (and even in the 4 years that I’ve been writing Telehealth Tuesday) many more possibilities have opened up for telehealth to fulfill on its grandiose promist to virtually (pun intended) redesign our current “sick care” approach to health care.
I’m reminded, though, that first and foremost telehealth is a clinical tool and that these days we merely have to empower and train the clinicians to wield this tool to the benefit of their patients.