Telehealth Survival in the Time Of COVID

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When COVID froze everything in place and shone a spotlight on your practice, what did it reveal about your “health?” Were you already exploring virtual care? How current were your phone and computer systems? Were your website and patient portal in good shape? And how about your staff… tech savvy, open to change?

COVID changed the definition of “sustainability” for providers and health systems. Survival, as always, meant adapting to the environment. So, if you had no telehealth capability, you had no revenue and could not provide continuity of care. 

For our client, the CEO-CMO of a Federally Qualified Health Center, survival boiled down to four essential tasks – keep patients, find or sustain revenue, get providers on board with telehealth, and remain sane!  

Clipboard showing 4 items for surviving COVID

Prior to COVID’s expansion of 1135 waivers for telehealth, reimbursement for virtual services for a non-rural FQHC was very limited. Many community health centers were reluctant to embrace telehealth and remote monitoring. Fortunately, our CEO was committed to using telehealth. He had seen the tremendous benefits personally as the telehealth provider on a previous managed grant project managed by Telehealth Associates. So there was no question that his Center would pivot to video visits to provide continuity of care for his patients. 

Here is how he did it. 

1. Keep Patients

The top survival priority, keeping patients, required a couple of things. First, the Center had to let people know it was open for business, even if its doors were not open. The Center hosted video conference calls with its constituent groups (Agencies that serve disabled individuals), put notices on its website, sent letters and emails and made calls to patients. 

Mother holding two infants in her lap holding a tablet, doing a telehealth visit.

We also had to make sure patients had the technology to connect and were able to use it. Telehealth Associates helped the Center create workflows for determining whether a group home needed a Center-supplied tablet and had connectivity. We worked with the Center’s telehealth team to create step-by-step processes for both the patient side and clinic side.   

2. Find or Sustain Revenue

The Center had a head start on survival item #2 as well. Two years ago, with our help, the Center developed a Chronic Care Management (CCM) telephonic care coordination program. Part of its objective was to generate a revenue stream to help fund telehealth. We tapped CCM enrollees as pilot patients in the video and remote monitoring pilots we helped the Center roll out all last year. So, in 2020, when COVID shut down office visits, CCM services helped keep the Center’s lights on. CCM care coordinators, accustomed to working virtually and familiar with the Center’s pilot telehealth programs, were able to scale up to do three things:

  1. Educate group home staff and patients on how to do video visits
  2. Remind and prepare them for virtual visits with the providers
  3. Troubleshoot connectivity problems  

3. Get Providers on Board with Telehealth

The CEO realized that his clinical team was all over the map in terms of telehealth understanding, confidence and commitment. He needed them all rowing together, but to accomplish that, he recognized that each person was in a different place on the spectrum of openness and receptivity. He categorized the spectrum into 3 buckets.

Three buckets describe doctors' fears about transitioning to telehealth'An “Oh Yeah” man himself, he nonetheless understood the overwhelm of team members in buckets 1 and 2. Keeping steady through daily upheaval, he was reassuring and encouraging. With our help, he provided instruction, training and practice. His advice:

  • Don’t lose the skills you are good at, use skills to learn new ways of doing things 
  • Don’t be frustrated with failure, understand where it went wrong and try again
  • Open your eyes to what is possible beyond the walls we live and work in

It was also important to remind everyone that their actions and choices mattered. For example, seeing a trend toward telephonic vs video appointments, he began sharing data on the disparity in revenue between the two modes. By the end of July, telephonic appointments had dropped to 3% of all visits.

4. Remain Sane…and help each other

Image of a person's hand reaching down to grasp the hand of another person reaching up for help.

Keeping the staff healthy and whole was a priority. Employees were encouraged to incorporate self-care into daily routines. All but two clinics in the system were closed, and providers who were too uncomfortable coming on-site for the Center’s urgent care services were equipped to work from home. The Center’s leadership kept the tone upbeat, collaborative, encouraging and positive.

Telehealth Associates was there (virtually) every step of the way, helping train Center teams, working with the Agencies to put their in-residence technology in place, and monitoring and refining workflows and procedures on both the patient and clinic side. 

What Survival Looks Like

COVID gave our CEO client the green light to accelerate the shift to a hybrid practice. And, as many of you have no doubt noticed, being in transition is a creative time. While some practices folded, others innovated.

Here are some examples of what the Center has done in response to the upheaval of COVID:

  • Made new hires to support virtual care for patients
  • Established new vendor partnerships for COVID-related mobile lab work, safe RPM kit distribution for monitoring symptoms
  • Developed an online referral program to make it easy for local hospitals to refer uninsured patients to the Center, to free up ER resources for COVID patients.

How are your survival instincts?  What creative, innovative things have you done to survive? What do you wish you’d done 6 months ago?

If you are frozen, Telehealth Associates can help.

Telehealth Associates encourages your pursuit of telehealth and is here to support you on your path. Contact us with questions, to explore options or for a free session to talk about next steps in implementing your telehealth program. 

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