Telehealth for chronically ill patients generates revenue and boosts care

Telehealth visits for chronically ill patients have advantages compared to in-person visits such as providing visibility of patients' home environment.

By Christopher Cheney

For healthcare providers, telehealth is an opportunity to generate revenue and boost the quality of care when working with chronically ill patients, a chief transformation officer says.

Telehealth visits can drive value for chronically ill patients. Telehealth visits are not only more convenient for chronically ill patients than in-person visits, they also are far less expensive than a trip to the emergency room.

"Instead of going to the emergency room for an unneeded visit and a very large charge, patients can get on a telehealth platform and speak to either a physician or a nurse who bills through their insurance. Providers can bill through an evaluation and management code such as a 99213," says Janice Coffin, DO, a practicing family medicine physician and chief transformation officer at the Medical College of Georgia, Augusta University.

Conducting telehealth visits with chronically ill patients generates five primary revenue opportunities for physician practices, Coffin says.

• In value-based contracts, telehealth and remote monitoring for patients with chronic conditions enables physicians to achieve quality of care goals and lower unnecessary readmissions, which results in higher incentive payments
•  Chronically ill patients with concerning health conditions can schedule a telehealth visit with their primary care physician rather than going to an emergency room or urgent care center
•  During the coronavirus pandemic, chronically ill patients who are reluctant to schedule in-person visits are more likely to schedule telehealth visits
•  Partnering with a chronic care services company that uses remote monitoring and telehealth provides a steady stream of revenue
•  With telehealth, primary care practices and specialty physicians can reach out to chronically ill patients who are overdue for physicals or follow-up visits

"With the rules changing and Medicare giving a lot more leniency in terms of reimbursement for telehealth visits, now physicians can get reimbursed the same amount of dollars for a telehealth visit without having to bring patients into the office," says Debbie Fisher, chief operating officer for Augusta, Georgia-based NavCare, which provides chronic care management services to Augusta University.

There are five primary best practices for conducting telehealth visits with chronically ill patients, Fisher says.

• As is the case with in-person visits, clinicians conducting telehealth visits should use situation, background, assessment, and recommendations (SBAR) or other standard tools to document clinical assessments
•  Clinicians should have a checklist for social determinants of health and the home environment, including an assessment of food in the home and checking for fall risks
•  Recommendations to the patient should include a plan of care for clinicians or a chronic care management team to follow up appropriately
•  After a telehealth visit, clinical protocols should be provided to remote patient monitoring or chronic care management teams, so that care and interventions can occur timely and appropriately
•  Clinicians should adhere to coding guidelines as well as code new and ongoing chronic conditions to the highest level of specificity, which can impact reimbursement and clinical interventions

Having visibility of a patient's home environment during a telehealth visit is advantageous compared to in-person visits, Coffin says.

"Patients can go into their kitchen and show me what they are eating. They can show me what medications and what dosages they are taking by putting their bottles upto their device camera. There is a lot of information that can be obtained when a patient does a telehealth visit because they are in their own living environment, which gives providers a better overall picture of the patient."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.