If there’s one silver lining to COVID-19, it’s the rapid adoption of telehealth that enables physicians to take care of patients while also limiting the spread of the virus. The Centers for Medicare & Medicaid Services (CMS) even expanded its list of telehealth-covered services during the public health emergency, allowing physicians to render certain preventive care, evaluation and management of conditions, and other services without requiring patients to come into the office.
One unintended consequence?
When using telehealth, physicians may be less likely to capture chronic conditions that affect risk-adjusted payments. Why? Lack of time, new workflows, and a variety of other causes.
This is detrimental to risk adjustment for two reasons. First, it can affect the quality of patient care—particularly during care transition when documentation becomes critical. Patients who benefit the most from remote care during the pandemic are often those that tend to have multiple chronic conditions. However, it is still critically important to capture patient complexity through appropriate documentation and coding.
Second, it negatively affects physician reimbursement under capitated or risk-based payment models. When documentation and medical codes don’t paint an accurate picture of patient severity, physicians receive fewer resources for those patients who are inappropriately perceived to be less clinically complex. The same is true for government-sponsored payers.
The good news is that a comprehensive risk adjustment and quality solution can help by taking some of the administrative burden off physicians so they can concentrate on providing high-quality patient care. The first step, though, is to address common myths about telehealth in a value-based care environment.
Below, we address three myths about telehealth as well as strategies to help physicians depict a more accurate picture of patient severity, acuity, or complexity when using this technology.
Myth: ‘I only have time to focus on the acute problem during a telehealth visit. I can’t possibly capture chronic conditions as well.’
Truth: Although physicians are often pressed for time during an encounter, it only takes a few seconds to check in with the patient about the status of their chronic conditions. It can be as simple as asking the patient whether they are taking their medications as prescribed for each chronic condition.
Physicians can also participate in health-plan sponsored risk adjustment and quality of care initiatives that can help them report the quality of care they normally provide. These initiatives provide clinical and administrative support to ensure accurate and comprehensive documentation and coding so physicians can spend more time on direct patient care.
Myth: ‘It’s too difficult to provide an Annual Wellness Visit (AWV) via telehealth. Care quality will suffer.’
Truth: In a recent survey, 49% of physicians cite ‘diminished quality of care’ as a top reason why they haven’t provided a virtual consultation. However, decreased care quality with telehealth isn’t yet proven, and for some patients, it may be the only way to get them in the door—albeit a virtual one. The AWV is an opportune time to capture and manage chronic conditions. During COVID-19, this is more important than ever as these diagnoses may place patients at higher risk for developing complications if they were to contract the virus.
Deferred care during COVID-19 has become all too common. Four in 10 U.S. adults reported avoiding medical care because of concerns related to COVID-19. One recent survey found that patients with chronic conditions are less engaged and that fewer patients are seeking preventive care. This means chronic conditions could go undetected and unmanaged for months at a time. There may also be missed opportunities for routine vaccinations or early detection of new conditions, both of which could result in poor patient outcomes.
Health-plan sponsored risk adjustment and quality of care initiatives help physicians efficiently provide critical preventive care services without jeopardizing the time spent on patient care.
Myth: ‘Telehealth won’t help me succeed under value-based payment models. It’s too risky to embrace this new technology knowing that my revenue could suffer.’
Truth: Telehealth is in no way a barrier to value-based care. In fact, it enhances value by increasing patient access and providing physicians the platform to capture and address chronic conditions.
In fact, more than 75% of clinicians responding to a recent survey said telehealth enabled them to provide quality care for an array of conditions and situations: COVID-19, acute care, chronic disease management, hospital follow-up, care coordination, preventative care, and mental/behavioral health. Additionally 60% reported that telehealth has improved the health of their patients, and the majority would like to continue to offer telehealth visits following the pandemic.
With the help of health-plan sponsored clinical and administrative support, physicians can use telehealth to improve quality care reporting while also supporting revenue integrity through accurate and complete data capture.
How Vatica Supports Providers
Physicians providing care via telehealth need extra support. Our team deploys on-site or virtual clinical consultants with backgrounds as RNs, LPNs, or PAs that serve as extensions of your team at no cost to the practice to help surface important items to address with paitents in a virtual or in-office setting, such as chronic condition management. Practices retain all fee-for-service payments generated from patient encounters and also receive incentives for coding visits.
The best part? It’s a health-plan sponsored initiative. That means it’s completely free for practices to participate. Learn more about how Vatica can help your practice.