Nephrologists: we need to prepare to stop our routine CKD and HTN clinic visits. I've been diving into options for #telehealth. I am by no means an expert but here's what I've learned. Would love more experienced people to chime in. A thread: 1/n
Disclaimer: I'm in private practice and I'm thinking about revenue. I'm committed to paying my staff their full salaries plus paid sick leave throughout this, and I expect to stay closed for two months. It would help to have some income coming in. 2/n
We can and should debate the structure of the US healthcare system another time. For now, I want to protect my patients, not have a six month backlog in clinic when we reopen, and keep the lights on. 3/n
So, #telehealth. In normal times the regulations are difficult. For one, the patient has to be in a qualifying originating site which isn't their homes. Clearly not ideal in a pandemic to make them travel to a clinic so they can have a televisit to my clinic. 4/n
But emergency legislation was just passed waiving that! And we've had a declaration of a national emergency so by my understanding this applies everywhere in the country. Here's an article (and I don't know this website well, etc, etc.) 5/n hitconsultant.net/2020/03/13/cor…
So with the location waiver, patients can receive telehealth in their homes, which makes sense because, again, pandemic. Codes that are covered are on page 6 and the usual office E/M codes are there. Use the modifier "GT" for telehealth. 6/n cms.gov/Outreach-and-E…
One thing I would LOVE to know is the requirements for vital signs for telehealth. I'm planning on having my staff request some home BP readings for those that have monitors. We'll call a day in advance to set up the visit and ask for them then. 7/n
What tech do you need? Gotta be an audiovisual link, live interaction, and HIPAA compliant. Lots of people have smartphones. I'm thinking Facetime. Looking into buying a few cell phones but I'll use my own if I have to. I trust patients not to abuse the number. 8/n
Why will they get my number? One regulation stands - they have to initiate the call. But you can call them to tell them about the option. 9/n
So for workflow, here's what I think. Keep my existing clinic schedule. Staff calls patient the day before. Gets BP readings or tells them to generate a few between now and tomorrow. In each clinic room, I've got a smart phone on a stand with a Bluetooth headset. 10/n
Patient has to make the call, but they have a time to do it. Staff answers the phone, makes sure everyone can see and hear, collects the vitals data. I come in, do the visit, type while I'm wearing my headset. Meanwhile in the next room the next call is getting cued up. 11/n
You should document that telehealth was consented to. I'm going to document that patient was at their home under the 2020 Coronavirus Preparedness and Response Supplemental Appropriations Act (from the article linked above in tweet 5) 12/n
Bill the office visit with the GT modifier. Private payers are coming on line with this. No idea about Medicaid. Don't care if the claim gets denied. Hope I don't get in trouble but I think we left normal behind about five days ago. 13/n
Seems pretty clear that this has to be for existing patients only. New consults are on hold (of course, unless urgent, then they come in) unless someone else has better information. We're a cognitive specialty. I think this can work. Welcome all comments and suggestions. 14/n
Honestly the hardest part is understanding the Cricket Wireless plans. I need a few cheap smartphones with phone numbers so I can do video calls. What are my best options? Don't want years-long contract. 15/n
I have heard through the grapevine that Texas just waived the video requirement for #telehealth. That would allow patients without smartphones to participate. How about it @GovWhitmer ? Can we do the same in Michigan?
