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Leveraging telemedicine to improve care coordination and financial recovery

Telemedicine emerged early in the pandemic as a highly effective option for safely meeting patients’ ambulatory care needs while minimizing the risk of COVID spread among patients and caregivers. In addition to being an important vehicle for care delivery, telemedicine has the potential to improve the patient experience through enhanced care coordination and help bolster health care organizations’ financial recovery.

To reap the greatest benefits from telemedicine and recoup some of the revenue lost as a result of canceled surgeries, personal protective equipment costs, and other COVID-related expenses, ambulatory care providers should leverage the reimbursable telemedicine components that promote the coordination of care across the patient journey.

Research has shown that effective care coordination allows for earlier detection of problems, more precise intervention, and increased patient confidence in providers. When utilized properly, virtual care advances care coordination because it allows for

  • Fewer unreimbursed hospital readmissions,
  • Improved capture of wellness screenings,
  • Optimization of value-based indicators, such as timeliness of appointments and prompt answering of care-related questions, and
  • New sources of revenue previously untapped through reimbursement for activities formerly considered to be simply the “work of the day.”

During the COVID-19 pandemic, reimbursement has become more ubiquitous for E/M (evaluation and management) visits conducted via telemedicine, and patients have become more receptive to virtual services. Within two months of the pandemic’s onset, nearly 70% of patient experience surveys administered by Press Ganey in the medical practice environment demonstrated at least some type of virtual service delivery, with data indicating overwhelmingly positive responses to telemedicine. Following is a list of billable components of virtual care that improve care coordination, facilitate self-care, and improve the transition from a higher care setting to the home environment. These elements can be incorporated into chronic care management, transitional care management, and behavioral health integration frameworks to make them stronger.

  • Virtual check-ins and e-visits are brief, patient-initiated encounters that are useful for providing periodic updates to providers on patient progress, answering care-related questions, and determining whether a more comprehensive visit is needed for an issue. For example, a patient might call to give the provider an update after starting a new medication for cardiac issues to discuss whether to continue the prescribed course, make a further adjustment to the medication, or schedule a more comprehensive evaluation.
  • Remote monitoring allows for physiological data transmitted by the patient to be evaluated by the provider. There are multiple billing codes within the domain of remote monitoring. Some require devices that are automated with functionality to wirelessly sync and upload data points to the patient’s portal. There are, however, less restrictive remote monitoring services, such as self-measured blood pressure monitoring, that do not have the same requirements.  
  • Interprofessional communication supports virtual care by allowing for collaboration between providers to give guidance for care decisions or next steps. For example, a primary care provider might seek an opinion from a cardiologist when a patient is not responding to a medication as expected, or seek guidance on a “watch and wait” approach versus a more aggressive route for an abnormal diagnostic finding. Leveraging interprofessional communication and communicating both recommendations and source can instill a great deal of confidence in the quality of the treatment plan.

Patient contact through telemedicine provides an efficient mechanism to enhance frequency of interactions, and now, many virtual components are reimbursable as stand-alone services. These virtual tools can help give patients the confidence and support they need to be successful in self-management as well as provide organizations with new sources of revenue.

About the author

Shelly leads engagements for the Clinical Improvement solutions team in Strategic Consulting, partnering with clients to guide policies and procedures, strategic plans, and patient care models. She restructures case management so patients and physicians are partners in planning treatment. Shelly steers clients through accreditation surveys, helping them rethink staffing and turn finance and efficiency metrics around. Prior to joining Press Ganey, Shelly was an administrative leader and held executive level positions like Chief Nursing Officer.

Profile Photo of Shelly Turner, DNP, MBA, BS, CPHQ