Abstract
The COVID‐19 crisis has seen some dramatic changes to health care as we know it. In particular, one area that has seen rapid changes is the area of telemedicine. Telemedicine is not a new phenomenon. Quite the opposite. For some time now, telemedicine has been used to connect those in rural areas to providers for both medical care and behavioral health care services. Unfortunately, the conditions surrounding it have been fairly stringent and have even gone so far as to require that specific audiovisual equipment be used in order for it to qualify for reimbursement from the Centers for Medicare & Medicaid Services (CMS) and other health insurers.
The COVID‐19 crisis has seen some dramatic changes to health care as we know it. In particular, one area that has seen rapid changes is the area of telemedicine. Telemedicine is not a new phenomenon. Quite the opposite. For some time now, telemedicine has been used to connect those in rural areas to providers for both medical care and behavioral health care services. Unfortunately, the conditions surrounding it have been fairly stringent and have even gone so far as to require that specific audiovisual equipment be used in order for it to qualify for reimbursement from the Centers for Medicare & Medicaid Services (CMS) and other health insurers.
With many patients placed under “shelter‐in‐place” orders, the current pandemic has created a huge spike in demand for telemedicine services from all sectors. To meet this new demand, on March 6, 2020, Medicare (CMS) announced that it would temporarily pay clinicians to provide telehealth services for beneficiaries across the entire country and that it would no longer reserve the service for those in rural areas. The previous stipulations regarding the specific audiovisual equipment have also been removed, allowing health care providers to use devices such as phones, laptops, smartphones or other electronic devices to connect with patients. Additionally, on March 17, the U.S. Department of Health and Human Services' Office for Civil Rights stated that, during the COVID‐19 National Public Health Emergency, providers may use free to low‐cost telehealth platforms, and apps, to provide telehealth services without the risk of being penalized for noncompliance with the Health Insurance Portability and Accountability Act (https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html).
With many health care providers excited to be able to provide these services but unfamiliar with how to conduct a telemedicine appointment, I have put together some important tips on how to set up your first telemedicine session for maximum success:
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Remember that practice makes perfect.
If this is your first time using telehealth software, we recommend that you practice with colleagues first before using it with clients, so that you know how to work it and how to troubleshoot problems. You will want to ensure that whatever software or application you have chosen will work, that you know how to send the link to your client and that you have the right operating system. A working camera and microphone, and, depending on your preferences, headphones or speakers, are also key to a great session.
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Consider your setting.
Even though telehealth basically eliminates your need for a separate office, you should still ensure you have a designated and secure space for your sessions. You should have sufficient light so that your client can see your face clearly, and without shadows. The background should be uncluttered and free from personal items, in order to ensure the client is not distracted during the session. It is also important to check that there are no distracting noises during your sessions. TV, radio, doorbells and other noises should be minimized, and you should ensure that others are not able to hear your conversations.
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Know informed consent laws.
Informed consent still applies to telehealth, and it is important to also take into account risks specific to delivery of care using technology. Informed consent laws for telehealth vary widely among states, with some requiring written informed consent, while others permit verbal consent. Make sure to check your local state legislation regarding the specifics for your area.
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Don't let technology get in the way.
Try to create the most natural environment possible. Continue to dress professionally. Make eye contact with your client by looking into the camera. Many existing patients have found telehealth an easy extension of the client/provider relationship, but it may take extra effort to make new clients feel comfortable with the process. Be warm and friendly and don't make clients feel rushed.
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Determine professional best practices.
It is always a good idea to check in with your specific professional organizations to see what suggestions/best practices they may have for your particular field of practice.
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Have a backup plan.
This is so important. I have heard numerous providers talk about blank screens, video cutting out or screens freezing. Communicate with your clients before the session and set up a backup plan ahead of time (maybe switching to a traditional call) so that you can complete the session with only a minor disruption.
As a company, Monroe & Weisbrod is committed to helping medical providers during the COVID‐19 pandemic in any way we can. We have officially made the decision to make our proprietary telepsychiatry platform available to use for free during this crisis. For more information, visit https://vidhealth.com/.
Please feel free to reach out to us with any questions you may have around telehealth. We would love to help.
Bo Claypool is the founder and executive director of Monroe & Weisbrod (https://www.psychiatryrecruitment.org/) based in Austin, Texas. He has spent the entirety of his professional life working in physician placement and health care executive search.