Telehealth: Providers Have More Options Than Ever Before [PODCAST]

David Craig, MD, Medical Director of Spruce Health

Telehealth has been around for well over a century, but the last few years have brought a major shift in the meaning of the term.

Now thanks to new technologies, HIPAA-compliant programs and apps, and forward-thinking companies like Spruce, providers have more options for utilizing telehealth than ever before. In fact, your organization can benefit in ways you've never thought possible.

I talked to David Craig, Medical Director for Spruce Health in a recent podcast about telehealth. The Spruce Care Messenger is a secure messaging and video platform for solo practitioners and larger healthcare organizations. Listen to the full podcast here or read excerpts and insights below.

The State of Telehealth and Telemedicine Today

Telemedicine and more broadly telehealth are widely used today by larger multi-site practices, hospitals, and solo practitioners alike. Yet, many organizations have yet to tap into the breadth of possibilities from telehealth and communication platforms like Spruce.

My guest today was David Craig, a practicing emergency medicine physician and Medical Director at Spruce, who points out that different organizations can find dramatically varying uses for this type of platform.

"The Spruce Care Messenger platform allows any practice of any size, from solo practitioner to large multisite clinics or even a hospital system, to connect all their doctors and mid-levels and office staff into a secure messaging and a video environment—and then also to be able to get in touch with their patient base. And that could either be a phone...or fax—so the traditional methods—and then also more novel things such as SMS, texting, or app-based secure communication. And, of course, telemedicine is a part of that.

We support the video visits and then also these adaptive questionnaires that we call "Spruce visits" that can save you a ton of time in triage and also definitive treatments. So we like to look at ourselves now as a one-stop shop for medical communication, whether it's in your team or with your patients."

Popular with More Than Millennials

If you follow our blog and have listened to our podcast, you know that the "retailization of healthcare" is a popular topic here. And, of course, it's tough to talk about the changing healthcare landscape without mentioning millennial influence. While Craig agrees, he points out that millennials are certainly not the only ones who want the convenience and access involved with telemedicine.

"It turns out that a good number of people, even in the Baby Boomer generation or Gen X, have strong preferences for it as well... It's not just convenience or a technology preference. There were things when they were surveyed, things like, 'I don't want to sit in a waiting room with other people who might be sick' or 'I've become mobility limited in my older age, so I want to be able to see a doctor for minor things without having to go in every time.'"

Another misconception is that telehealth is primarily important in rural areas. While this is an obvious use case for telemedicine, he notes:

"I think what surprises people is that people in urban areas love telemedicine too...Often, transportation issues are difficult for people even when they're in the suburbs or an urban area. Often people with medical issues have trouble transporting themselves and are dependent on a family member or someone else—and then work schedules play in."

Reimbursement for Telemedicine Services

There are lots of obstacles for providers using telemedicine, and one of them tends to be reimbursement. I asked Craig about where we are today in terms of reimbursement for telemedicine services...

"In the classical sense of direct reimbursement for a specific telehealth visit...it's not great. Starting with Medicare, they have a bit of an antiquated policy. I think their hands are tied a little, but it's not an especially a robust reimbursement climate with Medicare. Then in Medicaid it's very patchwork...being state-based. There are some states that have amazing Medicaid telehealth coverage and others that have almost none. And even when they have good coverage, sometimes it has very draconian limits."

However, he notes that there are methods, like using chronic care management codes for Medicare, that may make telemedicine reimbursable in some cases.

In fact, says Craig, even when you can't get directly reimbursed, there are other strategies you can use that still allow telemedicine to work in your favor financially—by saving you time and resources.

"There are a number of other strategies like that where telemedicine lands such as postoperative visits or other things where you may not get paid because it's part of a previous service anyway. And if you can move that without sacrificing any safety or quality to a telehealth environment, it may be more efficient, better for the patient. They often prefer it and that's effectively a way of getting time and efficiency back, which in its own sense is equivalent to reimbursement. "

What Kinds of Providers Benefit from Telehealth Services?

Today, not every practice or organization is going to sign on for telehealth. But there are, of course, some typical situtations where a provider is an excellent candidate for incorporating telehealth into their processes. I asked Craig about these standard use cases:

" I think you can slice by different axes to get your answer. So one cut is by field...Imagine fields like dermatology where they're not entirely visual but it's more visual heavy so it may lend itself to telemedicine well.

Another cut is the business model that you're in. So if you're a value-based setup where you've already taken on the risk or the risk sharing arrangement with whoever's paying you, then that could be a good fit purely based on you having a more capitated model.

Another is the type of telemedicine you're talking about...Telemedicine is not just video chat with a doctor. A lot of what you have in medicine are small issues...And being able to handle those in an efficient low-friction way is better for your office staff, is going to be better for you as a physician and it's certainly way better for the patients.

Then there's the concept of triage. If you're seeing uncomplicated urinary tract infection visits or something or birth control consultations or whatever, you can really pick those off and do those in a telemedicine format in a much more efficient fashion...You don't have to do every piece of definitive care and I think that's a huge mindset shift that really changes who is appropriate for telemedicine on the provider end and who's going to see a huge benefit from it."

There Are Many Models for Telehealth

Remember, telemedicine is only a part of telehealth. Telehealth can be used for communication within larger organizations or with provider referrals in a secure, HIPAA-compliant platform like Spruce. But even within telemedicine, your capabilities can expand beyond what many organizations realize.

At the end of our interview, Craig reminds us that telemedicine is not just a video chat or a quick fix, or the one essential element that many providers may picture as being outside their capabilities.

"I mean we have solo mental health practitioners, that's a big demographic for us that find a lot of value up to large systems and they're using it in entirely different ways, which is where I've just slowly accumulated that anecdotal evidence that telemedicine is not one thing. If I could impart one message, it's that one. Telemedicine is not one thing. It's not one technology, it's not one type of messaging, or video, or audio. It's not one type of workflow piece. It's not one type of visit.

[The only limitation] is the vision and desire to do it. But I promise you there is a way that it can make your patients happier, your practice more efficient, and probably your bottom line better as well.""

And there you have it. Telehealth can be useful for many different purposes within an organization. And with patients, telemedicine allows for better communication and greater efficiency, regardless of reimbursement model.

Any organization can find a way to make it work for them...you just have to be ready and willing to move into the future of medicine.