Physicians need telehealth to ensure they can treat their patients during this unprecedented COVID-19 pandemic. They also need to secure the necessary revenue to keep their practices functioning through accurate coding and documentation.

So how can physicians ensure they get paid for telehealth visits?

Since the beginning of the COVID-19 pandemic, 

® has received many questions from physicians on how to properly code and document telehealth visits. To answer your questions, we reached out to health care business consultant Elizabeth W. Woodcock, MBA, FACMPE, an expert on coding and documentation. The following interview has been edited for length and clarity.

 Where can physicians go to get the most correct, up-to-date information for telehealth coding and documentation?

Woodcock: It’s a great question. And we’re hampered by two details that are incredibly frustrating. First of all, almost every payer has its own nuances, its policy protocols related to coding reimbursement. And second of all, those are changing what seems like every day. So if you’re frustrated, you’re not the only one. I am, too. However, it appears that we are now at a ... sustainable state, meaning (the rules have been) worked out and as of today, you pretty much know what they are going to be.

ME: We received a lot of questions about whether you can be reimbursed via telehealth for phone calls that don’t use video.

Woodcock: On April 30, CMS actually made audio-only telemedicine possible. Prior to that, they had held steady to audio and video being required. But (that April 30 ruling) was actually retroactive back to the beginning of the public health emergency. Indeed, audio is now applicable. And so physicians can bill the telephone-only codes and, interestingly enough, receive reimbursement at the level of an outpatient visit. So it’s exciting to have had that change.

ME: That’s Medicare we’re talking about, correct?

Woodcock: That’s a great point. Yes, this is Medicare. And indeed, just like we discussed early on, because each payer has different policies, it pays to check with your particular payers to see if they allow phone-only telemedicine visits.

ME:We have received a lot of questions about modifier “CS.” Can you explain what that is and what physicians need to know to get paid for using it?

Woodcock: “CS” is a relatively new modifier that was brought about based on a law passed by the federal government and includes all payers. So this is not just a Medicare issue. All private payers did agree to this — not to the particular use of the modifier but to the fact that physicians will be reimbursed at 100% of the allowable if a COVID-19 test is administered or ordered during the encounter. There’s a bit of nuance in that the law says: If the encounter is for the evaluation of (whether) a test (needs) administered or ordered, that counts too.

So what do you do? For Medicare patients, use modifier “CS.” ... It’s a payment modifier that triggers 100% of the allowable. And because it’s a payment modifier, it needs to go on right after the CPT code. So for example, if you see a patient and it’s a level-three established patient, visit (99213) and you ordered a COVID-19 test, you want to put the “CS” modifier in the documentation. And what that means is your Medicare contractor will pay you at 100% of the allowable. It’s important to recognize, and this is a great payment tip, that you can actually go back to March 18 to use this modifier. Most of our Medicare contractors are requiring these claims be resubmitted. But you can go back to March 18 and resubmit them with the “CS” modifier to get paid at 100%. For other payers, they’re all obligated to do this, but you do need to check with them with regard to the policy about coding.

ME:What’s the best way to check with private payers? Are they updating physicians on a regular basis, or do you need to pick up the phone and contact the payer?

Woodcock: I wish we could pick up the phone and contact any payer, but that’s an impossible task because they don’t have phone numbers any longer. However, they’re certainly issuing memoranda. We are seeing that it’s actually on their websites. Most of them have a COVID-19 or a public health emergency resource page. So that’s probably the best bet. Unfortunately, Plan B is to go ahead and submit the claim and then get the denial.

ME:This was maybe the most frequent question we received in regard to telehealth: What are the current rules regarding “place of service”? And what do you need to do to ensure that you’re receiving the best possible reimbursement?

Woodcock: When the public health emergency was declared, CMS said, “Let’s go ahead and use a telehealth ‘place of service 02.’” So all of us were scrambling. And there was correspondence and communication coming out that physicians would be paid at the regular rate, except that the “02” modifier triggered a lower facility rate. I won’t go into the details, other than saying physicians were getting paid less. So CMS came out and said to replace the “02” with whatever “place of service” you would have used if that patient encounter had been face to face. And so, even though this is frustrating, I would argue that CMS was actually doing the right thing by saying, “Listen, we know this is triggering a lower reimbursement. We want doctors to get paid what they should. So if you would have been billing as a ‘place of service 11,’ which is a physician’s office, then please go ahead and continue to do that.” It was a great strategy. Even though it’s frustrating from a payment perspective, it really was the best thing to do.

ME:The next question asks about the G2012 code and whether it can be used for follow-up phone calls after a telemedicine visit. Can you talk a little bit about what’s allowed in terms of that “G” code and following up?

Woodcock: So the “G” code pays about $15 but does indeed require you to get outside of a seven-day window, so it cannot be used for services that originate from an “evaluation and management (E/M)” service that was provided. So if you call the patient two or three days later, the E/M code ... incorporated your reimbursement. But if you’re calling them nine days later or you’re just checking in with them, then that would certainly count as G2012. Again, about a $15 reimbursement. Now if you’re remote patient monitoring, another set of higher paying codes fall under that topic.

ME:Could you expand on those remote patient-monitoring codes?

Woodcock: Absolutely. Let’s say you have a patient who tested positive or negative for COVID-19, and you’re worried about them. So you’re basically checking in with them — you’re remote patient monitoring because (they’re not) coming into the office. ... There are multiple codes in that series. And they can be billed in units of time, and those units are in 20 minutes.

ME:What is modifier “95,” and how does it work?

Woodcock: Modifier “95” is the telehealth modifier Any time you conduct telehealth, be sure to add modifier “95.” It’s really an information-only modifier, so it doesn’t trigger a different kind of payment. It’s really meant for researchers to track on the back end and for CMS to know what type of visit you’re rendering. ... Let me just mention again that it’s with “place of service 02” and modifier “95” that we’re seeing a variation in terms of some payers asking for the “02” and some payers asking for the “95.” There’s also this crazy modifier called a “GT” that was kind of an old telemedicine modifier. Unfortunately, some payers are asking for that as well.

ME:So again, it’s important to check with your payers to see what they’re requiring to ensure you’re using the right modifiers to get paid.

ME:Here’s another technical question about modifiers: Can you use modifier “95” and “CS” at the same time?

Woodcock: You absolutely can. But because “95” is informational only, I’m going to use that in a secondary position. “CS” should go in the primary position because it triggers a different payment.

ME:Can you use modifier “CS” if a patient is evaluated for COVID-19, but then no testing is ordered. Is testing a required part of that?

Woodcock:would ask that our physicians really review that law. It’s my interpretation that it certainly can be evaluation only. I am seeing some payers be very specific about — you have to have the COVID-19 test ordered or administered for that encounter. I do want to mention that this is actually not just the encounter. So if the physician, for example, orders a flu test in addition to the COVID-19 test during the course of this encounter, those are also indeed covered at 100%. I didn’t want to forget that nuance. It’s important.

ME:In terms of technical glitches with telehealth, one of the questions we received was if a telehealth call is interrupted and essentially can’t continue because of a software glitch or some internet connection issue, how do you handle the billing?

Woodcock: The best way to handle this is to just default to a telephone-only code, which a few months ago would have meant a plunge in reimbursement. But now, it’s the same thing as a “99212,” “99213” and “99214,” respectively. So there are three telephone codes that now pay at the same rate as in-person visit.

ME:Is there anything else in regard to telehealth billing, coding or documentation that you think is important for physicians to keep in mind?

Woodcock: I know this is frustrating and at times overwhelming, but it does represent a new normal. So I do think it’s a great opportunity. (It takes) time to really learn these rules related to telemedicine, (but) I think it’s time well invested. All the data are showing us that ... patients are going to have an incredible amount of hesitancy about physically going to the physician office again. So it’s a great time to learn about this.

Articles

Your telehealth reimbursement questions, answered

Getting paid requires accurate documentation and selecting the correct codes. In our Coding Case Studies, we will explore the correct coding for a specific condition based on a hypothetical clinical scenario. Check out the following scenario involving a patient presenting with asthma and see if you can choose the correct codes.

Mother says son has had an exacerbation of asthma symptoms during their family vacation to a dude ranch in Arizona last week. Mother says that there was a lot of secondhand smoke at the ranch.

Mother says the albuterol inhaler was last used this morning, about 90 minutes prior to arrival, but seems less effective than usual. Father also has asthma.

 oropharynx clear, no plaques or exudates, minimal nasal flaring noted, no accessory muscle use.

 diminished breath sounds with mild expiratory wheezing heard throughout.

Intermittent asthma with acute exacerbation caused by exposure to second hand smoke

Nebulizer treatment given, with improvement; 3-day course of oral prednisone

How should this be coded? Here is some background information on documentation requirements and the available ICD-10 codes. When documenting asthma, include the following:

Exercise induced, cough variant, related to smoking, chemical or particular cause, occupational

Choose one of the three options below for persistent asthma patients

Acute, chronic, intermittent, persistent, status asthmaticus, acute exacerbation

	Mild intermittent asthma with (acute) exacerbation

	Mild intermittent asthma with status asthmaticus

	Mild persistent asthma with (acute) exacerbation

	Mild persistent asthma with status asthmaticus

	Moderate persistent asthma, uncomplicated

	Moderate persistent asthma with (acute) exacerbation

	Moderate persistent asthma with status asthmaticus

	Severe persistent asthma with (acute) exacerbation

	Severe persistent asthma with status asthmaticus

	Unspecified asthma with (acute) exacerbation

	Unspecified asthma with status asthmaticus

Mild intermittent asthma, with (acute) exacerbation main reason for visit, so listed as primary diagnosis.

Family history of asthma and other chronic lower respiratory diseases.

Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic). Per ICD-10 guidelines for asthma and other respiratory diseases, additional required code for history of tobacco use, or current use of or dependence on tobacco, when applicable.

Get maximum reimbursement for treating asthma with the right codes

Coding case studies: Asthma

Cardiovascular disease is one of the most common chronic conditions that primary care doctors treat, yet improving patient outcomes can be challenging for a variety of reasons. Treatment often requires a combination of prescription drugs and lifestyle changes, and patients need to adhere to all treatment recommendations to get better.

“There is the medical treatment side and the behaviors side, and the reality for many patients is that they struggle with both,” says Eugene Yang, M.D., FACC, University of Washington School of Medicine and chair-elect of the American College of Cardiology Prevention Section and Leadership Council. “It is across-the-board difficult to have a patient adhere to guidelines for their medications and also adhere to specific lifestyle recommendations that are based on clinical studies.”

As physician income becomes increasingly tied to patient outcomes through the CMS Quality Payment Program and value-based care contracts with private payers, these struggles can affect a practice’s bottom line.

“We are all increasingly being paid based on performance, and everyone is moving toward having a higher percentage of that type of payment model,” says Yang. “If you manage things well, you can reduce the rates of patients coming in with strokes and heart attacks.”

So what can physicians do to improve the cardiovascular health of their patient population? Experts say it starts with a firm understanding of each patient’s unique circumstances and adapting treatment plans to fit each individual patient.

One of the most common reasons a patient fails to follow a doctor’s treatment plan or fails to take prescribed medicine is social determinants of health. A patient who is urged to exercise may not have a street that is safe to walk on, limiting their options. The lack of a readily accessible grocery store can also present challenges for patients who need to eat a healthier diet.

For some patients, the signs of a lack of food or safe housing may be obvious, but for others, physicians may not even realize social determinants are a factor.

“There are absolutely unseen barriers that, even for care teams with long-term cognitive patients, can go totally missed,” says Aaron George, D.O., FAAFP, director of medical education for Meritus Health in Hagerstown, Maryland. “Sometimes it’s obvious when you have a patient with challenges you have to work through, but there are often socio-economic, family and community barriers that the patients face that we lack the ability to see upfront.”

George says to be careful about placing patients into categories and to be aware that bias cuts both ways. A patient who has a low literacy level and is struggling with social determinants may have a tremendous desire to be healthy and be willing to do anything to achieve that goal. Conversely, a patient who appears affluent with a high education level and no financial issues may have little dedication toward living a healthier lifestyle.

“One approach to solving this is to have a standardized initial process for trying to understand where a patient is,” says George, noting that tools are available from many professional societies that help a physician identify how a patient lives and their barriers to care. “Implement one of those tools for every patient at the outset, perhaps at their first visit, before they even step in with the physician. You will start with a firm ... understanding where they are coming from, as opposed to having information trickle out over the course of months or years of care.”

Ada Stewart, M.D., FAAFP, president-elect of the American Academy of Family Physicians, says that understanding the patient’s specific challenges and building a solid relationship are key to keeping patients on track with their treatment plan — and that includes assessing their mental health. “Make sure you are looking at mental health issues, such as depression or other stressors like alcohol use, as those are really important to be able to find out why folks are not adherent.”

Patients need goals to be successful but, according to experts, they also need to be part of the decision-making process when setting those goals. Patients need to understand their risks, what they can do to lower them and the importance of regular check-ins to chart progress or address challenges.

“Make patients accountable for their own health,” says Yang. “The way to do that is to increase the frequency of check-ins with patients. The more frequent check-ins, the better chance they feel they can achieve a certain goal.”

More frequent check-ins can also help identify what is working and what isn’t, says Yang. For example, a yearly checkup for cholesterol level won’t offer any insight into what the patient is doing that’s helping, but a more frequent one can help pinpoint behavior that is having an effect one way or another.

The pandemic’s boost to telemedicine may help doctors manage patients with cardiovascular disease better than before, says Yang. “With the increase in telemedicine, we are seeing more and more virtual visits, and that may allow us to increase the frequency of checking in,” he says. “The higher the frequency of checking in, the greater the benefits of achieving goals and maintaining adherence because the patient feels a stronger connection to the physician.”

When Stewart checks in with patients, she uses motivational interviewing techniques to see where they are in their treatment. For example, with high blood pressure, she’ll ask: “How is the medication working for you?” or “Are you able to take your medication every day?”

“If they say that they’re not taking their blood pressure medication, I try to make sure they understand the consequences of not taking it and emphasize the importance of the medicine, diet and exercise,” says Stewart. “Then I’ll address any barriers they have and let them know that I understand their challenges. You want to make sure that they recognize they are a partner in their health.”

She says for some patients, focusing on one key goal may be the best strategy. “We fail a lot of times as physicians in making sure our regimens are simplified,” says Stewart. Maybe a patient won’t walk a mile a day, but maybe they are willing to walk down their street or to the mailbox and back. “We have to talk about what their goals are and what they see themselves doing to get there.”

Experts say to be wary of overwhelming patients with too many goals and guidelines, or the patient may not achieve any of them.

“A lot of times you throw a whole bunch of things at them and you think they are listening, but when they come back for a follow-up, they didn’t do any of them because they didn’t understand,” says Stewart. “When they don’t hear you, we end up having increased hospitalizations and increased deaths, especially when we are talking about heart disease. If you put too much on them, then a lot of times they will just give up and say, ‘Forget it.’ ”

Set goals with the patient that they believe they can meet and keep making progress on, even if it’s in small increments. Other patients may be able to handle bigger steps. There’s no one-size-fits-all plan. “Every patient is not the same,” says Stewart. “You have to look at who your patient is, where they are, and what barriers they may have and what we can do to help them.”

Yang says that some population health initiatives are helping to identify high-risk patients by assigning them risk scores based on hospital utilization. A team of caregivers is then assigned to help the patient better manage their blood pressure and keep track of how they are progressing toward their heart health goals. He adds that physicians should use nurses, advanced care providers and other staff as needed to help keep patients on track.

Stewart only has one care coordinator for her patient panel, and that person will reach out to patients that Stewart has identified as high risk for nonadherence. The care coordinator will follow up about two weeks after an appointment to make sure the person is taking their medication and isn’t experiencing side effects and to answer any questions.

But even without the benefit of a full care team or computer-generated risk scores, George says there is one warning sign of increased cardiovascular risk that often goes unnoticed by physicians.

“I think the biggest warning sign that we ignore nationally is the subtle creep of weight gain,” says George. “I rarely find a patient that puts on 60 pounds in six months; it’s 3 pounds one year, 4 pounds the next year and six pounds the next year. Somehow, I think we all tolerate it and accept it as an almost unfortunate norm.”

Because the weight gain is minimal, physicians tend to ignore it and the patient is willing to accept it, says George. “I’m really quick to show patients the trend of their weight gain over the last eight years or 10 years, and how it’s gone up just a couple of pounds each year. I tell them, ‘Imagine where you’re going to be 10 years from now or five years from now.’ ”

Paying attention to patient trends is an important part of monitoring cardiovascular health. The more patient contact, the better.

“I can tell you that without a doubt, almost all my patients in the days leading up to their visit will take their medications because they want their blood pressure to look good, or they won’t eat bad foods for a couple days before they are having their lipid tests done,” says George. “But we don’t live life like that. For the majority of patients, the more frequent touch points that are brief and done by nonphysician team members are going to be increasingly important.”

How physicians can help patients adhere to treatments.

Personalize care to improve patient heart health

The variety of devices and apps that measure health data, known as wearables, are growing in popularity with patients. Despite their ubiquity, they are technologically in their infancy, according to experts, leaving physicians to figure out what to do with the data produced. While wearables may offer patients useful ways to engage in their own health, these devices are still developing the sophistication and clinical validity to be of optimal use to physicians.

So how can physicians comb through the noise of so much data for useable information that can help their patients? Experts say it takes a combination of creativity, discernment and patience.

Physicians should realize that health technology is still developing, says Crystal Riley, Pharm.D., a lecturer of health administration at New York University’s Robert F. Wagner Graduate School of Public Service. While there may be some quality difference between an app that a patient can download to a smart device, such as a watch or Fitbit, and a glucose monitor, very few wearable devices have been clinically validated.

“The devices, from a technological perspective, are not all created equal,” Riley says. “There haven’t been extensive studies done across all of these different wearables to make sure that the data they’re collecting (are) accurate.”

If inaccurate, she surmises, how meaningful can the data be?

Even if the data were all valid, Riley points out that for patients who wear their devices frequently or regularly, no physician would be able to sort through the amount of data that would accumulate.

Indeed, everyone is drowning in data, according to Christian Habermann, MBA, co-founder of MayaMD, an artificial intelligence (AI)-based health care company in Boston.

“Patients today have more health data at their disposal than ever before and so do doctors,” he says. “This is the information age after all, and it’s very accessible. The problem is that doctors today are already inundated and somewhat overwhelmed with their current workload, not to mention the endless hours of having to enter their patients data into EHRs.”

More data are not the solution and simply contribute to physician burnout, he says.

“Until there’s a way to really integrate data in a meaningful way, for the moment, I think it’s a really good patient empowerment tool and a mechanism for physicians to start the conversation about recognizing health patterns,” Riley says.

The most useful data to come out of wearables may actually be qualitative, gleaned from a conversation between physician and patient.

“Once you can figure out how to interact with this data without drowning in it, it’s worth the challenge because our patients see us three or four times a year and we make huge decisions about their (health),” says Betty Rabinowitz, M.D., FACP, chief medical officer of NextGen Healthcare, a health care technology company in New York that supports ambulatory care.

Rabinowitz says there’s a great deal of evidence that the data a patient brings from wearables can help physicians get a better snapshot of that patient’s health during a clinical visit or to the root of complex problems.

Additionally, Riley suggests that wearables also encourage patients to engage more with their own health care. “So the patient can look at their data, and the physician can ask if there are any spikes and give them markers to help evaluate their own health care.”

And, as Haberman points out, research shows engaged patients lead to better health outcomes.

These conversations around the data patients are gleaning from their own wearables can also help physicians personalize patient care, says Kyna Fong, Ph.D., CEO and co-founder of Elation Health, a health care technology company in San Francisco.

“That conversation about what (patients) are doing outside of your clinic is an important part of coming up with a treatment or care plan that works for that patient and can be really valuable for building relationships,” Fong says.

For wearable data to be truly useful, however, they have to go beyond the qualitative and offer actionable information that can integrate into a physician’s EHR. However, many medical groups and hospitals are reluctant to allow wearable data into their EHRs due to the lack of validity, says health care data expert, Theresa Hush, co-founder and CEO of Roji Health Intelligence, a health care technology and consulting company based in Chicago.

“We’re in the wild west of biometric data,” Hush says.

What’s more, she says, as AI-based algorithms continue to improve, the technology will begin to grow in capability — which also means growth in the amount of data.

Haberman says the data will begin to become useful, and even essential, when more sophisticated AI begins to pull trends and insights out of the streams of data.

“This is when the data can be used for real precision medicine, population health and preventative care,” Haberman says, citing the prediction and detection of most chronic diseases as one of its potentially powerful uses. “A lot of this new patient data could be pulled from wearables and biometric devices and then reside behind the scenes, if you will, in databases and warehouses that can collect and synthesize it. If certain associations can be made with the data and (that information) meets certain criteria that makes it imperative for a doctor to know, then it can be alerted in EHRs.”

A few vendors are already offering software and technology to help aggregate this data coming from multiple sources, such as wearables, health information exchanges and insurance claims, says Rabinowitz.

So how do physicians and practice managers decide whether or not these products are right for their practice? Rabinowitz offers four questions to ask of a software that might help a physician decide:

1 Can it ingest and interpret data from multiple sources?

2 Was the system designed for clinical use?

3 Can the system separate out inconsequential data from actionable data?

4 Do the insights integrate back into the EHR workflow?

Rabinowitz believes that without a comprehensive solution for collecting and analyzing data, physicians will eventually find that patients must use multiple wearables/apps to collect a number of different data points from blood pressure to sleep quality.

“That is absolutely time prohibitive and not scalable,” Rabinowitz says. The more comprehensive, the better.

As these technologies continue to evolve, Hush feels that it’s crucial for physicians to find their way into the design conversation.

“I think the worst thing to do with physicians is tell them what you want them to do at the last stage of the process,” says Hush. “They’re really needed in mapping out the clinical pathways of patients (who) are presenting with wearable data.”

She suggests that physicians speak to administrators and IT folks to be sure they’re a part of the design conversation whenever possible. “There shouldn’t be any black boxes deciding what a patient is at risk for that physicians are not validating through their own learning and education,” Hush says.

And, either way, she says, “I definitely advise physicians to start ramping up their understanding of this technology and how it can be applied. Look beyond their own EHRs and into other ways of aggregating data and putting (that data) to use, even experimentally.”

Though physicians should begin to embrace these technologies, they should do so with some care so they don’t wind up assuming responsibility for reviewing health data they did not solicit, advises Fong.

“If you don’t review all the pieces of the data or something is found later, you could potentially have liability.”

Furthermore, Fong adds, to have value, “(the data need) to have purpose, timeliness and a feedback loop where physicians can flag and correct issues. And health data systems need to start with patient benefit. When we strategically use physicians as care coordinators and data curators, and we listen to them when they say something isn’t valuable or correct — instead of dumping millions of raw records at their clinic door — that’s when data will become the most valuable for patient care.”

Hush believes that it won’t actually be up to the individual physician to sort through these individual streams of data, but rather the organizations or group practice administrators who will synthesize data and pass the information on to physicians.

“(The data) will be queued up for them by industries or population health solutions that show them the patients who appear to be at risk from a variety of factors and suggest the next step.”

In short, Haberman says, “For doctors to even think about accepting additional patient data from today’s wearables, it needs to be very concise and needed. So providers need to understand their patient population and what data from certain cohorts would really help to improve outcomes.”

How doctors can make data from wearable devices usable

Drowning in data

Like many physicians nationwide, Kansas-based primary care physician Jennifer Bacani McKenney saw a dramatic drop in patient volume when COVID-19 hit. A few weeks into the pandemic, McKenney knew she had to take action to keep the practice afloat.

“We decided to go back six months in our schedule to see if there were people we would normally see for regular visits like a monthly weight-loss check or a three-month diabetic check,” she says. “We called them and scheduled appointments either in the clinic, in the parking lot, through telehealth or by phone.”

Soon after, they began calling patients from lists their Accountable Care Organization sends throughout the year, including patients due for well visits and patients with chronic medical conditions who hadn’t yet been seen this calendar year. McKenney’s hope was to get them back on track for visits and let them know it was safe to come in.

Although patient volumes started to increase in early May when Kansas reopened its economy, McKenney says volumes are still down 50%.

This sustained dip in volume is not uncommon. The number of visits to ambulatory clinics declined nearly 60% by early April and is still about one-third lower than before the pandemic, according to a recent data analysis conducted by researchers at Harvard University and Phreesia, a health care technology company.

Only 31% of patients feel comfortable visiting their doctor’s office, according to a recent national survey conducted by Leede Research. Although patients increasingly embrace telehealth, 41% have delayed health care services and 38% intend to delay future care, treatment and procedures.

Rebuilding patient volumes will be a struggle for some practices, says Laurie Morgan, a practice management consultant and partner at Capko & Morgan in San Francisco. “The urgent messages patients have gotten for months about staying home and away from others may seem incongruent with long-standing advice about preventive care,” says Morgan. “Recognizing this hesitancy is, I think, critical to successfully nudging patients to resume care.”

Cheryl Mongillo, MBA, administrative director of two independent family practices in Delaware, says her staff calls patients who are due for a well visit, blood pressure check or hemoglobin A1c test to let them know the practice is open and booking appointments.

“We want patients to know that we’re here,” she says. “We’ve been here the entire time, and we’re not going to abandon them.”

It may be helpful to provide front desk staff with scripted language to use when talking with patients, says Owen J. Dahl, MBA, FACHE, LSSMBB, founder of Owen Dahl Consulting in The Woodlands, Texas. He suggests focusing on the following:

Reason for the call
(e.g., patient is due for annual physical).

Specific steps the practice has taken to ensure patient safety.

What patients can expect when they come into
the office.

“The more scripting you use — and the more consistent you are with the messaging — the more comfortable patients are going to feel,” he says.

“Patients will need to (hear) reassuring messages — plus messages about the risk of continuing to delay preventive and chronic care — multiple times to get them past their resistance,” says Morgan. “Probably, they will need to hear it many times.”

Social media is an excellent outlet for these types of messages, especially when practices use apps that enable them to schedule posts based on optimal times for engagement, says Morgan.

Office manager Debbie Emmons, CMM, CPC, uses social media to reassure patients at her Kentucky-based primary care practice that it’s safe to come into the office. For example, she posts pictures of providers and staff on Facebook wearing homemade masks donated by the community. “It got the point across that we’re all wearing masks, and this is what you’ll see when you come in,” she says. “We also tell patients that if they don’t have a mask, we’ll provide one.”

Email is another option. “However, email is easily missed in a crowded inbox, so practices shouldn’t be afraid of emailing important updates more than once,” says Morgan.

Practice administrator Catherine Franzetti, MBA, sends a monthly campaign through the patient portal with various COVID-19 updates and reminders to help patients of her New York City-based primary care practice stay informed.

And, notes Morgan, make it personal. “Another communication essential: personal contact. It’s invaluable to have someone from the practice contact patients and let them know their physician is concerned with their well-being. This can even be done by an employee working from home.”

Telemedicine, online booking and use of the patient portal should be part of every practice’s strategy, says Morgan. “This is how practices can shine,” she says. “These are excellent ways to ease patients back into a more regular way of interacting with their physicians.”

Franzetti’s practice began offering valid antibody testing in early May, and they now perform as many as 250 tests per week. “After one person gets the test, they usually want their whole family to get tested,” she says, adding that some employers require the antibody test before people can return to work. Once patients are in the office for the antibody test, physicians are able to identify other potential care gaps and services.

Kelly Shackleton, practice manager at an internal medicine practice in central New York, agrees. Her practice performs more than 200 valid antibody tests a week. When patients come in for the test, they see firsthand what safeguards are in place, e.g., separate entrances for healthy vs. sick or symptomatic patients, hand sanitizers at each door and a bountiful supply of personal protective equipment. Shackleton even removed 15 out of 20 chairs in the waiting area so patients don’t congregate. Once a patient arrives for their appointment, a medical assistant immediately brings them into an exam room. “All of this adds another level of reassurance that we’re taking measures to be safe,” she adds.

The CDC recently released new guidelines indicating that antibody tests could have high false positive rates. However, Shackleton says all the patients who have tested positive for COVID-19 also tested positive for the antibody.

To better ensure patient safety at her Kentucky-based practice, Emmons says providers evaluate symptomatic patients inside a camper that one of their physician assistants donated temporarily.

Asymptomatic patients are permitted to enter the practice for their appointments. Upon arrival, a receptionist takes their temperature. Patients also receive a mask donated by the community if their don’t already have their own. Then a medical assistant immediately takes them into an exam room. “It’s like we’ve stepped up to be a five-star resort,” says Emmons. “Our patients are getting that one-on-one special treatment. They also feel better knowing that sick patients aren’t even seen inside the practice.”

“Chronic Care Management (CCM) can be done fairly easily, and it helps maintain relationships with your patients,” says Dahl. If practices don’t have sufficient staff to take this on internally, they can hire an external vendor, he says. Physicians can bill for CCM every 30 days, receiving between $42 and $137, depending on patient complexity and time spent.

“It’s time for practices to aggressively work with media outlets to spread the word about the risk of children falling behind on their vaccines,” says Morgan. “There’s momentum to reopen schools in the fall, but kids need to be kept safe not just from COVID-19, but from other diseases that may be much more dangerous for children.”

Dahl agrees, noting that media interviews can be a helpful way for physicians to raise awareness of the importance of preventive and chronic care. These are free opportunities to market the practice.

“Rebuilding patient volumes won’t be like turning on a light switch,” says Dahl. “The expectation is that we need to plan on this taking a period of time.”

Returning to normal patient volumes will take a detailed plan and continued effort.

Strategies to rebuild patient volumes in the wake of COVID-19

While medical practices are understandably focused on financial survival, keeping up employee morale amid the fear and uncertainty surrounding COVID-19 is equally important, practice leaders say. And the keys to that are ensuring that employees feel safe and valued, and above all, building trust through regular communication.

“We’ve been communicating, communicating, communicating (since the start of the pandemic),” says Susan Coker, practice administrator of Tri County Internal Medicine in suburban Atlanta. That communication takes the form of daily huddles that she conducts with front-office staff and that the medical director conducts with the practitioners. They use the huddles to discuss everything from upcoming reductions in hours to the latest guidance from the Centers for Disease Control and Prevention.

Coker says employees use the daily huddles to ask questions, voice concerns and offer suggestions. “We always start by asking how everyone’s doing, and they’re good at communicating back to me,” she says.

At the Center for Primary Care-McDuffie Medical, part of an eight-practice independent practice consortium near Augusta, Georgia, physicians met daily with the practice administrator and key staff members during the first weeks of the crisis to assess how things were going and address problems and employee concerns, says Jacqueline W. Fincher, M.D., MACP, one of the practice’s five physicians. 

Following those meetings, their administrator would participate in conference calls with the practice’s other seven administrators to share information and coping strategies. “Communication is so important for making people feel valued, giving people a sense of, ‘We’re going to get through this together, and we’re going to do it safely,” says Fincher. 

In addition, the practice has been letting employees take off Friday afternoons or Monday mornings. “It extends the weekend a little and provides an additional break from the intensity of the job,” she says. 

Owen Dahl, MBA, CHBC, a medical practice management consultant and principal of Owen Dahl Consulting in Texas, suggests practices sponsor employee games and offer perks such as gift cards and catered lunches as morale boosters. Bringing in lunch has the added benefit of keeping employees in the office, thereby reducing their chance of becoming infected with COVID-19. 

Dahl also recommends looking for ways to provide staff members a sense of engagement with the practice beyond their own job, such as participating in task forces to create policies for working from home and other changes the pandemic is likely to bring about.

“The more you can get your staff involved and committed to the culture change that’s going to come,” he says, “the better off you’re going to be.”

While medical practices are understandably focused on financial survival, keeping up employee morale amid the fear and uncertainty surrounding COVID-19 is equally important.

Maintaining employee morale during COVID-19

If you’re hiring or looking to hire amidst a pandemic, you will have to up your recruitment game.

That’s because the nature of jobs, candidate preferences, and recruitment metrics are changing dramatically. You may be looking for candidates with multiple skills so that you can repurpose efforts when the needs present themselves, you may no longer be able to hire people already in your recruitment pipeline due to geographical constraints. Recruitment metrics may change significantly, which will need to revisit your recruitment strategy.

Here are five things you will need to do to hire top talent despite the pandemic.

SMART goals for HR professionals are critical to creating strategic hiring objectives that are:

goals that are clearly defined with the reasons to accomplish it

goals that allow measuring success at timely intervals; goals that can be quantified

goals that are realistic a nd can be accomplished taking into account current organizational status

goals that produce end results worth your time

Before creating recruitment goals, develop a plan of how they can be achieved. Create reports on how long the goal will take to be achieved, how the success will be measured, how the timeline will be decided, etc. This will help you steer clear of recruitment mistakes.

To create good job descriptions, you will have to look at your recruitment goals and set requirements accordingly. You will have to communicate your expectations clearly so that the only people who apply to the role are actually fit for it. For example, if you would like to hire someone who is comfortable with working on a contractual basis for three months after joining, mention it in the job description. This way, unfit candidates will filter themselves out, and you will save the time of going through hundreds of irrelevant resumes.

Make sure that every line is to the point and there isn’t an overuse of fluff words such as organization, business, success, etc.

Due to the impact of pandemics, such as the need for social distancing during COVID19, you will have to remodel recruitment metrics. For example, if your company is only looking to hire locally, you will have to modify your geographic search accordingly.

As a recruitment expert, you can also come up with strategies for internal hiring or project-based hiring. See if you can repurpose your employees or make gig recruitments. The goal currently should be to save time and cost and maximize the safety of your people.

While telephonic interviews have been the first step of a recruitment process for a long time, many organizations are now using video interviews as final interviews. Soon enough, face-to-face interviews may not even exist. So, adapt to the change while also keeping the comfort of your candidates and employees at the center. Make sure your recruitment staff members assist candidates in using technology.

Because of the new work-from-home culture, remote onboarding has also increased in popularity.The employee will start working with you without a single office visit. This is where the challenge lies, and your team should be prepared for it.

See if your team is equipped with remote onboarding tools such as video conferencing software, screen sharing software, VR technology to give office tours, and screen recording tools. Your team should be able to make the new employee feel like a part of the team.

Kelly Barcelos is a marketing manager specializing in human resources. Send your practice finance questions to: medec@mjhlifesciences.com.

If you’re hiring or looking to hire amidst a pandemic, you will have to up your recruitment game. 

5 things practices need to do when hiring during a pandemic

When we look back on this time, will we remember fondly the era when the American patient still had a trusted primary care physician? Unfortunately, that is a real possibility if our independent physicians continue to weather this storm without comprehensive support from our government and commercial payers.

The hospitals that are collectively fighting this global pandemic deserve all of the financial support that has been pledged thus far by the government and other commercial health insurers. As an industry and a country, we were unprepared for a virus of this scale to hit our nation, and the providers on the front lines need every ounce of support, in dollars, supplies, and in the 7 p.m. cheering that takes place across the country.

Yet, we should not underestimate the great, knee-wobbling impacts the pandemic has had on the health care industry, most acutely felt by the nation’s traditional front-liners in primary care. The plight of the independent physician has never been so stark.

As the CEO of one of the largest independent physician organizations in the country, we are in full protection mode of this cornerstone of American health care. COVID-19 has changed everything. Most pressing of course is protecting the future of primary care practices and the independent physician given the financial crunch this cohort faces after just a few months of COVID-19 driven business contraction.

While physicians are some of the biggest champions of the shelter-in-place orders, this has been crippling to our businesses. Much like local restaurants and other businesses that found their healthy balance sheets wiped out in the blink of an eye, independent physicians have similarly found themselves needing to reinvent their business models overnight. Strategically, my organization has long championed virtual health and through around-the-clock support of our independent physicians, made our proprietary technology platform seamlessly available to more than 2,500 providers during the first two weeks of the outbreak. Total virtual visit volumes increased from approximately 500 a week to over 7,000 a day in the span of 2 weeks.

However, patients are not seeking care at typical levels, with primary care in-office visits down 50% to 90% in the United States. With the coverage of virtual or telehealth visits, the high performing groups are only attaining 50% to 60% of pre-crisis volumes. For practices that have challenges related to geography and/or patient make-up, it can be considerably worse. That backdrop will prove unsustainable.

As stay-at-home orders lift, primary care providers are returning to their post as the essential frontline team to test and treat patients, and to help ensure the safety of our communities. They may find it necessary to change the physical structure and operational protocols of their practices based on lessons learned from this outbreak. Physicians will need additional funding to pay staff, to purchase personal protective equipment and cleaning supplies, to transform the practice’s operational workflow to safely care for their patients — and then to perform diagnostic tests and offer both sick and preventative health visits in their practices. It will not go back to “normal.”

We need immediate action at the state and federal levels, as well as support from commercial payers, to protect independent physicians and their patients. Dollars earmarked and dollars delivered to this cohort to date have been insufficient. Our communities need additional help to protect patient’s access to medical care by helping preserve both the viability of current physician practices and the ability to grow and transform their practices successfully in this new environment.

The plight of the independent physician has never been so stark.

Medical Economics July 2020 Edition

Your telehealth reimbursement questions, answered

Coding case studies: Asthma

Personalize care to improve patient heart health

Drowning in data

Strategies to rebuild patient volumes in the wake of COVID-19

Maintaining employee morale during COVID-19

5 things practices need to do when hiring during a pandemic

Is this the end of the independent physician?

4 myths about succession planning for physician practices

Personalize care to improve patient heart health

Meeting the financial challenges of COVID-19

Political contributions:What to know before you donate

Telehealth compliance programs avoid and mitigate risk

5 things COVID-19 is teaching us about the patient experience

Overcoming racial biases in patient care

Fanning the flames: the impact of COVID-19 on physician burnout

What doctors need to know about PPP loan forgiveness