EPtalk by Dr. Jayne 2/11/21

Even with all the turmoil the US has gone through in the last several months, the institutions of government are still going strong, and the folks at CMS have not missed a beat. They did, however, extend the deadline for submission of 2020 data for the Medicare Promoting Interoperability Program. You now have until April 1, 2021 at 11:59 p.m. ET to attest through the QualityNet portal.

New Hampshire lawmakers have introduced HB 602, which aims to eliminate existing provisions protecting telehealth coverage. It would eliminate coverage entirely for audio-only services, which may have the unintended consequence of reducing access for those either not able to access the internet or who aren’t technically savvy enough to manage audio/video links. Surprisingly, one of the bill’s sponsors, Representative Jess Edwards, was one of the co-sponsors of the 2020 law that created payment parity for telehealth coverage.

As a telehealth physician, audio-only visits can be high quality interactions. In addition to the limitations above, some patients are just not comfortable on video due to their living environment or other factors. We’ll have to see whether this bill makes it through the process or not.

The ongoing usefulness of telehealth is discussed in this recent Journal of the American Medical Association editorial. The authors note that both patients and clinicians may want to continue virtual visits and that those visits could be as effective as in-person visits or used in conjunction with in-person visits as a hybrid model. Concerns about use of telehealth in the absence of hands-on examinations are valid, particularly when considering the overuse of expensive tests in lieu of physical diagnostic skills. Still, some conditions don’t require extensive physical examinations, but do require a physician’s cognitive effort.

For example, I was diagnosed with a food allergy a few years ago and I now doubt that diagnosis. I’m trying to get a second opinion from an allergist. The next available appointment that meshes with my work schedule is two and a half months away. No physical exam elements are part of this evaluation, and I recently had a full physical exam with the findings available in the shared EHR. Essentially, I need a learned expert to perform a review of my existing records and have a discussion with me about the risks/benefits of testing to determine whether it’s worth trying to proceed.

I’m willing to pay for the physician’s knowledge, experience, and time, but the construct in which we operate requires me to drive halfway across town to do it instead of being able to teleconference with the provider in the open slot that she has on Friday that would work with my schedule except for the drive time.

Of course, not every visit is suitable to a non-visit approach, but it’s time we think outside the box and focus on patient access, delivering high-value care in ways that are win-win for everyone involved. Real concerns also exist about fraud, abuse, and low-quality care. I would argue, however, that telehealth can be an important adjunct to whole-person care and for scenarios where a physical exam isn’t necessary or a recent exam is well documented. It could save a substantial amount of time and money for all parties involved.

I’m continuing to follow up on some random leads from the Consumer Electronics Show. One of them was a note that I made for voice-activated faucets. Kohler has launched a not only operate on command, but can measure specific amounts of water. The faucet also connects with a smartphone app that allows households to monitor water usage and be notified if it appears anything is out of the ordinary. Some models even offer a “wash hand” command that will instruct a user through the recommended steps for handwashing, including audible guides for lathering, cleaning, and rinsing. For parents who are tired of hearing two rounds of “Happy Birthday” as they try to instill good habits, it’s tempting, but the $1,700 MSRP is daunting. Most of us will have to go back to the old-fashioned egg timer and some adult supervision.

I enjoyed having easy access to the CES materials and sessions for a reasonable time after the show. Whatever HIMSS plans for its hybrid conference in August, I hope they improve their learning management system, because trying to find the sessions you want to watch after the fact is sometimes daunting. As someone who used the HIMSS sessions in the past for Maintenance of Certification credit for my informatics boards, it always seemed like the sessions I wanted to attend were on top of each other and watching after the conference was the answer. I hope they announce more information soon about the hybrid format, because I need to make some hotel decisions soon.

I had some additional adventures as a patient this week. The local hospital sent me an email reminding me that I had a bill due that I actually paid a month ago. I tried to use the integrated chat function to get it clarified, and the first thing I experienced was that despite the chat requiring me to enter the bill’s ID code along with the amount due (so that it could presumably be made available for the agent when he arrived in the chat), the agent asked me whether the bill was for a different amount that has never appeared on my account. I also quickly noticed that the chat client had no audio indicator that the agent had messaged me, so I had to sit there and stare at it to know if there was a communication. The agent kept telling me I had a zero balance despite the email and the home page that clearly showed a balance, and then told me not to worry about it.

I asked him to please escalate the fact that the system is sending balance due emails to patients with zero balances, since I’m a referring physician as well as a patient and know that would bother my patients as much as it bothered me. He then decided to tell me it is a known issue and that they are working with the vendor to resolve. I’m not sure why he didn’t tell me that up front when he realized my issue looked like one of the known issues, or why he decided to tell me once I said I was a physician, but either way, It wasn’t outstanding customer service. I hope the vendor gets their act together and fixes the defect soon because it’s annoying to say the least.

Do you feel like your healthcare team has accurate billing practices? Or do you see a high volume of patient complaints? Leave a comment or email me.

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