Curbside Consult with Dr. Jayne 11/10/25

The hot news around the telehealth virtual water cooler this week was the new CMS billing requirement that telehealth physicians list their actual location rather than an office address. The previous requirements allowed us to avoid using a home address. This not only protected our personal information, but also provided uniformity for our practice organizations.

For those telehealth physicians employed by hospitals or health systems, this could lead to requirements that they physically go to the campus to provide telehealth services. This creates additional load on the hospital, which may not have space for telehealth providers. Allowing them to practice from home, while repurposing clinic space for additional providers, was one of telehealth’s benefits. The CMS rule does not address the needs of physicians like me who work for independent telehealth organizations that don’t have a campus or building in our local area. 

Although CMS claims it will protect the home addresses, I’ve been a victim of data breaches and identity theft enough times that I don’t trust anyone to keep my information private. Plenty of other government agencies don’t have appropriate policies to deal with people who practice from their homes, including the Drug Enforcement Administration and many of the state controlled substance agencies. Their regulations haven’t kept up with the times, but I don’t think anyone is surprised by that.

Also, there is no guarantee that a physician who is not in the office is doing telehealth from their home. I have done it from hotels in at least a dozen states, from the homes of family members, and from a docked ship. I certainly don’t expect my employer’s credentialing organization to keep up with that.

Other conversations around the water cooler continue to revolve around the ongoing government shutdown. Some clinics are seeing higher-than-usual rates of no-shows and cancellations. In lower income areas and the academic faculty clinics, patients are citing financial issues as a barrier to transportation.

Although some of our clinics can provide cab vouchers for patients to get home, it’s more difficult to arrange transportation to the clinic. Now that we’re over a month into the shutdown, we should start to see data on patient prescriptions and fill rates, and whether those have been delayed by all of the issues. I’ve seen data from at least one military facility that showed a clear impact, but I’m not able to access that kind of data for my own facility. It would be an interesting research project, however.

The hot clinical topic of the week was the news that the American College of Cardiology and American Heart Association have updated the hypertension guidelines. The new numbers mean that many more patients will qualify for a hypertension diagnosis. Depending on how much of a focus an organization has placed on the management of hypertension, this could potentially mean a fair amount of work will need to be done in the EHR and elsewhere in clinical applications.

Even if we’re talking about modifications to EHR-based alerts, the lift could be significant if the organization hasn’t standardized the EHR or has created different alerts for different locations, specialties, or types of visits. It can also mean modifying dozens or hundreds of reports, patient outreach campaigns, and patient education materials.

Although these two organizations have reached agreement on the recommendation, a number of other organizations have not endorsed the new guidelines. They include the American Academy of Family Physicians, the American College of Physicians, and the International Society of Hypertension. If your organization follows one of their guidelines, you probably have some time before these groups get on board with the new, lower numbers.

It’s still a good opportunity though to take inventory of your hypertension-related alerts, reports and outreach programs to get ahead. I’ve peered under the hood of a number of the EHRs of large healthcare organizations over the last 20 years and some of you have your work cut out for you.

It will also be interesting to see how long it takes consumer-facing healthcare apps and tools to update to the newer guidelines, or if instead they will just stay where they are. I’ll be keeping a close eye on my wearables to see if there are any changes and will report in when I see them. I only use a couple of apps, so if readers see anything before I mention it, please share.

Regardless of the technical ramifications of updated guidelines, there’s also the real-world clinical practice element related to a change like this. How do we as physicians convince our patients to lose more weight or take another medication to bring them into compliance? Many patients find it impossible to reach the previous goals, so there’s not much of a chance of them meeting the new ones.

It will also be interesting to see if the prior authorization processes for weight management medications follow the new goals right away or whether payers gravitate toward the guidelines with more lenient goals.

One of my informatics colleagues asked a question about how real-world evidence (RWE) fits in a situation like this where the proverbial cheese has been moved. Certain EHR vendors have pressured everyone to get on the RWE bandwagon. I’m no expert in the field, but if you’re looking to see how clinicians treated patients with a blood pressure that used to be normal but now isn’t, they’re not likely to have done many interventions because the blood pressure was viewed as normal. We will see how long it takes for real world evidence to shift and for there to be patterns that align with the new thresholds.

If you’re an expert in real-world evidence, I would love to hear from you, and I’m happy to keep you anonymous. Maybe a fireside chat on the hamster wheel of clinical guidelines is in order? Or just some good old-fashioned ranting about the challenges of practicing medicine in an era where physicians are seen as less knowledgeable than TikTok celebrities?

What do you think of the new clinical guidelines, the ramifications to your health IT systems, and their impact on real-world evidence tools? Leave a comment or email me.

Email Dr. Jayne.