Public Health

Lessons for a small practice on using telehealth for COVID-19 care

Andis Robeznieks , Senior News Writer

The rapid adoption of telemedicine is seen as a key strategy to promote social distancing and limit the spread of COVID-19 by allowing patients to communicate with their doctors without leaving their homes. For those apprehensive about launching such a service—especially on short notice—a physician who has successfully integrated telemedicine into her private practice posted a 10-minute YouTube video.

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“I made the video because I’m on social media and a lot of people were on Facebook asking a lot of questions about how to set it up, how to bill, and how to do an exam,” said AMA member Carolynn Francavilla Brown, MD, a family physician and obesity medicine specialist, who’s been practicing telemedicine for three years.

Answers can also be found in the AMA quick guide to telemedicine in practice that has been developed to help physicians swiftly ramp up their telemedicine capabilities. In addition to informing physicians on the recent actions taken by the Health and Human Services Office for Civil Rights and the Centers for Medicare & Medicaid Services (CMS), the guide gives instruction on getting started; policy, coding and payment; practice implementation; and links to other helpful resources.

“The use of telemedicine and remote care services are critical to the safe management of the COVID-19  pandemic, while also ensuring uninterrupted care for 100 million Americans with chronic conditions,” said AMA President Patrice A. Harris, MD, MA. “The AMA strongly encourages the adoption of telemedicine as a responsible way for physicians to meet anticipated demands for care and treatment.”

Doctors can also connect with peers regarding telemedicine and COVID19 through an AMA Physician Innovation Network virtual panel that will be active for the next coming weeks and ask experts from around the nation about best practices.

A CMS Fact Sheet explains how expanded Medicare coverage for telehealth enables beneficiaries to receive a wider range of health care services from their physicians without having to visit a health care facility.

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Dr. Francavilla Brown had previously made other obesity-related videos for Green Mountain Partners for Health, her four-physician practice in Lakewood, a large Denver suburb. But this is the first video she posted on YouTube.

“Instead of answering a bunch of individual questions, I decided to record the video,” she said. “It was very impromptu, and I was tired from working all day, but I felt compelled to do it.”

The do-it-yourself production took two takes, and Dr. Francavilla Brown said the first version had more jokes, but the second and final take included more needed information—though she noted that the information is not as difficult to find as it was on March 11 when she posted the video.

“A week ago, it was hard to find information on how to bill for a telemedicine visit, now every specialty society and every private insurance company has guidelines out there,” said Dr. Francavilla Brown, a Colorado alternate delegate to the AMA House of Delegates.

The video includes:

  • Tips on connecting with patients and setting up a telemedicine workspace.
  • Tips on conducting an exam, including checking a patient’s throat and getting vital signs.
  • Recommendations on how to note and document the visit.
  • Recommendations for AMA Current Procedural Terminology (CPT®) codes and modifiers.

“We need to keep people who are not sick out of the ER,” she says in the video. “We need to keep sick people at home.”

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Her practice is transitioning to mostly telemedicine visits, with about 13 per day. For patients with histories of asthma or chronic obstructive pulmonary disease who need an in-person exam, a spot has been designated in the practice’s parking lot for drive-up examinations by someone on staff wearing protective gear.

As of March 22, there have been 591 confirmed cases of COVID-19 in Colorado, including 51 in Jefferson County where the practice is located.

“We know it’s here,” Dr. Francavilla Brown said.

She believes the wider adoption and use of telemedicine that began during the pandemic will continue once the public emergency fades.

“I think things aren’t going to go back to the way they were,” Dr. Francavilla Brown said. “The cat’s out of the bag.”

She is concerned, however, by private companies emerging on the scene during the pandemic and offering telemedicine and randomly connecting patients and physicians with no prior relationship.

“While there are corporate telehealth options expanding at this time, we need to make sure private practices have the tools to continue offering care to their patients through telehealth and maintain continuity of care as much as possible in this time of crisis,” Dr. Francavilla Brown said.