Dr Kane relates lessons learned during the pandemic about using telehealth in her gastroenterology practice. 

Sunanda Kane, MD, is professor of medicine at the Mayo Clinic in Rochester, Minnesota.

TRANSCRIPT:

Dr. Sunanda Kane: Hi. I'm Dr. Susie Kane, professor of medicine at Mayo Clinic here in Rochester, Minnesota. For this year's DDW, I'm going to be speaking on Saturday morning during the session entitled "Improving Your GI Practice With Digital Technologies and Artificial Intelligence."

I'm going to be speaking about telehealth and what I learned in the past year. At Mayo Clinic, we were doing telehealth before the COVID pandemic. Certainly, just as everyone else, we ramped it up so that we could take care of our patients over the phone and over the Internet.

We used a Zoom-based platform. What did we learn? First of all, we learned that some patients love this. There was no travel or extra time off from work, and there were no indirect costs like parking, childcare. Patients could do it from the comfort of their home, or from their office, or wherever they wanted.

We also learned though, that there are some patients who hate this, that they do not feel connected to their provider. They like that face to face. They always used the visit to their provider as a social event or an excuse to get out of the house. Some just don't have the right equipment, or they're just not tech-savvy enough to know how to use it.

Don't forget that there are parts of the country that don't have appropriate broadband. You'd think that that would not be an issue, but certainly, it is. There are some patients who had a failed attempt and are not interested in trying again. Remember, that even though it may seem very convenient, there are some patients who will not buy into this.

We also learned that the platform that you choose matters. There are multiple different platforms out there, and that not all are going to do what you need it to do for your practice. We used a Zoom-based, and as an institution, I didn't have to worry about this. I did learn, from my patients and from my colleagues, that there are many options out there.

A web-based option allows for access from any device. There are some platforms that require a computer, and even some required certain operating systems. There are some that are savvy enough to communicate with your EMR for scheduling.

There are some that are based on when you go to bill, a payment structure that is bundled for fee-for-service, versus those that are pay-per-use, versus those that there is a fee-per-member-per -month, based on the practice that you're in. It was really important to understand what kind of platform that you have.

Now, the other thing that we are learning -- and this is actually now a moving target -- the billing is confusing but worth learning. It is always important that you have a templated phrase for stating that this is telehealth, just so that you don't get in trouble later on. For new patients, there is a different billing system than for established patients or for consults.

It is a nice way, telehealth is, for getting to learn new patients so that you can actually triage that first visit, getting to know the patient, and allowing for planning tests and procedures in the future. This also allows for a warm handoff to any allied health staff or APPs in your practice.

Moving forward, as you refine how you're going to be using this, these are some of the other ways that you can use telehealth, not just for the emergent visits that you needed. Speaking of emergent visits, there are patients who are appropriate for these types of visits and some that are not.

Some patients may call first thing in the morning with a complaint, and you may know that they are chronic complainers. Rather than spending time on the phone, you can schedule them for a telehealth visit and be able to be paid for your efforts, as opposed to playing phone tag with them or having your nurses get sucked up into yet another visit with them.

There are patients that are not appropriate for telehealth. Some patients who love this system are going to take advantage and try to get all of their care versus via telehealth, which would mean they call with abdominal pain, which is new. They call with rectal bleeding. Those are not appropriate for telehealth.

It's really important that you have templated scripts that your office managers and your frontline phone desk folks can use, and that they hear certain diagnoses and automatically tell the patient that they are not eligible for telehealth. The more times they hear that message the better off they're going to be, and you're going to help your desk staff with those scripts.

Again, the patient's going to say, "Well, why can't I just talk to the doctor? I'm willing to do a phone visit." The other thing to remember is that, again, your platform may have billing per visit that the patient is going to receive, and that most of the time those are coming out of the patient's pocket. They need to understand that up front.

For the convenience of being able to speak to you that day or not coming in, there is that opportunity cost. They may not be traveling in or getting childcare, but they are paying for the visit themselves, which again circles back to the whole issue of billing and billing codes that you understand, so that you are not leaving money on the table, and that you are getting paid appropriately for your efforts.

It's been a big success here at Mayo, and it is not going to go away. We are going to be using this in the future, so make sure you understand how you can best use it for your office practice. Thank you.