In mid-March, many dermatology practices were forced to contend with lower patient volumes or to shut their doors completely. It was certainly a new frontier for many dermatologists with virtually an entire nation abiding by social distancing guidelines and shelter-in-place orders. Some opted to treat patients with emergencies only, in an effort to preserve personal protective equipment and do their part to help flatten the curve. Others turned to telemedicine as a way to provide patient access.
Telehealth has proven to be a stabilizing factor for both dermatology practices and patients. With the adoption of the Centers for Medicare & Medicaid Services (CMS) Interim Telemedicine Final Rule1 and similar policy changes by private payers, providers now receive reimbursement on par with in-person visits for many telemedicine encounters and can see both new and established patients for virtual visits. Providers can receive reimbursement for live-interactive, two-way communication, as well as telephone evaluation and management encounters, and even virtual check-ins (store-and-forward) where patients can send photos and messages to their doctor for evaluation. During this public health crisis, The CARES Act2 also reduced many regulatory burdens on practices, making it easier for doctors to start using solutions as soon as possible and provide more patients with access to the health care they need.
It is important to remember that many physicians (and patients) are using telemedicine for the first time. Prior to coronavirus disease (COVID-19), schedules were packed for 2 to 3 months with patients waiting to see their dermatologists in clinic. In this environment, telehealth was not a necessity. The COVID-19 pandemic has changed this dynamic, with many practices integrating telehealth visits for acne, rashes, or concerning skin lesions.
At the end of the day, it is up to individual practices and doctors to decide when to use telemedicine. I’ve seen a wide range of dermatology cases via telemedicine over the last month or so, including immunobullous diseases, acne, shingles, skin cancers that needed to be addressed, and precancerous lesions that could be treated with topical therapy. While we cannot necessarily biopsy or excise lesions, we can diagnose, prescribe, order tests, and schedule follow-up in person visits for more urgent clinical scenarios.
Navigating the telehealth landscape has proven to be a valuable learning experience. Here are some of my practical tips on how to jumpstart and build a virtual, telemedicine practice and what the future may hold.
#1: Communicate With Your Patients
Let your patients know that you’re available to see them through the telemedicine methods you choose to implement. This initial hurdle can be overcome by informing your patient base that even if your practice is open, they can still see you virtually if they prefer to do so. Whether it’s a message on your voicemail for when patients call in, an email or note on your website or social media, you want to let your patients know how you are using technology to practice as safely as possible.
You’ll also want to educate your patients about which telehealth options you offer and what to expect at their virtual appointment. Take into consideration your patient’s comfort level with having a live video exam. Would they rather send you photos of a rash or lesion through secure messaging instead? Can their visit be postponed until you can accommodate in-person visits? Make sure you or your staff explain your patient’s options thoroughly.
#2: Make the Technology Transition as Easy as Possible
Many patients may be intimidated by technology. Whether you’re using a smartphone app or a desktop-based website for telehealth, your patients and your staff will need some coaching on how to use the technology so that they can have a comfortable and effective visit. Making sure everyone knows how to use the technology, educating your staff on the clinical scenarios, and knowing how to help troubleshoot technical difficulties are possibly the biggest obstacles for telemedicine.
The patients I’ve visited with recently over telemedicine are incredibly appreciative that I’m able to see them, reassure them, or even treat them. Telemedicine, particularly real-time video conferencing, adds a personal touch that can help practices maintain and extend the patient-doctor relationship and provides a friendly face amid the chaos.
#3: Help Your Patients Get “Camera Ready”
Video quality and lighting are extremely important, especially in our field. Thankfully, many of today’s smartphones have high-definition video capabilities and the best images and video quality often come from the rear-facing camera, which is usually equipped with a flash. Patient images will benefit from as much lighting as possible, so I recommend having a telemedicine solution that can take advantage of a smartphone’s flashlight to help to more clearly see lesions and other skin conditions.
I also encourage patients to attend their appointments with a trusted friend or family member, such as a spouse or child who can hold the phone for them. This extra set of hands is incredibly helpful for the efficiency and thoroughness of the exam, particularly for hard to reach areas.
I advise patients using a mobile telemedicine solution3 to hold their mobile phone 5 to 7 inches from where the lesions are located. I also find it is immensely helpful to have whomever is holding the phone move the camera slowly so that it is possible to see the lesion clearly and from different angles.
#4: Get Creative and Use Technology to Your Advantage
It is imperative for us as dermatologists to use this time to deploy virtual care and practice tools to improve the safety of our patients and our employees as our practices begin to reopen. Since the office experience has certainly changed a bit, you’ll want to communicate new office procedures and safety precautions to your patients.
Using an on-demand messaging service can help broadcast a mass message to your patient base that you have reopened and communicate important safety announcements. Incorporating appointment reminders can reduce no-shows and help reinforce new office procedures like wearing a mask. Online scheduling can free up office staff and empower patients to schedule either virtual or in-person visits at their convenience. Finally, secure messaging can notify patients in the parking lot that they are ready to be roomed directly into an exam room, obviating the need to have a waiting area and helping to reduce the risk of viral transmission.
Secure, online patient portals can also improve office efficiency and can help reduce in person interactions by getting the documentation work completed before the visit even starts. For example, asking patients to upload identification and insurance cards through a portal can help streamline front office practice operations while updating allergies, past medical and social history, medications and preferred pharmacies can speed up the back-office.
After the visit has concluded, consider how to streamline copay collection with text-to-pay and tap-to pay-options. Technology can help make these workflows contactless. At checkout, use your practice management system to create recalls. This is an important step to stay in contact with your patient well after they have left the office and get their follow-up visit on the calendar.
COVID-19 has expedited the need for virtual tools that can aid your practice clinically, operationally and financially. It’s all about digitizing more aspects of the patient journey and working to streamline operations.
The Future of Virtual Care
Telemedicine and mobile check-in platforms are going to be critical for getting dermatologists and their patients through the remainder of the public health emergency. Even after offices reopen and are deemed safe, it is likely that some percentage of our patient base will prefer the convenience and safety of virtual visits when clinically appropriate. Practices that adopt contactless workflows will be able to improve their own efficiency and reduce the risk of transmission.
Dr Sherling is cofounder and chief medical and strategy officer of Modernizing Medicine and practices with Palm Beach Dermatology in Lake Worth, FL.
Disclosure: Dr Sherling is the cofounder and chief medical and strategy officer of Modernizing Medicine.
Editor’s note: The materials included in this article were current as of May 29, 2020, and may be subject to change. Updates and details on the topics covered herein may be available from CMS, the Centers for Disease Control and Prevention, and/or commercial payers with which you contract. There is no warranty regarding the ongoing accuracy of the information provided and the foregoing is not intended as legal or medical advice. Please consult applicable state and local laws and regulations, as some states are not moving as quickly as the Federal government to adapt to the changes that may be required to help physicians meet the increasing need to provide care outside of a traditional clinical setting.
References
1. Coronavirus waives & flexibilities. Centers for Medicare & Medicaid Services. May 29, 2020. Accessed June 1, 2020. https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers
2. The CARES act works for all Americans. US Dept of the Treasury. Accessed June 1, 2020. https://home.treasury.gov/policy-issues/cares
3. modmed Telehealth. Modernizing Medicine. Accessed June 1, 2020. https://www.modmed.com/telehealth/
