By Christopher Scuderi, DO; Mark Weber, MD, PhD and Julie Braddy-Roberts, MD, FAAFP

Over the past two months, many family medicine physicians have seen their practices develop or expand telemedicine capabilities due to the COVID-19 pandemic. This shift towards telehealth virtual care delivery has created equally great opportunities and challenges. Rapid modification of traditional outpatient workflow processes to support the provision of care in a virtual environment has been critical during the pandemic to maintain patient health care access and ensure medical practice viability. Although the changes in workday procedures has been profound for physicians and patients, we must consider that the impact of these changes has also been seismic in scale for support staff. 

As family medicine practices embrace the transition towards telehealth and strive to optimize the quality of care in the virtual medical environment, it is imperative that we engage and integrate our clinical support staff within these newly modified workflow paradigms.

The following are tips and lessons learned by family medicine practices that have successfully navigated the waters from the traditional to the virtual model. These best practices are offered as potential opportunities to creatively and efficiently utilize existing staff in the coordinated delivery of telemedicine.

Prior to the virtual visit

  • Notify patients of the availability of virtual visits.
    • Call patients who have scheduled in-clinic appointments.  
    • Suggest telehealth to patients who have recently cancelled appointments.
  • Carefully evaluate clinic schedules for telemedicine opportunities.
  • Consider offering annual wellness visit initial (G0438) and AWV Subsequent (G0439) as a virtual visit; both are now reimbursed by Medicare at parity for telehealth.
  • Transitional care management visits (hospital follow up) can now be offered virtually to Medicare patients as a check in virtually from their home as well.
  • Review the patient’s insurance coverage and copays in advance of the virtual encounter, if applicable.
  • Help walk patients through the process of accessing the telehealth platform. Take patients on a trial run if needed.

Day of the virtual visit

  • Initiate the virtual visit. 
  • Make sure the connection, lighting and sound are appropriate for the exam.
  • Obtain and document home vitals (blood pressure, pulse, temperature, weight, pulse oximetry, height and blood glucose are options) if the patient has the capacity to perform these measurements from home (not required for billing).
  • Prepare the chart for the visit: review medications, past medical and surgery history, and allergies. This can be completed by the staff over the phone, prior to the scheduled time of the virtual visit, or at the beginning of the telehealth encounter, before the physician has logged into the exam.
  • Review current care gaps and HEDIS scores, if applicable.
  • Update social determinants of health.
  • Queue medication refills.
  • Review vaccination history and schedules, and remind patients of any impending vaccinations.
  • Address any remaining concerns or health issues.
  • Document the patient’s chief complaint and any additional active concerns.

After the virtual visit

  • Schedule patient for future appointments.
  • Help the patient with referrals, imaging or lab orders.
  • Address billing items, as appropriate.

Change in the field of medicine remains a guarantee, no matter the era of practice. It is important to remember, during this historic time of unparalleled challenges wrought by the COVID-19 pandemic, that we must prioritize clear and frequent communication with our teams. Our staff is facing unique stressors, both at work and at home during this time. Developing coordinated telemedicine workflows will improve the productivity of our practices, help maintain the cohesion of our care teams and ensure safe access to high-quality care for patients in our communities.  

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