In these extraordinary times, many people across the world are now doing what I’ve been happily doing for more than 10 years — working from home! It is so trendy it even has an acronym: WFH. Catchy.
My husband Eugene, on the other hand, is an interventional cardiologist. Besides answering phone calls from hospital staff and patients some evenings and weekends, often while we are right in the middle of eating or watching a movie, he has not had the pleasure of WFH-ing.
That changed a couple weeks ago.
Eugene developed a fever, cough, and chills after being exposed to a flu patient in the hospital. Not taking any chances, he got tested for the flu, other viruses, and COVID-19, and self-quarantined at home while waiting for the results. He ended up negative for flu, positive for another common cold virus, but the COVID-19 test was taking forever to come back, so the quarantine continued for several more days. He was prepared to just read echocardiograms, but then another opportunity came along.
Thanks to the timely change in the Centers for Medicare & Medicaid Services (CMS) reimbursement policy, video visits are now reimbursable at the same rate as office visits, a game changer for health care providers. Interestingly, traditional phone visits still garner very low reimbursements. The incentive is clearly for the patient to be able to see the provider, and vice versa.
On Tuesday morning, I moved out of my home office, and it became an exam room. Eugene had 10 patients scheduled that day. Here is a summary of the process:
- Monday, the clinic administrative assistant called scheduled patients and offered video visit options. Most gratefully chose that method, but some wanted to come to the clinic, which was also permitted.
- Monday, the clinic RN sent the provider a calendar invite with the Zoom link, and also sent the patient the same link.
- The provider logs into Epic to view scheduled patients
- The clinic RN begins a Zoom session with the first patient and completes the medical history and medication reconciliation portions of the note
- The RN texts the provider indicating the first portion of the visit is complete
- The provider initiates a Zoom session with the patient
- Hopefully, the connection is successful, and the two are able to have the same type of conversation they would have in the clinic, ultimately agreeing on a treatment plan
- The provider completes the rest of the note in Epic
I interviewed Eugene afterward to talk about some of the challenges with this method of engaging patients. He noted that two disadvantages were the lack of vital sign data, and the inability to examine the patient.
For vital signs, he asked each patient if they were monitoring their blood pressure with either a home monitor, or by using machines available in drugstores. Often, they were, so he documented their self-reported results. For the physical exam, most of the patients were well-established with previous exams on record for reference. He did see at least one new patient, and scheduled a follow-up visit in three months, hopefully in the office if it is safe, to complete that exam.
The other challenge was making the video connection work. In one case, Eugene could not hear the patient, so they switched to a regular phone call. Another patient could see him, but he could not see her, so they just continued to use the video option. The other connections worked perfectly.
Eugene emphasized the advantages of video visits during this pandemic; most importantly, patients are kept at home. He was able to adjust medication, write new prescriptions, recommend future procedures that are necessary but not urgent, and provide what I think is his awesome “doctor lecture” on the importance of exercise and nutrition in combating heart diseases, which will continue killing hundreds of thousands of Americans each year after this virus has passed.
Thankfully, the COVID-19 test was negative, and my husband headed back to the clinic on Wednesday. He is still seeing most outpatients by video, plus caring for inpatients in several hospitals. Like everyone else, I am grateful for all the members of the healthcare team who are suiting up and saving lives right now, but really wish he’d WFH more often.
When this is over, we healthcare consultants should be prepared to ask our clients how video visits changed their practices during the pandemic, and if some of those changes are here to stay.
By Kelly Soh, a Principal with The Innova Group, a national healthcare consultancy helping clients make capital investment decisions
Dr. Eugene Soh is an interventional cardiologist with Carient Heart & Vascular, providing comprehensive care throughout Northern Virginia