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March 6, 2023

AMA's 5 steps for reevaluating your telehealth program (and 1 step they missed)

Daily Briefing

    The American Medical Association (AMA) last month released an updated telehealth toolkit outlining five steps "to help practices improve patient access, satisfaction and continuity of care," Tanya Albert Henry writes for AMA.

    Why practices should consider revaluating their telehealth programs

    At the start of the pandemic, physicians scrambled to integrate telehealth into their practices, leaving little time to thoroughly vet vendors or fine tune workflows, Henry writes.

    Now, with 70% of physicians saying their organization is likely to continue using telehealth, AMA says it is an ideal time to reevaluate how well telehealth is working for patients, physicians, and other industry professionals — and find ways to make it work better.

    Late last month, AMA released an updated toolkit designed "to help practices identify different types of telehealth services, employ efficient telehealth workflows and understand how key regulations affect telehealth," Henry writes.

    "It's highly variable based on the individual physician preferences, as well as the patient population and the resources the practice has, but everyone has a better sense of what they are comfortable with and what their needs are. It's a good time to go back to the start line and reevaluate," said toolkit co-author Jill Jin, an internist, clinical assistant professor of medicine at the Northwestern University Feinberg School of Medicine, and a physician advisor at AMA.

    5 steps to revaluate your approach to telehealth

    According to AMA, these five steps are designed "to help practices improve patient access, satisfaction and continuity of care, while enhancing care team well-being and increasing revenue."

    1. Determine which services to offer

    As physicians gain a better sense for which visits work best virtually and which are best handled in person, practices will be better able to determine which services they want to provide through telehealth visits. Currently, a variety of telehealth services are payable under the Medicare physician payment schedule, including ED visits, advance care planning, diabetes management visits, and the Medicare annual wellness visit.

    2. Choose the right platform

    Finding a platform that meets the physician practice's needs is essential. While some practices provide audio-only visits, others rely on videoconferencing platforms like Zoom, FaceTime, or Microsoft Teams.

    3. Know relevant laws and policies

    With any deliverymodel, a practice must meet all federal and state laws and standards related to billing privacy and security, informed consent, medical licensure, credentialing and privileging, prescribing, quality reporting, and liability. 

    4. Establish team-based workflows

    According to AMA, telehealth workflows should mirror in-person workflows as closely as possible and integrate team-based care principles. During the pandemic, telehealth workflows often diverted to a "doctor does it all" model, which is not sustainable, Henry writes.

    5. Assess and streamline

    When a practice changes any process, it is important "to engage champions and early adopters, capitalize on and communicate successes internally and get frequent feedback on inefficiencies and opportunities for improvement," Henry notes. (Henry, AMA, 2/28)


    Advisory Board's take

    Step 6: Get clinicians on board with telehealth

    By Jordan Peterson

    The AMA toolkit provides essential guidance — but it is solely focused on the technical challenges surrounding telehealth.

    The article cited that 70% of physicians say their organizations plan to continue using telehealth, but how many of those organizations have the support of their clinicians? We know that getting clinician buy-in is the first step of any successful initiative, but this is often easier said than done. Part of what makes change management so hard is the focus on technical challenges at the expense of other adaptive challenges, like securing buy-in.

    People tend to focus on technical challenges because they are well defined, bounded, and concrete. That is why we have heard so much about the technical challenges of telehealth in recent years. You've probably heard clinicians have voiced concerns about integrating telehealth into their workflows, dealing with faulty video and audio connections, and uneasiness about patient privacy — and AMA's toolkit clearly targets those concerns.

    However, the rise of telehealth has driven practices and clinicians to rethink how patient care is delivered, leading to adaptive challenges. Adaptive challenges are personal, abstract, and messy — and that makes them harder to identify and address. Common adaptive challenges of telehealth include clinicians feeling:

    • Loss of identity: "I didn't start practicing medicine to stare at a screen all day."
    • Loss of autonomy: "I don't want to be told when my visits have to be virtual."
    • Fear about care quality: "Telehealth is bad medicine."

    The good news is that while difficult, it is not impossible to address these adaptive challenges. Many adaptive challenges stem from clinicians' concern that they are losing the human touch in healthcare and jeopardizing their relationships with patients. Reminding clinicians of the many benefits of telehealth, including the potential to make their work easier while improving patient care, is a good place to start overcoming adaptive challenges.

    This is a reminder to think about all types of challenges — even the ones that are difficult to identify and address. We do not want to solve all the technical challenges and be left wondering why telehealth is still not working. That's why we researched this problem last fall and identified three tactics to overcome adaptive challenges.

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