Executive Session: Effective telehealth in pediatrics, OB/GYN to counter future spikes in COVID-19

Key takeaways

• New best practices in scheduling (e.g., shifts of televisits for providers who may be quarantined or facing childcare limitations) and better understanding of physicians’ preferred workflows have emerged during the COVID-19 pandemic.
• ​Telemedicine continues to help families stay with familiar pediatric physicians and close the loop from delivery to post-partum follow-up, easing travel burdens on patients.
• Pre-conception planning and post-partum follow-up visits can be done effectively via televisits for OB/GYN practices.
• It’s important to keep clinical team members working at top of licensure, delegating troubleshooting and data entry to appropriate support staff to keep physicians on schedule.

Medical practice leaders are no longer “swimming in a sea of question marks” in trying to manage the COVID-19 pandemic should infection numbers spike throughout flu season, according to Richard T. Schlosberg IV, MD, FAAP, pediatrician and chief administrative officer at ABCD Pediatrics, San Antonio, Texas.

Dr. Schlosberg, who also is a member of the MGMA-ACMPE Board of Directors, joined William R. “Bill” Hambsh, CPA, FACMPE, MGMA-ACMPE Board Chair and chief executive officer, North Florida Women’s Care, Tallahassee, Fla., for a discussion of the ways telemedicine has been a “lifeline” in the early months of the pandemic and its potential for effective, quality care delivery heading into future waves of the pandemic and long-term use in a variety of specialties.

Both practice leaders herald the expansion of telemedicine despite some obvious limitations in their respective specialties. For Schlosberg, pediatrics still benefits greatly from in-person experiences, but “there are definitely areas in pediatrics that can thrive in a telemedicine environment,” such as behavioral health (e.g., ADHD) that allows patients to be comfortable in their own homes. Those visits also give pediatricians better insight into patients’ home environments.

Hambsh, noting how much hands-on work is done in examining OB/GYN patients, said his practice created a spreadsheet of medical conditions that meet the criteria for a telehealth visit. He noted that virtual visits for a variety of consultations ease the burden on patients who have difficulty finding childcare and those who live farther from clinic locations. Similarly, Schlosberg said that it was a benefit for pediatric patients — who might be staying with grandparents or at a second home during quarantine — to visit their usual provider rather than go to an unfamiliar physician or urgent care center amid the pandemic.

Lessons learned ahead of future waves

As the pandemic continues, the threat of patients getting comfortable and letting their guard down regarding safety precautions is real, both leaders say. But as COVID-19 cases rise in dozens of states, both Hambsh and Schlosberg sounded cautious optimism based on lessons learned in the past seven months and continue to work to educate patients.

Hambsh said that flu clinics are up and running to help ensure patients are vaccinated, and Schlosberg noted that testing equipment is available to help patients quickly know whether they are dealing with COVID-19 versus the flu. “That’s going to be a game-changer should our numbers spike this fall,” Schlosberg said.

Scheduling patients and providers in new ways helped both practices. Hambsh said his practice shifted physician extenders to do a full televisit schedule in a morning or afternoon for virtual post-partum appointments. At Schlosberg’s group, a new telemedicine appointment type was added to the regular workflow, and physicians could alternate between well visits, virtual visits and acute sick visits in-person.

The success of either approach to virtual visits, both leaders asserted, is keeping workflow changes minimal and ensuring your support staff continue to prepare patients to see a physician, such as collection of copays, documents and medical history by front desk staff and medical assistants (MAs), respectively. “That workflow doesn't slow down our pace of the day,” Schlosberg said. “If the physician had to be the IT support person in the front office, clerical person and the MA initial history person, it would take us 30 minutes to go through what would normally be a 15-minute visit. And that is not sustainable with day-to-day workflow.”

Another suggestion offered by Schlosberg: Beginning afternoon sessions with a virtual visit. “The very first appointment after lunch everyday always seemed to be provider-heavy and staff-light because of staggered lunches,” Schlosberg said. Beginning with a virtual visit relieved some of that strain, as it allowed the physicians to get to work right away while requiring less time and resources from MAs.

While the public health emergency opened new platforms for virtual care delivery, Schlosberg said that it remains important to instruct patients how to be good telemedicine users: To find a quiet place that’s appropriately lit where they can feel comfortable speaking about sensitive matters. “The perception of a confidential doctor visit needs to be maintained,” Schlosberg cautioned.

The future of telehealth

While many experts believe the next generation of telemedicine will involve remote patient monitoring (RPM), both Hambsh and Schlosberg said their practices aren’t doing much remote patient monitoring yet, as many of the technologies are more geared toward cardiology, endocrinology and other specialties. In particular, Hambsh noted that emerging fetal monitoring technology has not evolved to the point that his physicians are comfortable with them. But both believe that the pandemic has shown physicians and practices “that we can change quickly,” Schlosberg said.

However, improvements in technology are enabling the elimination of waiting space and notifications of patient arrival for curbside visits (e.g., collection of nasal swabs for testing), and both leaders predict a more holistic patient-provider experience via technology.

“There’s going to be a lot more integration of telemedicine into our EHR platforms,” Schlosberg said. “Those technologies exist — we just have to marry them all together, and that’s going to make the patient experience seamless to them, tying in all specialists, primary care and outside labs into one common app.”

In the near future, both leaders said the ability to take phone calls that were once done for free and quickly shift them into telemedicine appointments has been a financial lifeline. “You can grow your practice by 20%, 25%, 30% by adding that percentage of telemedicine visits and keep your same physical space,” Schlosberg said.

“Over time, just as cell phones and text messaging was new to us a decade ago,” Hambsh said, “I think this is going to be second nature and probably the preferred method for patients to have treatment, if eligible, over traditional medicine.”