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Driving Improved Access and Reimbursement While Delivering Better Care


4 reasons to be hopeful for the future of virtual care.

virtual care cms,telehealth benefits,telemedicine access

Virtual care could improve access to care — and much more. Image has been altered. Licensed from Andy Dean - Fotolia.

The Centers for Medicare & Medicaid Services (CMS) made recent updates to improve access and expand reimbursement for telehealth and virtual care services. The measures will help drive healthcare organizations to deliver better patient care from a timing and quality standpoint. CMS proposed expanded benefits for Medicare Advantage to provide beneficiaries with more convenient access to healthcare via virtual care and telehealth services. CMS’s 2019 Physician Fee Schedule is also intended to drive more access and adoption as Medicare will pay providers for these kinds of services, including quick check-ins between patients and providers.

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With this expanded access to virtual care and telehealth services, more providers and home health organizations will be working to implement this technology to reap the multitude of benefits that virtual care platforms can offer — from increasing patient satisfaction and staff efficiency to improving health outcomes while avoiding excess costs.

Increasing Patient Satisfaction

According to AARP, 87 percent of adults age 65 and older want to stay in their current home and community as they age. The Centers for Disease Control and Prevention defines aging in place as “the ability to live in one’s own home and community safely, independently and comfortably, regardless of age, income or ability level.”

Virtual care can help older populations remain engaged and active in managing their health while keeping them at home as long as possible. The hospital-at-home type of care ensures that patients understand how to self-manage their conditions on a daily basis. Leveraging virtual care technology, providers’ video calls, emails, secure messaging and text messages can facilitate deeper patient engagement by regularly emphasizing the treatment plan, reminding a patient of upcoming appointments, addressing questions about medication reconciliation and recommending changes to improve one’s overall health and well-being. Access to home health staff (and even clinicians, specialists and pharmacists) is now at the fingertips of these patients. And remote family members and informal caregivers can also be included in the communications and virtual appointments to drive greater understanding of the patient’s care plan.

Improving Staff Efficiency

With the increase in the aging population, more patients will face a turning point in their care, especially if they are living with one or more chronic conditions.

Virtual care technology can optimize visiting nurses’ productivity by enabling nurses, specialists and related specialists (e.g., pharmacists, nutritionists, etc.) to communicate via video in real-time. The real-time “live” interaction will limit disruption to existing workflows and reduce travel time and costs for all care team members, while improving alignment on the patient’s progress and next steps in the care program. Patient wait times for serious interventions are minimized as clinicians can readily be included in the video-based virtual visit if the nurse is unable to answer the patient’s question or address the emerging concern. Staff members’ available time can be better used to deliver compassionate care to more patients versus driving to a handful of patient appointments each day.

Driving Better Outcomes

Each key stakeholder involved in a patient’s care can benefit from increased access to and reimbursement of a virtual care platform.

As coordinating conversations across a patient’s care team is difficult with busy schedules and various locations, a virtual care communication platform enables providers to connect with each other, regardless of the various locations. Using video, a provider can ensure that clear, efficient and open communications take place among care team members and that the quality of care — and patient’s concerns, needs and wishes — are maintained throughout the care continuum. If a patient needs to be transferred from home, all stakeholders can discuss the best way to move the patient in so that it minimizes the patient’s wait time and maximizes the continuity of care. The expanded use of virtual care will help keep patient-centric care at the forefront for all providers and settings.

Minimizing Excess Costs

As providers have the ability to detect potential patient issues before immediate in-person consults are needed, preventive care can be conveniently delivered via video, and expensive in-person critical interventions (whether at the emergency department or at home) can be minimized. The Health Care Cost Institute estimates that the average cost of an emergency room visit is $1,917, while the Agency for Healthcare Research & Quality estimates that the average cost of a readmission for a patient is $13,800 (Medicare) or $12,300 (Medicaid). In this way, leveraging virtual care helps to avoid excess costs for all organizations across the care continuum.

What CMS’s Virtual Care Push Means

Virtual care is an effective and efficient way to bring care to patients and help them remain comfortably and conveniently at home. By using technology to provide patients with better access to follow-up care, healthcare organizations can optimize their community’s physical and financial health while lowering costs for all stakeholders. The latest CMS developments help to drive better access and reimbursement, leading to better outcomes for all involved.

Lee Horner is CEO of Synzi.

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