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Apr 2 2012   12:03PM GMT

Reimbursement for telehealth services: There’s a technology for that



Posted by: Jenny Laurello
EMR adoption, Hello Health, telehealth

Q&A with Steven Ferguson, Patient Management Officer, Hello Health

1. What unique challenges do small physician practices face compared to their larger counterparts in regard to EMR adoption?

Independent small physician practices (1-5 doctors) differ significantly in their approach to shopping for, and acquiring, EMR products. The big boys, especially when you are talking 50 or more physician practices typically have committees and consultants involved in the selection process.; That means the eventual users of the technology are often times not directly involved in the tire kicking process that goes on before a vendor is signed. With a small practice, most often the user IS the buyer – and this changes everything.

Doctors in any size practice are typically very busy. Small practices are essentially small, independent businesses, where doctors are providing care, and also carrying out numerous administrative tasks as well (I know of one solo practitioner who even cleans his exam rooms each evening). The result is that these practitioners have very little time to commit to researching and test-driving EMR products. Remember, there are literally hundreds of EMRs to choose from. As a result, doctors have to rely on word of mouth and Google searches to narrow their search. This can leave doctors frazzled. Studies have shown that when consumers have too much choice, they often make no choice at all. This applies to EMR shopping.

So what does this mean for small physician practices? It means that vendors have to earn the trust of the physician. I think that simply selling an EMR system, and then walking away puts the doctor in a vulnerable position – remember, their livelihood depends on this new system operating effectively. A better approach is for the physician to enter into a partnership with an EMR company. Both entities need to have some skin in the game. Both need to be able to work together to make the implementation, and essentially the practice transformation a success.

The large practices set aside budget, earmarked not only for purchasing an EMR, but also for finding the best EMR in the first place. The solo practitioner usually doesn’t have cash on hand to throw at this sort of endeavor. As a result, you are seeing some EMR vendors offering their products for free. This may work well for doctors who don’t mind using a system with pharma advertising embedded in the user interface. However, Hello Health takes it a big step further and helps doctors make more money with an ad-free, subscription-based technology solution.

2.  As a vendor, why did you choose to focus on this part of the market?

Small, independent primary care practices need help. They face shrinking reimbursements and higher overhead and we’ve heard this many times over. Hello Health has always been about keeping the independent practice independent. We survey physicians regularly and their main concern is safeguarding their autonomy. They would much rather work for themselves instead of for the institutions we associate with large practices and hospitals. I think control plays a large part in their drive to remain independent. Control over how they practice medicine.

From the beginning we realized that primary care was feeling the pinch more than most specialists. We also understand that family medicine is more relationship-based than what you have with your average orthopedic surgeon, for example. Patients see their family doctors on a regular basis and from this, relationships are formed that may last years and years. There is value in these relationships, for both sides. Doctors get to know their patients, their patients’ families and most importantly their health as it changes with age.

We asked people what they would like to improve with their family doctors and the responses skewed overwhelmingly toward better communication. From this we developed our strategy for patients:

  • i. improve communication channels between patients and their doctors
  • ii. provide better care

We asked doctors what they would have to accomplish in order to secure their independence, and by in large they indicated that they needed to improve their finances. Accordingly, we developed our strategy for doctors:

  • i. make doctors more money
  • ii. provide better care
  • iii. put back time in their day

So far our strategy has worked. Doctors see how the Hello Health business model can improve their bottom line and patients, after having used our communications tools say they can’t imagine going back to a ‘traditional’ practice.

3.  How will the recent $10M in funding Hello Health received be used? Will you be expanding your offerings?

The new funding will go a long way in helping us ramp up our sales and marketing efforts. We are currently active in New York, New Jersey and surrounding states, as well as Atlanta. We recently added sales professionals to cover the Southwest and mid-Atlantic regions. Because Hello Health seeks to build a partnership with each and every practice, our marketing, sales, training and implementation efforts are intensive. We are not just another vendor to a new practice. We are a partner. Getting into the details of how we partner with a practice is an interview in and of itself.

We have practices in 25 states, so our reach goes beyond our sales territories. Doctors hear about us at conferences, find us online and via our social networking presence, which we continue to refine.

 4. National Coordinator for Health IT leader, Farzad Mostashari, M.D., said last week that technology alone won’t spur patient engagement because “it’s a two-way street”  – patients need access to their data, but physicians also need access to patient data coming from medical devices and the like. How does Hello Health help to accomplish this bi-directional conversation that is so important to the patient / physician relationship and how do these roles need to evolve as technology becomes more widely available?  

Hello Health has been at the forefront of bidirectional data exchange. From the day we went live in our first practice, our patients have always had access to their data. With each release we’ve made the patient experience better by introducing even more ways to exchange data, like our shared document library.

Dr. Mostashari is absolutely right when he says, “it’s a two-way street” but I would argue that outside of our Hello Health practices, we’ve never really had that bi-directional conversation, so the population at large doesn’t even really know how important it could be to the patient/ physician relationship.

There’s no question that the technology exists today to easily provide patients access to their data, and conversely for patients to send data to their doctors. You don’t have to look any further than the WellBox solution within the Hello Health platform and Qualcomm Life to see what possibilities exist. The bigger question, that I don’t think anyone has a ‘real-world’ answer to is,  who’s going to pay for this?

There will always be a small segment of the population who are proactive and curious enough to capture and track bio-data – and that’s great. Movements like Quantified Self (QS) seem to be gaining momentum and there is interest from the VC community. However, QS represents the extreme, and is not necessarily linked to any specific disease monitoring. They are the innovators and early adopters and I respect them for taking their health seriously. For the rest of us, consumer products like Nike Fuelband and FitBit are making inroads into our everyday lives.

But let’s say a patient is hypertensive and is monitoring their blood pressure at home. They can easily communicate this data to their physician during regular visits, and that works ok because the doctor is getting paid for that encounter. Now let’s say that the patient has a Bluetooth BP cuff and their readings can be sent automatically into the cloud on a daily basis. Let’s even say that the doctor has a dashboard where he or she can go to check on all of their hypertensives’ BP on a daily basis. This is also good, right? You would think so, but unfortunately the doctor isn’t getting paid for the time he or she spends checking this data. Neither is their nurse practitioner. And who pays for the Bluetooth BP cuff? The reimbursement mechanisms will have to change if Dr. Mostashari’s vision is to be realized.

5.  Case studies of success (i.e., utilizing remote visits, etc)? What are examples of this technology in action?

Two of our earliest customers in Manhattan represent great success stories. One runs an internal medicine and hematology practice in Mid-Town Manhattan. The other has a similar practice on the Upper East Side.

Both doctors tout the merits of digitizing their practices, and for many of the same reasons. Initially, both doctors considered staying the course with paper-based charts and schedules, feeling that they would be well served by these time-honored tools. However, requests from patients for improved communication methods soon had both of them looking for alternatives. What convinced them to try Hello Health was not just the intuitive EMR, or the value of the patient’s portal, but rather how the platform was able to tie the functionality together to provide synergy and thus more value.

Dr. Colleen Edwards sums it up best when she says, “One of the unintended benefits I’ve found is the e-mail conversations that you have, or instant messaging conversations or telephone conversations, now automatically become part of the medical record. That’s a huge improvement for me.” Stated another way, it’s not enough to have an EMR, provide secure messaging and conduct virtual visits. All of these things have to be tied together. The message thread becomes much more valuable if the provider can save it automatically to the patient’s chart or attaches it to a specific visit note.

When doctors start getting paid for all of the work they do, a curious thing happens – patients start respecting their time, and doctors start making more money. During a recent interview, Dr. Edwards stated: “The feature of Hello Health that really tweaked my interest was the ability to bill for remote services, or virtual services. As an internist, I do a lot on the telephone that I wasn’t getting reimbursed for. Whether it’s a straightforward urinary tract infection or sinusitis, or someone wanting to discuss their headaches over the telephone, I was making 10 phone calls like that a day that I wasn’t getting reimbursed for, and I thought I should. And it got to the point where I thought I was being abused. I was so responsive, I always return my phone calls, and then having this ability to actually capture a little income, and make the patients realize that my time isn’t free and it’s valuable, really made my antenna go up.”

At Hello Health, when we hear stories like this we can’t help but smile. This was our goal from day one — use technology in a way that makes doctor’s lives easier, and more rewarding while at the same time providing valuable tools to patients that enhance their relationship with their doctor.

For more information on Hello Health, please visit http://hellohealth.com/physicians/.

Comment on this Post

Leave a comment:

Radevan  |   Apr 9, 2012  2:01 PM (GMT)

Great to hear Hello Health is taking medicine in a technological direction. It will help ease the mind of several of those [A href=”http://www.ringadoc.com”]online doctor[/A]s. Plus EMRs over the cloud will help de-clutter an office and keeping things electronically and securely will help a doctor office be more organized and more easily accessible when in need.


 

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