Patients

Medicare and Medicaid – two important programs for paying for health care for American Indian and Alaska Native (AI/AN) people. As we near the end of the COVID-19 Public Health Emergency (PHE), it’s going to be important to understand the differences between these programs and how they may impact reimbursements for telehealth services moving forward. Understanding these differences will be important for understanding the next steps for continuing to get reimbursed and any challenges that may be encountered in that process.

After a Veteran gets milk from the dairy aisle, and some bread from the bakery section, he stops at the ATLAS pod in Walmart and has a healthcare visit with his/her mental health, specialty, or medical provider.

In hopes of sparking renewed commitment to applying improvement science to telehealth, we offer this Telehealth QI and QA Miniseries. Today is the third in the series.

Recall that data can come in many forms and doesn’t have to be a report out of your electronic medical record (EHR). It can be hashmarks, start-end times, glass globs in a jar and more. I’m not kidding about glass globs. Once when I visited the Institute for Healthcare Improvement (IHI) there were two jars; one was labeled “Having a good day” the other was labeled “Having a bad day”. Each person who checked in at reception put a glob in the jar that reflected how their day was going.

At this time of year, I feel it is important to take the time and reflect on what makes us happy, and what we are you thankful for. I am truly thankful for my family and friends. I am also thankful to be working in telehealth with the Southwest Telehealth Resource Center. Through telehealth I’ve met some amazing people and I’ve reached out to some of them and asked them to help celebrate this season of Thanksgiving by sharing what they are thankful for. Hopefully their thoughts will inspire some of you and maybe even make you smile. All of us at SWTRC wish you and yours a wonderful thanksgiving holiday!

Telehealth has many benefits including reduced, or eliminated travel and wait times; decreased exposure to communicative diseases; easier access to healthcare professionals and therapeutic interventions; and greater flexibility. However, for many individuals with disabilities, Telehealth and it's associated benefits may be out of reach due to web inaccessibility. Benefits can become barriers because of websites’ inconsistent compatibility with screen readers, closed captions, magnifiers, speech to text software (used by individuals with limited dexterity), easy to understand instructions and hyperlinks (for individuals with cognitive disabilities), and alternative text formats.

Let’s do more interprofessional consultations! And let’s start by calling them e-consults.

What are e-consults?

Electronic consults (e-consults) are asynchronous clinician-to-clinician exchanges that are used when there is not a need for a face-to-face (in person or telehealth) visit between a clinician/specialist and a patient. Under the umbrella of telehealth, e-consults are considered a store and forward option that uses telephone, Internet and/or an electronic health record (EHR). Patient information that has been gathered and documented is provided by the treating/requesting clinician to a consultative physician with a request for medical advice and/or an opinion. According to the Centers for Medicare & Medicaid Services (CMS) “…these inter-professional consults are typically initiated by a primary care practitioner to a specialist for a low acuity, condition-specific question that can be answered without an in-person visit. CMS also considers e-consults as assessment and management services.

For many Americans, their first personal experience of being a hospital patient quickly becomes a crash course in the importance and value of having a skilled and dedicated bedside nurse. At a higher level, this points to the importance of a sufficient nursing staff which impacts the entire workflow of the hospital. Without sufficient bedside nurses, patients in the Emergency Room and Intensive Care Units cannot be moved to the floors, resulting in longer waiting times for care for those newly arriving. Beds that cannot be staffed are beds that do not exist for all practical purposes. Unfortunately, a shortage of nurses has long been a problem for hospitals across the United States. The coronavirus pandemic has brought this challenge to an entirely new level, resulting in a request by the American Nurses Association that the U.S. Department of Health and Human Services declare the current nursing staffing shortage a national crisis.

Why am I ALWAYS crying? I swear right when I think to myself… “I got this, I GOT THIS”. Tears, puddles, Niagara Falls… pouring out. Every time I’m asked to share my experience. Why cry? Because of all the LOVE I have as a healthcare provider and the genuine connections I made during our crisis immersion in collaboration with the Gallup Indian Medical Center (GIMC), Gallup, NM.

States across the country are proposing or enacting legislation that supports making the increased access to telehealth that occurred during the pandemic permanent. However, many states seem to struggle with how to appropriately regulate remote prescribing requirements as there is wide variation in approaches and priorities emerging in these proposed and new laws.

As the COVID-19 pandemic becomes increasingly under control and more states are ending their public health emergency declarations, legislatures across the southwest have sprung into action to enact bills that permanently expand telehealth services.

At the forefront of this new legislation is Arizona’s HB 2454 that Governor Doug Ducey signed into law on March 5, 2021 to provide comprehensive amendments to the state's laws governing telehealth. In Arizona and other southwest states’ new telehealth laws, entities are generally prohibited from denying coverage for telehealth services and are required to cover remotely provided services at the same rate as equivalent in-person services.