MHQP Releases Results of “Together for Better Telehealth” Surveys

Comments: 

• “It changes depending on who I’m seeing. I foresee more online visits as kids go back to school. Telehealth visits have fallen off as the unmet demand for physicals deferred is being addressed as patients are more willing to come into the office.”
• “Choice should be based on patient preference.”
• “In person is much more efficient.”
• “Would prefer more video visits, but it is not being offered or stressed with patients as much as I would like it to be.”
• “I provide a great deal of phone care but remain uncomfortable billing for the majority of these interactions because patients have become accustomed to receiving this care without a charge.”
• “Would actually like to do more video visits, but recently patients have been much more interested in being seen in person.”
• “I think video visits are the way of the future, but the connectivity needs to be greatly improved in order to be efficient and timely in completing these visits.”
• “Our patients have significant impediments to video with band width and connectivity issue in rural area. Since there is no evidence that video is superior to or adds anything significantly more to the visit, the differential reimbursement is creating a disadvantage for those without resources or living in areas with poor internet connectivity.”
• “Telehealth has been very very helpful to maintain continuity of care for our patients.”
• “I have been hesitant to perform to many video as they don’t appear any more effective than a good phone conversation. It is only financial that we will eventually need to convert potentially to this format. Currently the workflow to have patients ready and checked in without provider waiting or troubleshooting is not efficient.”
• “This has been challenging and refreshing also. With the proper triage, appropriate scheduling and making sure the technology is working both sides, telehealth is a blessing much needed in primary care. This should carry on from now on, at the same level we perform now, not just because of the pandemic. This way of practice is modern, fresh and needed reform in our practice. It helps to get patient care faster and more efficient. Based on my experience at least half of the primary care visits don’t need the patient to be at the office. And doing it right the interaction with the patients is wonderful. They show me around their house, they feel more comfortable talking about any issue, they don’t need to take time off from their work or wait in waiting rooms. I love it!”
• “Phone calls are secondary for patients without the ability to do video or for patients with ESL and need of translator.”
• “We are a small municipal agency and have been meeting people outdoors when we can.”
• “Video capability remains very complicated and time-consuming due to the platform my organization has chosen to use.”
• “My patients prefer in person visits.”
• “New patients often want an in-person meeting if they respond well to treatment. Then back to telemedicine for safety. Especially among elder patients.”
• “It changes based on evolving state policy.”
• “Internet and video are not available, complicated and/or not smooth to use for most of our clients.”
• “I am very high risk and isolating at home. Telehealth has helped me stay in touch with patients. Patients who are savvy send me e-mail and I will return calls or set up a formal telehealth visit depending on the issue.”
• “Phone is due to poor internet connection or lack of internet, a patient with a trauma history where video is triggering and uncomfortable, or a patient with social anxiety that’s intensified by video.”
• “The only time we use phone is when there is a significant tech issue.”
• “Overall, patients seem much more engaged in Behavioral Health video visits. Somehow, they manage to be both more intimate but less anxiety provoking for patients.”
• “I have been using video since the beginning and it has been great for the patients and families; I have access to details, to family and history that I didn’t have in-person. Family has been more engaged. And is safe for patient, family and clinician.”
• “I try my best to have patients engage in video visits as I find that it offers more information (visual) and I am better able to remain engaged.”

Please share any criteria or strategies you use to determine when it’s best to have a phone vs. video vs. in-person visit:

• “Patient is able to track key health parameters required for assessment (e.g., blood pressure, weight) at home. 2) Patient has available technology (video preferred, phone is last resort) 3) Patient concern re: the safety of in-person visit during pandemic 4) Provider concern that in-person visit is needed to assess the patient. 5) Patient preference to have in-person visit.”
• “Chronic disease, anxiety/depression, rashes lend themselves to telehealth. Anything needing exam (e.g. abdominal pain, ear pain) needs in-person.”
• “Does the patient need vaccines or tests done? Does the patients need a physical exam that can’t be performed by telehealth? Does the patient want an in person visit? After initial assessment, do I feel an in person visit is needed for delivery of appropriate care?  If answer to any of the above is yes, then do an in person visit. If not, do virtual.”
• “GYN: If they would benefit from an exam or need a procedure, we are trying hard to capture their testing, radiology tests before an initial visit where we can better complete the consult. Follow up visits to assess success of treatments and many post op visits can be done by phone. OB: we are seeing patients almost as regularly but using televisits for many of the early visits and doing more in person visits at the end of pregnancy largely for blood pressure monitoring and monitoring of higher risk pregnancies.”
• “Hard of hearing needs in person; no BP or weight reading in someone over 40 or with Hypertension/Obesity needs in person; psych issues do well virtually.”
• “I look at phone visits for elderly non tech savvy patients who I need to have extended treatment plan discussions with. I look at video visits for issues like acne, initial rash evaluation, eczema or psoriasis initial visits. I prefer ‘seeing’ it in person but it depends on patient’s availability and preference.”
• “I want to offer video as first option. Younger people tend to do it.  Older patients seem to want to come in person.  Most people want to come in person for their “physical” even though I think it unnecessary.  It is mostly driven by patient preference.”
• “If the patient requests or I need to actually listen to lungs, heart, etc., I will see in person. Many of my patients are homeless, no phones which make in person visits mandatory.”
• “In person for things like looking in ears, pelvic exam needs. Pretty much everything else can be done via video.  It works especially well for behavioral health issues as patients feel secure in their own habitats talking via video.”
• “In person only for clients unable to access telemedicine effectively (one elderly client , 2 young children). In person occurs out of doors, with masks, with only one exception. That one client can not tolerate being out in the heat with a mask and is seen indoors at a 12 foot distance in the waiting room of our closed practice.”
• “In-person may be necessary in some crisis situations, but telehealth is working swimmingly. I highly recommend video in all cases where the client is capable of and has access to the technology.  You only glean so much about a client’s presentation, mental status, and so on during a phone call.  At least in a video you can have eyes on the client and can see body language as well as hear their voice.”
• “Looking at rashes via video or on My Chart is not the same as seeing and feeling the rash in the office in 80% of cases. In person is always best with children, as we cannot assess abdomens, hearts, lungs and most rashes via video.  Also, it is great for the children to get out of the home.”
• “No phone visits, since they don’t count in productivity. I would love to do more of these with my elderly patients as it worked well during initial COVID confinement.”
• “Office visit for unique clinical problems, language issues, reliability issues.”
• “Only if very high covid risk would I do video or if something simple like going over MRI.”
• “Patient choice with clinician’s input regarding safety and clinical need for visual and other in person information.”
• “Patients that need a lot of manual treatment should be seen in person is able. Patients that need more education and lifestyle modification can be seen via phone or video. Patients requiring exercise can be seen in person or video.”
• “Phone calls as a medium do not have sufficient data to do complex therapeutic work. Video does. In-person reserved for patients with an urgent/emergent problem who should not be referred to the ER.”
• “Phone is the default, in person for something that needs to be examined in person (ie neurologic exam, vaginal exam), video for rashes or patients who are motivated to figure it out!”
• “Phone when patient says eyes look normal to them but just has symptoms . Video when eye is red or other signs . In office when the need to use bio microscope or needs dilation due to flashes or new floaters or loss of vision.”
• “Scheduled lab follow up, no new issues, CPE for healthy person, mood/psych issue will try to conduct video visit. Problems that require more extensive examination (abdominal pain, significant MSK pain) or problems that may have dangerous etiologies (chest pain, dyspnea) not appropriate for phone.”
• “Straightforward post op patients can almost always be televisits (phone or video). I always prefer video unless the patient cannot do a video visit – then if appropriate I will do a phone visit.”
• “Technology available to my patients is the only reason I select phone over video – would always prefer video. In person most related to high complexity or need for in person physical exam.”
• “This is patient driven based on availability of smart phone, tablet, computer and ability to use technology.”
• “Video has been great for medication checks (adhd or anxiety/depression), or if kids are away at college and can’t come into the office.”
• “Video is preferable unless patient is technologically incapable (which is almost all geriatric patients).”
• “Video is very difficult for elderly patients. Video through Epic hard for everyone. Using Doximity or just face time when possible. Find the phone just as good as video and in some ways less distracting.”
• “Video visits for patients that have potential symptoms of COVID, inability to present to office due to medical frailty or transportation issues or for patients that experience extreme anxiety in being out in public settings during the pandemic.”
• “We do all visits as a televisit first, and use that to determine if a patient needs to be seen in person. If a patient needs medication teaching (e.g., insulin) or complex medication reconciliation that can’t be done via video, we do a one time clinic visit and then follow up via phone.”
• “We have a standard triage system across the system that uses a red, yellow, red approach to book appointment. Green – just book immediately for telemedicine. Yellow – ask more questions, can go either or. Red – definitely book face to face or send immediately to a nurse for triage.”