The Role of Telehealth in Value-Based Care

By Karen Youmans, MPA, RHIA, CCS, President and CEO, YES HIM Consulting
Twitter: @YesHIMconsult

Healthcare providers can receive incentive payments through value-based programs based on the quality of care provided to Medicare patients. Value-based programs move payments to providers based on quality rather than quantity. The Centers for Medicare & Medicaid Services (CMS) list their value-based programs to support a three-part goal: “Better care for individuals, better health for populations, and lower cost.”

Understanding Telehealth in Value-Based Care

Telehealth provides healthcare without an in-person visit by utilizing technology (HHS, 2023). Patients can talk to their provider over the phone, via video chat, or through secure messaging. Telehealth can also involve remote monitoring of the patient’s vital signs, such as blood pressure and heart rate, via devices worn by the patient. Then the technology sends the results to their provider.

Healthcare equity is defined as the opportunity for everyone to receive healthcare regardless of social or economic status. Underserved communities include, for example, patients with low income, patients who live in rural areas, older patients, and patients with disabilities. Underserved communities often lack equal access to healthcare, which can lead to higher mortality rates, higher rates of disease, increased illness severity, higher medical costs, and other consequences.

Telehealth opens the door for improved medical care for these underserved communities. For example, telehealth can provide healthcare visit options for patients located in remote locations and allow physicians to receive consultative advice from a specialist at a distant site as technologies securely share medical information. Telehealth can provide remote patient monitoring of vital signs and chronic diseases such as diabetic blood glucose readings.

Some of the benefits of telehealth include:

• Improved access to care, especially for patients in rural or underserved areas.
• Reduced healthcare costs through decreased hospital readmissions, fewer emergency room visits, and increased patient self-management.
• Enhanced patient engagement and satisfaction through increased convenience and flexibility.
• Increased convenience and greater flexibility for patients who may not have transportation, can’t take off time from work, or can’t leave home due to caregiving responsibilities or disabilities.

Overcoming Barriers to Telehealth Adoption in Value-Based Care

There are still some barriers to overcome in terms of fully adopting telehealth into the value-based care model. Those barriers to telehealth access include:

• Lack of technology (i.e., smartphone or computer access)
• Lack of sufficient internet access
• Lack of private space to participate in virtual visits
• Language barriers.

There are various programs/plans to help overcome technological barriers, such as using devices in schools or libraries that offer free access while ensuring secure connectivity. Additionally, healthcare providers have business partnerships with grocery stores or pharmacy chains for free access to devices and internet with secure connectivity within a private area.

Overcoming the language barriers can be accomplished by utilizing images and words within the online communication platform, developing materials in various formats and multiple languages, and including screen readers or closed captioning options.

It is crucial to outline the telehealth workflow as it drastically changes from the in-person healthcare delivery workflow. The impacted processes include scheduling, billing, check-in, triage, consent, and documentation. Staff education and training are essential as roles may be altered when technology dramatically increases.

Examining the technology platform is imperative for the implementation and success of a telehealth program. Providers need to review the online scheduling process, troubleshoot instructions for technology problems, look at the integration with their Electronic Health Records, provide signatures on legal consent forms, as well as offer adequate documentation during and after the telehealth visit.

The Role of Medical Coding and Auditing in Telehealth Value-Based Care

Accurate medical coding and auditing are essential within a telehealth value-based care model. Medicare added over 100 CPT/HCPCS codes for the duration of the COVID-19 public health emergency (PHE). Telehealth visits billed to Medicare are paid at the same Medicare Fee-for-Service rate as an in-person visit during the COVID-19 PHE.

The Administration plans to end the COVID-19 PHE on May 11, 2023. However, recent legislation authorized an extension of many of the policies outlined in the COVID-19 PHE through December 31, 2024.

For example, patients enrolled in Medicare can be granted telehealth services as approved in the 2023 Medicare Physician Fee Schedule, which can be accessed from the comfort of their own homes. Non-behavioral telehealth services can be provided from any location without any geographical limitations. And some non-behavioral telehealth services can be delivered using audio-only communication platforms.

The Medicare Telehealth Services List has been updated and simplified by CMS to make it clear that telehealth services will continue to be available until the end of 2023. CMS plans to address any further updates to the list for CY 2024 and beyond through established processes within the 2024 Physician Fee Schedule proposed and final rules.

Conclusion: Next Steps

In conclusion, telehealth is becoming increasingly important in the value-based care model as it offers numerous benefits, such as improved access to care, reduced healthcare costs, enhanced patient engagement and satisfaction, and greater patient convenience and flexibility.

Medical coding, auditing, education, and consulting play a crucial role in successfully implementing telehealth in value-based care by ensuring accurate coding, identifying compliance issues, providing education and training, and optimizing the telehealth workflow. Overall, telehealth has the potential to significantly improve healthcare delivery, especially for underserved communities, and is an important tool in achieving the goal of better care for individuals, better health for populations, and lower cost.