On March 20, Dr. Anna Loengard, Chief Medical Officer of Caravan Health hosted a video webinar and addressed the impact of COVID-19 on primary care including planning, prevention, patient management, and virtual care options.

The novel coronavirus has been spreading through the country more rapidly each day. We are holding this series of webinars to help support providers that are facing the crisis now and help others who will certainly be seeing it soon to plan and prepare.

Dr. Loengard discussed the importance of keeping healthy patients out of the acute care environment as much as possible. Providers not yet inundated with COVID-19 patients should first develop processes and procedures to triage, test and treat/support acutely ill patients when this disease enters the community. As more states and communities move to “shelter in place” orders, to the extent that staff is available, reaching out to their patient base to make sure they will have access to food and medications in case they become ill with COVID-19. The Caravan Health COVID-19 Resource Page is our curated informational site. We are continuously updating to share information and best practices for all levels of health care providers and systems.

Planning for the future is critically important as we don’t know when the COVID-19 pandemic will run its course. Tracking chronically ill patients can help avoid a “second tsunami” of patients who were overlooked as the crisis first hit. One imperative is to stand up virtual care to reduce exposure for both health care workers and elderly and vulnerable patients. As the virtual medicine options are implemented, practices may consider rotating physicians and other clinical staff from in-person to telehealth.

The audience raised several important questions which are summarized here:


Can Annual Wellness Visits be done via telemedicine – how can we do BMI and BP measurements?
Technically, yes, AWV is an allowable service. However, these measurements would have to be patient reported, which requires the patient to have specialized equipment. In this unprecedented health emergency, we urge all health practices to note the practical limitations of offering population health services and focus on keeping otherwise healthy patients out of the office.
Can transitional care management be done with an e-visit?
Yes, TCM can be billed under telehealth.
Should our practice focus on annual wellness visits right now?
While Caravan usually stresses the importance of the AWV, we want you to put your patients and your staff first at this trying time. If you have the staff to continue annual wellness visits, this could uncover needs and could generate more resources for you. Right now, this is a question of weighing the risks and benefits. We are actively looking at our annual wellness visit and remediation requirements so that we are all responding in the most responsible way. Our first concern is for you, your patients, and your staff.
Can we do telehealth visits with audio only?
The telehealth rules require a real-time audio and visual connection.  CMS has announced there will be no auditing for HIPAA compliance during this public health emergency. That means telehealth visits could take place via a smartphone with video using Facetime or Whatsapp. We recommend that, in your long-term planning, you find a HIPAA-compliant technology for patient safety and care.
A different virtual option is the shorter virtual check- in, which can be audio only. Remember that a virtual check-in can’t be within seven days of an E&M visit and can’t result in an E&M visit within the next 24-48 hours.

Can Licensed Clinical Social Workers bill for telehealth?
Any provider who can normally bill Medicare can bill for Medicare telehealth, as long as it is a service that is allowable via telehealth. The telehealth code is essentially a place of service that denotes that the provider and patient are in different locations. We expect there to be patients who will need a lot of support and counseling as chronic disease and social distancing create a second wave of patients and LCSWs may be able to provide much needed services.  
The list of services that may be provided via telehealth can be found here. LCSWs can also bill Digital Assessments.

Can an LPN do telemedicine like and RN and MA?
LPNs, RNs, and MAs could support telehealth services in the same way they support a patient in an ambulatory setting. This is allowable since there are the same standards and the same services. The coding is the same, the only difference is the place of service. (Update from webinar: When performing AWVs using telehealth, it is advisable to have the provider review the Personalized Prevention Plan with the patient before closing the visit.)
Could we contract with home health agencies to do a non-traditional visit, not for home health services, but to aid patients who don’t have access to technology for a telehealth visit?
This is an idea worth exploring as we look into opportunities for expanded capacities, especially in those rural areas with less access to technology and fewer health professionals. This could be a great way to partner with your home health providers. Some people in our network have been sourcing solutions for this.
Will Caravan offer a webinar on behavioral health telehealth especially as it involves a lack of broadband and a lack of patient technology?

We will be talking about telehealth in much greater detail in the webinar titled COVID-19: The Telehealth Imperative. Behavioral health through telehealth could expand your capacity. Whether that’s through the collaborative care model or through telepsych or e-consults, there are a lot of different ways to solve those issues.
 Is the virtual check-in done through an EHR patient portal?
The virtual check-in, a shorter service than a full telehealth visit, can be conducted by telephone. A digital E/M – for example, an established patient with a relatively minor condition, like a UTI or other condition, contacts you through the patient portal, or a secure messaging application. There could be multiple messages and that time would all count for the digital E/M visit.

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