Webinar #13- Video & Collateral- Business Impact of COVID19

Link to slide deck: COVID Webinar_13.pdf (2.6 MB)

Can we get a PDF of the responsibility matrix?

Below are two sample Responsibility Matrix that practices can add their own list of items, etc. The purpose of these forms is for style and not content. Feel free to download either option and customize it for your own needs.

PMI_Responsibility_Matrix_Sample.pdf (165.6 KB)

PMI_Responsibility_Matrix_Sample.xls (137.5 KB)

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As promised, here are answers to questions posed in the chat during the webinar on July 2:

From Ruth Sakakeeny To All Panelists : How or when do you bring the sick visits into the office?? Later that day, block visit/hold spots for sick visits that need to be seen??

I believe this question was posed when I was talking about our Telemedicine as a Triage Tool strategy and our mantra of “Every Sick Visit starts as a Telemedicine Visit”

@rsakakeeny, this is definitely something that we have been tweaking and I am sure will continue to evolve. Right now, we have the afternoon blocked for the “Sick” provider, as well as appointment slots blocked in the morning for telemedicine triage for that same provider and most days a second provider, as well, who is mostly telemedicine and some onsite overflow for the Well office provider.

With the mantra, “Every sick visit starts as a telemedicine visit” we do this for a couple of reasons- 1) to potentially keep the patient at home, 2)to determine whether they will be scheduled at the “Well” or the Sick office, and 3) to lessen the amount of time spent in the office for the onsite portion of the visit.

During the initial telemedicine visit, if the provider determines that the patient needs to come in, the provider then has a couple of decisions to make- Well office or Sick office (we have two sites that feed into the Sick Office (formerly known as the waiting room in our (physically) larger office), today or tomorrow, and if going to the Sick office, we try to bring less-COVID-like symptoms in first before COVID-like symptoms.

The provider tells the patient which office and possibly a time- otherwise tells the patient to expect a call from us to confirm a time. We keep the telemedicine visit open so that the onsite portion can be documented in the same visit, and we then schedule a 30 minute slot using a “dummy” patient we named “Misc, P” with the name of the real patient in the appointment note. The reason for the 30 minutes is that the logistics involved to safely see the patient means that the visit just take more time.

For 2 offices that funnel into the Sick Office, we have never seen more than 5 patients in the afternoon. Granted, it’s summertime and there is very little contact between children that would generate more sick visits.

As promised, here are answers to questions posed in the chat during the webinar on July 2:

From Laurel Mehler : Misha- how do you handle (or do you not have) patients who are not very tech savvy or equipped? i’m challenged by that aspect as I try to do as much remotely as possible.

@lmehler Great question! Pre-COVID, frustration with technical problems was one of the biggest obstacles to our attempts to implement telemedicine in our practice. We had a lot of pushback from providers and staff internally and from patients externally. I think that frustration is lessening as people become more familiar with video/telephone visits and become more willing to troubleshoot their way into a visit.

And at the risk of sounding Pollyanna-ish, sometimes, just deciding that this is the approach and it’s going to work is half the battle. My 75-year old dad (who is still using paper charts, btw) has been using telemedicine since mid-March with patients who are often older than him, and so I do say if he can make it work, anyone can!

When faced with a patient who is not tech savvy and is having problems, the number one key to success we have found is remaining calm and treating the situation like it is very normal and no big deal. We don’t let a parent get too frustrated, so if the troubleshooting seems like it is not going well, sometimes, the easiest thing to do is pick up the phone and talk to the parent/patient since getting them the care they need is more important than them fitting into your workflow.

We have found that it is important to work with the staff so that they have strategies and feel comfortable guiding a parent through their connectivity problems. We have someone on our team who enjoys this stuff and has been a champion for figuring our standard obstacles and letting the rest of us know how to fix them.

For tech challenged- maybe they have poor internet connection or they are out in the country, in which case, we hop on the phone. You cannot do everything by phone, but it’s a start.

I have seen some threads other places where practices make devices available to patients or hand the patient a device to use from the parking lot.

Thanks, Misha.

As promised, here are answers to questions posed in the chat during the webinar on July 2:

From Staci Young To All Panelists : Agree Eliza! I love telemed for behavior visits. How do we convince the insurance companies to continue to pay?

@staciyoungmd The AAP has a great advocacy roadmap and PMI has posted some really great advice on media outreach.

@SKB has pointed me in the right direction before reminding me that each state AAP chpater has a Pediatric Council, which is a group that advocates for payment issues on our behalf:
from @SKB: “Pediatric Councils are the folks in MIAAP who have volunteered to be your state’s liaisons with payers around pediatric issues. https://www.aap.org/en-us/professional-resources/practice-transformation/getting-paid/Pages/aap-pediatric-councils.aspx

And @skressly also gave me great advice on this topic pointing me to specific advocacy resources at the AAP, including these:

AAP letter to payers advocating for continued telemedicine/telehealth coverage beyond COVID-19 public health emergency
AAP Press Release calling on all insurance companies not to cut off payments for telehealth during COVID-19 pandemic

As @skressly said, “These can be shared and used by anyone for advocacy.”

She also advised reaching out and educating your families, parent groups, and big employers in your community who may not even understand the telehealth coverage they selected for their employees.

Webinar #6 #business-impact-webinar-series has great advice on advocacy

In short (too late, ha!), we need to educate the public (patients and employers), advocate for legislative/regulatory reform, and advocate with payers directly. Easy, peasy :slight_smile:

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As promised, here are answers to questions posed in the chat during the webinar on July 2:

From wayne siegel : For Misha, who do you have do the telemedicine visit? All providers? If many calls come in at once do nurses start them?

@wgsieg54 we have changed our provider schedules so that providers are either all Well Visits or all Telemedicine or Sick and we have scheduling rules for each. Each day there are 1-2 Well Visit Providers who we load up with Well Visits. There is one Sick Provider who sees telemedicine in the morning (as a same day sick triage tool) and onsite sick in the afternoon (based on patients who started with a telemedicine visit). There is 1-2 Telemedicine providers and at least one of them is onsite to absorb overflow because we are booking the Well Visit provider so tightly- we used to hold Well Visit slots for new babies and new baby follow ups, but have shifted that expectation to the onsite telemedicine provider.

Right now, we are starting everything as a telemedicine visit. We are advising that if a nurse speaks to patient (which we are trying to avoid) that the RN documents as a billable telephone call (and not as a patient case as we previously did). This is something we are working through now as we have gotten busier.

We block a lot of slots for same day and this seems to be working- for the past 3 weeks we have been back to baseline volume and even a little bit higher.

The biggest thing this has helped are those end of the day phone calls waiting for the provider.

As promised, here are answers to questions posed in the chat during the webinar on July 2:

From SHARON MCFAYDEN-EYO : How do you handle the prescription refils for ADDH with TM visits w/o EMR?

@sharonamcfayden, sorry, I am not sure if I understand your question… for telemedicine we use a combination of doxy.me and and an integrated platform that our EMR is piloting. The provider has the patient’s chart open during the visit and documents the encounter in the same way they do when the patient is in the office. Prescriptions are then created in the EMR and sent electronically to the pharmacy.

Let me know if that answers your question!

THANK YOU for doing all this great followup work, @mishamoore.

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@Paulie This responsibility matrix is beyond great, thank you. Would you consider a short webinar in which you walk through this grid and share your thoughts on the different items- why they are on there and what is key about them? I would volunteer to be the “student” to your “Socrates” :blush: :innocent: :laughing:

Normally the Responsibility Matrix is provided as a guide for each practice to document who’s responsible for each duty within the practice. I’ve seen some with over 200+ items listed to designate who responsible for each item, etc.

The utility of the sheet relies on self-reflection of the practice to list everything that needs to be done to keep the practice going. Happy to set up a Zoom meeting for those who want. Maybe sometime next week?

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Yes, let’s make it happen!