In Living Color: Extending Your Practice’s Reach Via Telehealth

The advent of smart phones has enabled patients to avoid lengthy travel and made languishing in waiting rooms a thing of the past as telehealth has become more and more common in endocrinology practices.

Telehealth can help manage the kind of chronic conditions, such as hypothyroidism or diabetes, that are considered hallmarks of endocrinology. Such visits help make education and ongoing medical care easier to administer.

Several recent studies have shown that telehealth is growing in the medical field as more practitioners are using technology to see their patients using Internet technology such as videoconferencing visits. Payers are reimbursing for such visits through CPT medical coding implemented in early 2019, which cover both physician-and-patient visits as well as physician-to-physician consults via the Internet, telephone, and/or electronic health record referral services.

In a July 2019 study of doctors’ interest in telemedicine published by physician medical network Doximity, more than 21,000 physicians said they were interested in telemedicine job opportunities; of 15 medical specialties, endocrinology ranked number 11 of specialties most engaged in such positions. A white paper published by nonprofit Fair Health in April 2019 that analyzed insurance claims found that the number of claims that were submitted using telehealth increased by 53% from 2016 to 2017 — a bigger jump than claims submitted via retail clinics, urgent care centers, ambulatory surgery centers, or emergency rooms.

Telehealth lends itself to endocrinology, says Nisha Jayani, MD, an endocrinologist with Paloma Health, an online medical practice focused on treating hypothyroidism in newly diagnosed patients as well as those who have lived with the condition for some time. “Technology helps us guide patients through their care so that they don’t have to be on top of it,” she says. “We exclusively see patients via online video calls, and we use technology to automate as much as we can, such as forms, intake questions, and reminders, so that we can offer the best experience possible without compromising care.”

How Endocrinologists Can Use Telehealth

For endocrine patients who see their physicians frequently for ongoing care, telehealth visits help them save commuting time and allow them to skip paying for parking and gas. For patients who live far from the doctor’s office, telehealth helps bridge a gap. “It allows us to reach patients, such as those who live in rural areas we wouldn’t normally be able to reach,” says Peter Alperin, vice president at Doximity.

It’s a two-way street, as telehealth also extends endocrinologists’ reach, Jayani says. “There is a huge shortage of endocrinologists in the U.S., especially in some rural areas, and using telehealth is an amazing way to improve access to care,” she says.

“If you can find a place for telehealth in your practice, it can be very satisfying,” he says. “You can do a tremendous amount of good to be able to reach populations that otherwise wouldn’t have access.” – Peter Alperin, vice president, Doximity, San Francisco, Calif.

Endocrinologists who see patients through telehealth can provide specialist care to patients who may otherwise have been followed by their primary care physicians for diabetes or thyroid conditions. The lack of travel time can help make the visit more productive, Alperin says.

Using telehealth for people with diabetes, endocrinologists “can check a patient’s feet, do a visual physical exam, and spend a good amount of educational time with a patient to discuss what the patient needs to do to maintain their care,” Alperin says. “The physician can also go over lab values, which don’t necessarily need to be done in person.”

For patients with hypothyroidism who don’t want to or cannot be seen in person, “there is still much that can be done with a live video visit,” Jayani says. “We can see the thyroid, have the patient do a thyroid check and swallow to see any protrusions, get a reading of symptoms, see the patient’s constitution, and talk to the patient with a comprehensive history.”

According to Jayani, her patients say that telehealth’s convenience allows them to speak with the doctor without forgetting details. “Patients have remarked that when they’re not in the exam room in a gown, they are more relaxed,” she says. “They are more likely to remember all their questions.” They also aren’t wasting time in waiting rooms or filling out paperwork during the visit. “The online intake questionnaire patients fill out before a consultation helps us to do a better job without wasting time during the visit,” she adds.

Saving time is a bonus for patients, too. “They don’t have to take as much time away from work for visits or waste time sitting in waiting rooms,” Jayani says.

Besides collecting details like a patient’s preferred pharmacy ahead of time, Paloma Health’s online intake “asks patients more than 40 questions on hypothyroidism, with logical steps between them,” she says. “Someone diagnosed with Hashimoto’s does not answer the same question as someone with congenital hypothyroidism. It really helps us offer a personalized approach and makes sure that, as doctors, we have the information we need to treat patients efficiently.”

Handling Telehealth’s Challenges

Technology always comes with its own learning curves and telehealth is no exception. “Patients and doctors have to make sure they have the proper tech set up,” Alperin says. Learning how to work it properly also takes time. But, he says, “I think today, most patients and doctors are very comfortable with conducting video calls.”

Jayani agreed. “The upside is that once you get it right, you still need to make some adjustments here and there, but most of it will work for quite some time,” she says.

Alperin adds that seeing a doctor through a video visit could make it more challenging to develop a patient/doctor rapport. “There’s something very human and trust-building about seeing someone in person, and developing that trust means people are more willing to follow the advice you give them, and what they are willing to tell you,” he says. “It’s very possible to do that in telehealth, but it might take a little longer.”

“There is a huge shortage of endocrinologists in the U.S., especially in some rural areas, and using telehealth is an amazing way to improve access to care.” – Nisha Jayani, MD, endocrinologist, Paloma Health, Gardena, Calif.

Telehealth visits aren’t for every patient. It’s important to use clinical judgement in cases where patients should be directed to in-person care, Jayani says. “At Paloma, we have a treatment protocol that excludes patients from our care if we believe they would be better treated with regular traditional visits, such as, for example, patients with a history of thyroid cancer or those with COPD and a history of recent MIs.”

Making Telehealth Work

Jayani suggested physicians who want to implement telehealth learn all they can about the technology as well as whatever specific training is recommended for the visits. “Technology should improve patient experience, not the contrary,” she says. “Make sure that you are at least a bit tech savvy; otherwise, you and your patients will not enjoy the experience. Also, train yourself with mock consultations before your first consultation.”

Making the experience a positive one can go a long way toward reaching more patients, Alperin says. “If you can find a place for telehealth in your practice, it can be very satisfying,” he says. “You can do a tremendous amount of good to be able to reach populations that otherwise wouldn’t have access.”Jayani says that physicians are likely to benefit as well.

“Telehealth is the future of medicine and we should embrace it and work with other constituents in the healthcare system to support this level of care,” she says. “We are doctors, but we are first and foremost humans. I see so many of my friends working from home with all the benefits of being close to their families. Why should we not enjoy this as doctors?”

— Alkon is a Massachusetts-based freelance writer who is the author of the book, Balancing Pregnancy with Pre-Existing Diabetes: Healthy Mom, Healthy Baby. She wrote about planning for medical leave in the June issue.

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