Telemedicine is Here to Stay

Mitchell Fong is the Director of Telehealth at Renown Health, a multi-hospital system that is locally governed and locally owned. Renown is a not-for-profit integrated healthcare network serving northern Nevada, Lake Tahoe and northeast California and was an early adopter of telehealth in 2012.

Mitchell Fong and Ray Barrett of Telehealth Certification Institute discuss what goes into a telehealth program, the impact COVID-19 has had on the necessity and delivery of remote services, the increase in utilization of telemedicine for both provider and patient, the challenges of pushing through change to improve access to healthcare for all, and the fact that telemedicine is here to stay.

Fong has been in the field of healthcare for over a decade. He holds a degree in molecular biology, a masters of Public Health with a focus in epidemiology, and an MBA. He helps create the strategic plans for population health vision and is dedicated to improving healthcare in a community and getting services to those who really need it. Fong says that telehealth is essentially a startup of healthcare, looking to validate what you can do and how you can drive change. Being persistent is a key element for those innovators and ultimately for those in the industry. 

Nevada is the 7th largest state, yet is ranked 47th with regard to access to care. This is primarily due to Nevada having counties designated as frontier, which is more remote than rural and they have no access to specialists. Fong knows of patients who have driven over 2 hours during a snowstorm to attend a 20 minute follow up cardiac consult. There is a broad area in need in healthcare where telemedicine could be impactful and prove to be more efficient, easier and safer for the patient.

With COVID-19, we are facing a move to value and drive preventive medicine visits. For example even in urban settings, parents can’t take their kids as easily to the doctors office. The challenges we face when increasing the perceived value and the utilization of telemedicine include:

  • stigma
  • adoption
  • access to technology
  • learning curves
  • reimbursement and licensure parity
  • short-term solutions converting to long-term goals
  • modelling use of technology

The greatest challenge to overcome is the stigma that healthcare through a camera won’t provide the same quality of care as an in-person visit. We have to address this stigma from both aspects: the clinicians’ end and the patients’ end. More often than not, the care needed can be addressed through a virtual visit, and the necessity of this modality due to COVID-19 has proven to be quite successful.

Having the peripheral tools on the patients’ end (such as bluetooth stethoscopes, otoscopes, etc) makes a virtual visit just as impactful and as comparable as an in-person visit. We can also enhance the ability for asynchronous telemedicine. For example, patients can send pictures to a dermatologist, who can then use their “down time” (perhaps from no-shows or cancellations) to review the material and provide asynchronous care.

Barriers include reimbursement, state licensure and all of the policies that are restrictive of telemedicine and prevent parity. There are a lot of positive moves to address these as a result of COVID-19. Ultimately what we need to have is parity between telemedicine and in-office visits from both the service coverage and reimbursement standpoint. Once that is established, the access to care will be a challenge for health care providers, but it can be worked out if reimbursement is in place.

COVID-19 necessitated a lot of quick program launches for many organizations. You need to reevaluate what was done for the short term to make sure it meets your program’s long term sustainability goals. Making sure you have the right quality, the right vision and the right backbone to set yourself up for sustainability and expansion.

 

The process of being a telehealth coordinator requires persistence, transparency, to be a good collaborator, and a good model for what you want your product to be. If that means meeting via video, then encourage everybody to jump on video meetings. This has been new and a challenge for some, but we need to start encouraging the fact that video is now a part of healthcare - it’s no different than face-to-face.

A telehealth program requires teamwork and collaboration. Ask yourselves, “What is the value you want to deliver to the patient?” Change is not easy, so the program has to push through and make these changes and deliver value to the patient.  Be responsive and adaptive when tracking metrics - start with a clear baseline and make sure what you are doing impacts the key metrics. There will be a learning curve but the provider “buy-in” is extremely important. A program needs physician champions – this is ultimately what is going to be the drive to success.

Renown Health is currently working on “webside manner”: providers become more comfortable if they get the right training and understand why telehealth is so impactful on the other end. Delivering that training, making your care team feel supported to use technology while making sure you all have shared goals and vision, that’s the key to delivering the outcome you want.

The conversion rate of in-office visits to telehealth visits is a metric being followed closely. Defining the percentage of success for providers who are willing to see new patients via telehealth and then refining the algorithm to improve efficiency (improving no-shows and cancellation rates) and for identifying patients who are appropriate for telemedicine, and those who are not a good fit for remote services.

 

Adoption, access, parity, screening for fit, and modelling technology - all prove to be both the challenges and the key to drive successful telehealth care programs.

Mitchell Fong advises us all to keep pushing forward: Telemedicine is here to stay.


You can find more information about the Virtual Visits program at Renown Health here and detail on a telehealth grant they recently received.

2 comments

  • Comment Link Beth Vanbeek Thursday, 27 August 2020 08:04 posted by Beth Vanbeek

    Burton T,
    Thank you for your comment! We are very happy to hear that you enjoyed the presentation and found it to be informative!

  • Comment Link Burton T Wednesday, 26 August 2020 17:50 posted by Burton T

    Fantastic presentation! Well spoken, and highly informative. Thank you for providing this content.

Leave a comment

Make sure you enter all the required information, indicated by an asterisk (*). HTML code is not allowed.

Vey helpful and user friendly. Most importantly informative. Very good information to enhance an individual's practice.
La Keicia Boyd
Licensed Professional Counselor / Private Practice
I really gained a deeper understanding of Telehealth. I think this course helps pave the way for success in our field. This was very convenient. I am so blessed to take a course like this during the crisis we are facing as a nation. This course really helps me perform at a high level for my job. THANKS!!!!!!!
Jackie Tanna
Therapist / Region One Mental Health
This course was very informative and very relevant to today's telehealth practices!
Keith Ayson
Housing Case Manager / Bridgeways
The course was so informative and I was glued to my screen for the entire duration. I received so much knowledge concerning ethics in telehealth and I am greatly encouraged to read about all the standards and policies that pertain to my practice. Thank you!
Bridgette Nalumu
Public health consultant / Green and Purple Consultancy Network
Easily one of the best online or in-person workshops I have ever attended. The information was unbelievably relevant to current practice with our students doing e-learning and having to provide online therapy and support. Thank you so much for this workshop and the information.
Vincent Amador
School Psychologist / Thornridge High School
This was quite beneficial. You explained well at a comfortable pace and you provided sufficient details for me to develop an Emergency Management Plan. Thank you!
Dr. STEPHEN KIURI GITONGA
This course was extremely helpful understanding the legal requirements for interstate telehealth counseling.
Donald Kirk Henderson
Licensed Professional Counselor / Milestone Family Resources
Very informative! Well organized! Takeaway- protect yourself- know your ethical code and standards/ be insured.
Brenda Staerker
Private practice / Thaxton Holistic Wellness
This course was very interesting and allowing me to understand the way telementalhealth services need to work correctly.
Patricia A Hill
Mental Health Counselor II and LCDC, MAC / Central County Services
Very well done. Encourages active engagement in telemental health process while guiding effectively.
Chris Brotherton
Marriage and Family Therapist / Addiction Counselor / Brotherton Counseling LLC
I learned a lot in this course and will put what I learned into practice when I move my home office space.
Raymond Corbo
Clinical Supervisor and Counselor / Redeemer Counseling Services
The training was very informative, there was more in-depth information to the details of privacy and HIPAA on an electronic level that I was not aware of. The more technological part of it was new information to me.
Nellie Decker
Therapist II / Yakama Nation Behavioral Health
This course is providing me with valuable information that will be helpful in providing competent and effective services for clients.
Nancy Sweet-Holp, LMSW
Therapist / Liberty House of Albany
I took the Board Certified-TeleMental Health Provider Training Certification Course in 2018, I feel so lucky to have found the TeleHealth Certification Institute. It's a top notch training center which has continued to provide me with tools and the knowledge to grow my private teletherapy practice. I recently participated in the TeleMental Health Preparedness Summit 2020 and was definitely not disappointed. The excitement and enthusiasm from the participants and TeleHealth Certification Institute staff is contagious. I've been inspired, since, to look into taking more courses, and joined their FaceBook group. I will likely join their consultation group in the near future. I don't believe there is another training institute out there that is as good as this one for everything telebehavioral health. Thank you Ray! You are a visionary!
Larissa Golloub, LCSW-R
Psychotherapist, solo practitioner / Larissa Golloub, LCSW
Courses were very informative! Extremely helpful!
Carron D. Alexander
LPC / Premier Counseling Services
It was one of the best courses I’ve attended; clear, well-structured, creative, transparent and professional! Bravo.
Elizabeth Tramonte, PsyD
Private Practitioner / Elizabeth Tramonte PC
Brillant concept and a great way to support counselors as they transition into on-line therapy/services.
Bianca Abrams
License Professional Counselor / The Wellness Institute of Atlanta
Necessary technological guidance!
Frances D Murdock
Educational and informative content that was easy to follow and comprehend.
Scott Lipp, Ph.D., LMHC, LAC, NCC
Licensed Mental Health Counselor; Adjunct Professor / Greater Things, LLC; Florida Atlantic University
Amazing and relevant information conveyed over excellent format. This is a professional organization worth joining.
Summer Allan Wilson LCSW-S; Nationally Certified TFCBT
Pediatric Psychotherapist / East Texas Family Guidance Center
Thank you for an informational, relevant course to help me obtain my TMH certificate. Excellent presentation.
Tomica Horton
counselor/therapist / Jodi Province Counseling Services
Great, course. Really helped me during this challenging time to connect with students.
Priscilla Robinson
School Counselor / Baltimore County Public Schools
Wonderful free training. Helpful discussion on how to aid clients in breaking out of the negative thought trap.
Jaime Wright
This course was eye opening and highlighted some definite areas for improvement to better address emergency management planning.
Nikkita Scott
Director of Counselling & Student Activities / Bbermuda College
This course is more comprehensive than all the other HIPAA courses I've taken combined.
Michelle R. Gould, LMHC
Mental Health Counselor

The course was very detailed and informative. It covered everything that is necessary to work with Tele mental health.

Cynthia Allison
Mental health Counselor / Friendly Therapy LLC
Very informative training, instruction was clear and easy to follow
Jill Bogan-El
Therapist
Very informative. I learned things that I wasn't aware of about state laws!
Tamara Coleman
Counselor / Tamara Coleman Counseling LLC
The training was well structured and presented by a knowledge individual. Information shared in the training was useful, clear, and concise and can easily be incorporated into future practice techniques.
Dora Falls
LPC, MAC Private Practice - / Private Practice