AMGA CMO Council: Telehealth Reporting and Staffing

AMGA COVID-19 Resources

Discussion Summary
April 12 2020

This summary is based on a discussion via AMGA’s Chief Medical Officer/Medical Director Council listserv as of April 12, 2020. For more information about the CMO Council, please click here.

Question: How are other groups reporting patient reported vitals­—specifically blood pressures—during a telehealth visit? MIPS 2020 specifies patient reported vitals are not acceptable as they must be performed by a clinician or a remote monitoring device such as an ambulatory blood pressure (BP) device that is downloadable. If we enter into the vitals of the visit as per the norm they are then used in reporting. Are you instructing your providers to not enter into the vitals but just reference it in the body of the note as a home reading?

  • Record it as "patient self-reported."
  • If you enter in vitals as "patient reported," it will still become part of your BP metric in Epic. CMS may announce a change to certain quality measures in regards to increased telehealth visits due to COVID-19.
  • Have physicians enter patient-reported blood pressures in the body of the notes and not in the vitals section when they are patient-reported and not able to count toward certain measures.
  • Reach out to NCQA to get it in writing that if a patient stores a blood pressure on a digital blood pressure machine (e.g., Omron or iPhone BP cuff) and shows the reading to the physician on the telehealth visit camera (not sharing verbally), that it does count for the HEDIS measure of Controlling Blood Pressure for the Medicare Advantage Stars Program. There are certain documentation requirements in the language of the chart note to ensure it is counted, but it can count under the "remote monitoring" clause.

Question: How are you handling requests from physicians to do telehealth from home only? We have some that are requesting this but are still considering coming to the office as an essential part of our work.

  • Encourage telehealth within the office. Only utilize home for an instance in which a provider is quarantined waiting on COVID testing and take on case-by-case basis.
  • Do the majority of your primary care and many specialty care visits virtually. Have the majority utilize video with a medical assistant doing a virtual check-in. Learn as you go, as fast as you can.
  • Rotate providers between home and the office, as there must be someone in the office to see patients. Reduce the number of providers in the office and, if necessary, combine office staff and close an office if that makes the most sense for any number of reasons.
  • Reserve home telemedicine for special circumstances only (high risk, quarantined). There is the need for seeing patients in the office when appropriate, as well as concerns around VPN being overloaded or unreliable if many people are accessing it from home.
  • Consolidate your ambulatory clinical locations and convert a significant amount to video (preferred) or phone visits. For video or phone visits, let providers work at home. Similarly, your MAs, LPNs, and front-office staff should also work at home if they have the technology as we try to adhere to social distancing.
  • Have at least one clinician in the office, some working from home in quarantine or cycling in/out of the office. Duplicate office workflow for virtual care—front-end representative checks in patient, who hands off to certified medical assistant (CMA), who does virtual rooming and then hands off to clinician for virtual visit.
  • Ask each site to determine the appropriate "rotation," starting with minimum clinicians necessary to handle in-person visits and office matters. Develop a clinician agreement regarding things like privacy rules (no Alexa on in the background), wearing business casual clothes, using the approved video platform, etc.
  • Use a rotational schedule, always having representatives from every department on site clinically in your non-respiratory location. High-risk providers preferentially stay home and work from there. Space people out, close down some buildings. MAs do pre-visit check-in before the visits. Some clinicians do telemedicine from work, while others from home—depends on whether the clinician has fast-speed internet, adequate hardware, etc. As you start to consider the recovery phase, you will be bringing more back to your clinics, but not all—do in segments. Set up all of your sites for semi-permanent physical distancing.