AMGA CMO Council: Staffing Telehealth Visits from Home

AMGA COVID-19 Resources

Discussion Summary
April 15, 2020

This summary is based on a discussion via AMGA’s Chief Medical Officer/Medical Director Council listserv as of April 15, 2020. For more information about the CMO Council, please click here.

Question: How are you handling requests from physicians to do telehealth from home only?

Practices are seeing fewer patients in person and are rapidly converting, on a “learn as we go” basis, to video (preferred) or phone visits with patients. Providers doing virtual or phone visits can usually work from home. More often, practices are doing primary care and specialty visits virtually. Practices are rotating telehealth from home to minimize the number of people in the office and adhere to social distancing guidelines. As they consider the recovery phase, most offices plan to bring more clinicians back into the clinic in segments. Offices are managing telework from home with on-site practice in the following ways:

  • Medical assistants (MAs), LPNs, and front-office staff may also work from home and do a virtual check-in
  • Duplicating office workflow for virtual care visits (see workflow below)
  • Keeping at least one clinician in the office while others are cycling in/out from home
  • Creating rotation schedules so representatives from every department are available on-site, with rotations based on the minimum clinicians needed to handle in-person visits and office matters
  • Combining office staff (closing/consolidating offices) to ensure enough clinicians are available to see patients at the office as needed
  • Developing clinician agreements for telework (e.g., privacy rules, dress code, approved video platforms)

Sample Telehealth Workflow

Virtual visits

  • RN, LPN, or CMA does virtual “rooming,” checking patient in and completing work-up for virtual visit prior to the appointment
  • Front-end staff virtually communicates/informs provider when patient is ready for the virtual visit
  • Provider monitors communications so they know when the patient is ready and sends a link to patient via email or phone when it is time to start virtual visit
  • Physician documents virtual visit in appropriate notes/software

Phone visits

  • Provider makes every effort to complete a telehealth [video] visit
  • When video is not possible, visit may be converted to a telephone visit
  • Provider makes the call and documents the visit
  • If patient is CCM eligible, provider records the minutes they spend with patient
  • Provider enters an order if patient needs to be scheduled for follow-up

Criteria for Telehealth Staffing

  • High-risk providers are given preference to stay at home and work
  • Work hours are the same as in clinic
  • Must be available, accessible, with the same level of support
  • Must respond promptly to communications (Jabber, voicemail, emails, etc.) during work hours
  • Must demonstrate self-discipline and self-motivation
  • Must demonstrate organization and time-management skills
  • Must maintain a professional work ethic
  • Must demonstrate working knowledge of hardware/software programs
  • Must maintain HIPPA compliance/patient confidentiality
    • Patient information in paper form must be shredded
    • Others at home cannot hear/see the virtual visit
  • High-speed DSL internet access/cable modem

More Responsibility for Clinicians
Practices are staying afloat by consolidating ambulatory clinic locations and, in the worse cases, furloughing staff. This may mean there is no staff "running the clinic from the office in real time," as providers are working from home. As a result, providers are being required to:

  • Start notes (in the patient record) and function without nursing support
  • Ask and enter screening information (e.g., PHQ-9, Asthma Action Plans, etc.) that are typically done by nursing or other staff

Clinicians Not Working from Home
Some clinicians and practices feel the need to see patients in the office and consider coming into the office an essential part of their work. In these practices, only a few clinicians may be working from home. Although telehealth from home is an option, it is reserved for special circumstances such as high-risk or quarantined individuals waiting on COVID testing. But even these offices are encouraging telehealth appointments to patients from the office. A lot depends too upon whether staff have access to high-speed internet, adequate hardware, etc. Clinicians who live in rural areas, where the internet is not as well-supported, are more likely to be working on-site.

Concerns about Telehealth from Home

  • Overloading/destabilizing the virtual private network (VPN) if too many people access it from home
  • Maintaining quality control
  • Availability of staff when needed in the office
  • Maintaining patient privacy