April, 2020

HOD and HB-amb Virtual Health Services During Coronavirus COVID-19 Crisis

In order to serve our communities and facilitate access to care during this time, Advocate Aurora Health, Inc. (AAH) is expanding the use of telehealth and telephonic care available

to AAH employed providers. This will allow AAH employed providers to treat patients with COVID-19 symptoms, patients with confirmed COVID-19 diagnoses, and patients with other

conditions if it is in furtherance of AAH’s goal to minimize potential exposure and/or transmission of COVID-19.

Therefore, expanded use of telehealth and telephonic care is available to AAH employed providers until further notice.

The CMS granted a federal waiver of licensure requirements. We are optimistic that, in light of the federal

waiver of licensure requirements, states will follow suit. In the interest of patient care we are allowing our physicians and other health care providers to practice across state lines during this

emergency (but it is not mandatory). Additionally, even if states were not to follow suit, we believe the current emergency under

which providers are operating would enable us to provide a focused and vigorous defense against any licensure-related issues. AAH will be staunch and vigilant in standing behind

those providers who step in to help with this crisis.

What is Virtual Health?➢ Virtual services are defined by the delivery of healthcare services, which includes:

➢ Video Visits – A visit between a clinician and patient that uses telecommunication systems via video, synchronous, or asynchronous. Can be quick-care or scheduled.

➢ Electronic Visits – A communication between a patient and their clinician and through an online portal

➢ Telephone Visits – Brief communication technology-based service, e.g. virtual check-in, by a clinician who can report evaluation and management services

➢ Remote Patient Monitoring - Interpretation and follow-up of recorded video and/or images

Due to the COVID-19 outbreak, telehealth benefits and coverage was expanded through the Stafford Act and the National Emergencies Act under the 1135 waiver for Medicare beneficiaries

Approved Virtual Health Clinicians

➢ Physicians

➢ Nurse Practitioners (NP)

➢ Physician Assistants (PA)

➢ Nurse Midwives

➢ Clinical Nurse Specialists (CNS)

➢ Certified Registered Nurse Anesthetists (CRNA)

➢ Clinical Psychologists (CP) and Clinical Social Workers (CSW)

➢ Registered Dietitians or Nutrition Professionals

Note: CPs and CSWs cannot bill Medicare for psychiatric diagnostic interview examinations with medical services or medical evaluation and management services. They cannot bill or get paid for Current Procedural Terminology (CPT) codes 90792, 90833, 90836, and 90838.

VIDEO VISITS

Two Steps to the Process

➢ Scheduling

➢ Conducting

Scheduling: Hardware Requirements

➢AAH-issued workstation

➢NO WEBCAM REQUIRED

Scheduling: Software Requirements

➢ Full Outlook Client (not the web version)

➢ Zoom plug-in for Outlook

➢ If a workstation needs either of these, the workstation ID# must be submitted with the request – IT will “push” out the software and it will be loaded with the next restart

Scheduling: Security Requirements

➢ Full Zoom license

➢ Permission to schedule on behalf of the clinician

➢ Permission to “mail from” the generic email address

➢ If an individual needs any of these, a request with the scheduler’s email address must be submitted –we strongly recommend back-up schedulers

Scheduling: Email requirements

➢ MUST have a @aah.org or @advocatehealth.org email address

➢ If an individual still has an @aurora.org email address, a request must be submitted to migrate them first

Conducting: Hardware Requirements

➢ A device with a working webcam and mic

➢ Preferred: Personal smart phone, iPad/tablet or laptop with integrated camera

➢ Optional: AAH-issued laptop with webcam

Conducting: Software Requirements➢ Zoom

➢ Access to EMR (for documentation)

➢ Access to your Outlook Calendar will make life easier, but is not required

➢ If you are using a personal device, download Zoom like you would any other application

➢ If an AAH-owned device needs Zoom, the workstation ID# must be submitted with the request – IT will “push” out the software and it will be loaded with the next restart

Conducting: Security Requirements

➢ Full Zoom license

➢ Access to EMR

➢ If an individual needs any of these, a request with the scheduler’s email address must be submitted

Patient Requirements

➢ Must have a smart phone, tablet, or computer with web cam

➢ Must download Zoom to whatever device they’re going to use before beginning the visit

➢ Will sign up for a free Zoom account

Scheduling: EMR

Step 1: schedule patient like normal in whatever EMR you use.

Nothing will change

Scheduling the Visit

Login to Outlook, go to Calendar. Select the day and time to schedule.

Click in the time slot once to highlight it blue

Click on Schedule a Meeting (located in the top banner)

Click on the down arrow next to “Advanced Options.” Click “Schedule for” to select the provider.

Type in the Title Line: the video visit meeting information

Invite the provider as a required attendee. Can click on the box to search the address book.

Highlight and copy the body of the message. Once highlighted, right click and select copy.

Send your Zoom meeting.

Click on the Email button in the bottom left corner and click “New Email” at the top left.

Remove your signature from the body of the email (if you have one). Right click in the body of the email and paste the message that you previously copied.

Click on the down arrow next on “From” button and select AAH-Vvisit@aah.org

In the Subject Field, put appointment information

Click in the “To” field and enter patient’s email address.

In the body of the email, add the Date and Time at the top. Click Send.

Please expect a phone call 1-2 hours before your scheduled appointment for registration

Live Demo

Conducting the Visit

Arriving and Rooming

1-2 hours before the visit, support staff will call the patient on the telephone and go through the normal arrival and rooming process. This can be done by 2 different people, or the same individual. Will be vary between departments.

Patient MUST be registered and arrived

Clinician Workflow: EMR

At the time of the visit, the clinician will open the patient’s chart from their schedule in the EMR and prepare for the appointment

Clinician Workflow:

Entering meeting from the Outlook Calendar

(shown on a laptop computer)

Go to your calendar in Outlook and double click on the appointment to open it

Click on Zoom Meeting

Select “Open Zoom Meetings”

(alternatively, can open in the browser)

You are now in your Zoom meeting, and will meet with patient here

Clinician Workflow:

Entering meeting from the Zoom

(shown on an Android)

Find and open Zoom on your phone

Choose “sign in”

Sign in to your AAH-issued account

You will see a list of your meetings for the day. Find the one you want and select “Start”

You will then be connected. Note that you can swipe right or left for different screen views.

Once you’re in Zoom, your workflow is the same as the Epic-integrated visits.

There are multiple tip sheets available for various options.

You are able to add extra people to the call

(patient can invite a guest, you could add interpreter,

nurse, scribe, etc)

Live Demo

Clinician Workflow:Documentation

• Same as if the patient were there in person

• Add verbiage to your note that the service was performed by real-time, two-way audio-visual technology.

• Add verbiage to your note as to the City and State that the patient was in during the visit.

Clinician Workflow:Billing/Coding

• Can base on total time spent with the patient or medical decision making alone (physical exam requirements are waived for now)

• Epic: add a GT modifier

• Other EMR: follow directions of your chargemaster

GT modifier

Most important thing to remember about the visits

GT modifier in LOS

There are existing tip sheets to walk you through this

GT modifier in Charge Capture

There are existing tip sheets to walk you through this

Follow-ups

➢ Send a note to your staff if there are any f/u recommendations that you want completed –additional appointments made, etc

➢ Work with your market protocols for routine labs, imaging, etc