For those just beginning their telemedicine efforts, it is essential to convene a multidisciplinary team from the start, Diebert says. "We ended up pulling in our Epic [EHR] builders. We pulled in our finance team. We pulled in the managed care team. We pulled in the government plan team. We pulled in the clinical team. Just because it hit every aspect and has a ripple-down effect into everything you do.
"It comes down to even how I schedule the patient, how I refer the patient, [how we] work to follow each transaction to see if you're going to get paid and if you're not getting paid by that managed care company."
In the process, Mercy Health officials would discover existing contracts where a particular company covered telemedicine but not in particular communities, Diebert says. "It was just so unknown that nobody really did a good job around negotiating contracts around telemedicine, not from a managed care standpoint," she says. "Medicaid, Medicare, if you're in a rural community, that becomes a whole different thing, but we have a mix of metropolitan, urban, and rural communities, so we're hit with all the different kinds of scenarios."
The scheduling issue also sneaks up on telemedicine programs. "You have to schedule the patient, you have to schedule the physician, and their schedule is their office area, because you're taking a slot of their time away from their regular schedule," Diebert says. "You have to make sure that they're in a telemedicine room, and that the telemedicine room has the right type of equipment," which these days includes a growing variety of scopes attached to computers and the Internet. "So it is much trickier than just saying I'm going to schedule this patient in this office room."
The telemedicine boom also puts pressure on hospitals to standardize their technology platforms from clinic to clinic. "I have a physician coming in, and he's going to do telehealth in four different hospitals or four different clinics. I don't want him going to five different applications to get to all of those things. It needs to be streamlined, because the other side of it is, from a scheduling perspective, you cannot impact their schedule, because it impacts their productivity if you don't have that room and that patient in that room ready to go. You can't be saying, 'Wait, the camera's not working or this isn't working.' You have got to be ready to go so that 20-minute visit goes on like clockwork."
In this upcoming HLM webcast, learn how specialists and specialty services are reaching outside hospital and clinic walls to engage patients via the Internet, and how telemedicine innovators are overcoming challenges such as billing, scheduling and contractual agreements. November 19, 2013, 1:00–2:30 p.m. ET. Register today.
This article appears in the October issue of HealthLeaders magazine.