key: cord-0943246-mqe3w48e
authors: James-Stevenson, Toyia
title: The Virtual Gastroenterology Clinic
date: 2020-06-15
journal: Clin Gastroenterol Hepatol
DOI: 10.1016/j.cgh.2020.06.012
sha: 1b9d102198c57d5d462a065102a963ba7cca54f8
doc_id: 943246
cord_uid: mqe3w48e

nan

Prior to the COVID-19 outbreak, telehealth incorporation into medical practices varied widely across specialties. Several factors limited broad acceptance of telehealth including regulatory limitations, platform challenges and perceived low demand. CMS has rapidly expanded telehealth provisions under the Public Health Emergency (PHE) declared on January 31, 2020 1 . Effective March 6, 2020, the 1135 waiver allows for expansion of outpatient video visits to include patients outside of rural areas and those located in their homes. In most states and territories, providers can now deliver services across state lines and from their homes without having to update their addresses with Medicare 2, 3 . For the duration of the PHE, telehealth visits are reimbursed equivalent to in-person visits for new and return encounters. Many GI practices already implement tele-education through preprocedural phone teaching on bowel prep and dietary modifications, and these have been shown to improve quality, efficiency and value through improved polyp detection and bowel prep quality 4 . With restrictions on non-urgent in-person visits and endoscopic procedures, gastroenterologists who incorporate or expand telehealth in their practices may reduce the risk of COVID-19 exposure for patients and providers while maintaining patient access and revenue streams.

Updated Clinic Workflows. As practices begin to ramp-up visits that were halted during the initial COVID-19 outbreak, in-person visit capacities may be limited due to social distancing requirements, PPE shortages and other safety concerns. Some providers may develop hybrid clinics where in-person and virtual visits are conducted within the same session or during separate sessions within the work week.

Others may even schedule virtual visits during endoscopy sessions if increased wait-times are required between procedures. Clinical space and technology may need to be updated to allow for greater privacy for physicians to perform virtual visits, including adding cameras to hardware and flexible use of patient rooms for virtual visits. Large waiting areas and physician work areas may need to be reconfigured for safety and privacy reasons. Updated scheduling algorithms that define appropriate indications for inperson, virtual and phone visits could improve patient satisfaction, safety and reduce cost. Back-up systems should be available when connectivity issues or technology failures occur to minimize disruptions in the appointment. Healthcare systems, therefore, must promote comprehensive platforms with proven reliability, simplicity, and high patient/provider uptake.

Before the Visit. Rapid expansion of telehealth due to the COVID-19 pandemic has required the swift implementation of virtual visits with minimal time to properly train staff and troubleshoot potential issues. GI practices must educate the entire healthcare team to optimize virtual clinics. Standardization of the scheduling process helps ensure patient privacy while protecting confidential medical information. When scheduling the visit, patients should be allowed to opt-in, and offered phone or in- Telehealth provisions have not changed substantially for Virtual check-in services that allow for billing with patient consent 2 . Providers may use HCPCS phone code G2012 for 5-10-minute telecommunications to determine the need for an office visit. Currently, however, a provider is reimbursed better through billing for a 5-10 minutes phone visit with code 99441 (Figure 1 ). Virtual check-in code G2010 allows for billing for patient-initiated store and forwarded images which is not reimbursable by some states and commercial payers. Take-Home Points. Implementing a GI virtual clinic during the PHE can help practices protect the safety of patients and staff, while expanding access points for care. Modernized GI clinic workflows with efficient telehealth platforms utilized by appropriately trained healthcare members is optimal. Staying current with billing and coding is challenging but worthwhile. Ultimately, the patient may expect providers and payors to deliver high-quality telehealth services long-term. 

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