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Telehealth Has Altered the Practice Landscape: How to Mitigate New Communication Risks in Your Practice
By Thomas J. Bryant, ARM
President, Physicians Insurance
In our last Informed Practice blog post, Telehealth Wins Parity in Massachusetts: Implications for Your Practice, we discussed the enormous increase in telehealth visits.
Before the pandemic, fewer than 2 percent of Tufts Health Plan claims in Massachusetts were for telehealth visits. Last April, the number of claims rose to 60 percent before dropping down to around 20 percent currently. But telehealth has accounted for a whopping 80 percent of behavioral health visits within a period of the prior 11 months, and those numbers are holding steady, local health care leaders reported in March 2021.
The likelihood that most, if not all, medical practices will participate more in telehealth in the future was all but cemented by the recent move by the Massachusetts legislature to sign into law parity for primary care and chronic care services for the next two years, and permanent payment parity for “tele-mental” services.
Last time, we discussed some new risk factors — document retention, compliance, and a new regulatory environment — in the “brave new world” of telehealth, but in this column I’d like to discuss in more detail the importance of considering traditional risk elements such as communication breakdowns through the new lens of telehealth.
Before the pandemic hit us hard in early 2020, communication was already a vitally important risk factor for practices to consider. It’s been estimated that across the nation, medical errors caused by breakdowns in communication can lead to as many as 1,000 deaths per day and cost trillions of dollars in health care costs each year. Coverys had estimated that a full 8 percent of its claims across a five-year period involved primary or secondary communication issues.
Of the claims where communication was the major malpractice risk element identified, 50.1 percent of the related claims involved issues of provider communications, while 44.9 were provider, family, and patient communication related. At a distant third place, at just over 4 percent, were email, fax, and telephone issues, a Coverys study showed.
“Persistent risks that can lead to poor patient outcomes involve the interweaving of communication, process, and cognitive issues,” according to the study, which gives an idea of the complexity at play in addressing risk in your own practices.
So how can we shore up possible communications leaks in our practices?
I am drawn back to advice we offered before the pandemic about creating a “culture of safety” but thinking in terms of giving telehealth communications a makeover.
Experts suggest focusing first on areas where risk is highest. The Coverys data showed nearly 68 percent of communication-related claims resulted from incidents occurring in the hospital setting, with the top two areas of vulnerability being surgery and emergency departments. We know doctor-to-doctor communications are also warning spots accounting for one-third of communication-related claims. But as our health systems in Massachusetts are becoming larger and more intertwined, could these risk areas also apply to your practice?
Where are the fault lines in your system?
When you are engaged in a crucial step in patient care, such as a patient hand-off, think of it as a fault line — a brief but potentially life-altering moment when critical patient information must be communicated accurately, timely, and clearly. A miscommunication here can have a negative impact on a patient’s outcomes.
Build a solid infrastructure. Are you vulnerable in the area of communication-related errors? Consider implementing communications training and designating safety champions. Be sure entries in EMR are accurate and complete.
Err on the side of too much documentation. We know record retention needs attention when handling telehealth claims, but what about the quality of the medical record itself? COVID-19 has caused delays and postponements of medical care, procedures, and tests throughout 2020 and 2021, and physicians need to document these decisions carefully, especially in patients with chronic illness.
If delaying a procedure or test carries a risk that a patient’s known medical condition may worsen, the provider should document that the procedure or test was unavoidably delayed and that the patient was advised completely on the risk.
Establish a rapport immediately. The space involved with making that first impression via telehealth is significantly smaller than meeting in-person in a clinical setting. Jonathan Mack, PhD, RN, NP, the director of a telehealth training program at the University of California San Diego, states that “the clinician needs to be trained to listen and look into the camera because that’s what’s going to appear on the screen for the patient as though the provider is looking at the patient.”
The clinician needs to be trained to listen and look into the camera because that’s what’s going to appear on the screen for the patient as though the provider is looking at the patient.
Demonstrate that your patients are receiving the same value as in-person care. Simple steps such as dressing the part by wearing white lab coat or standard light-blue attire helps communicate to your patients that the care they will receive is on par with that delivered in-person. Researchers from the Arizona Telehealth Program offer helpful tips for developing “screenside manners” and emphasize the importance of optics, linking to a 2005 article published in the Journal of Telemedicine and Telecare, concluding that the way a provider’s practice environment looks is just as essential in a telehealth visit as it is during an in-person visit.
As we navigate this new landscape, new best practices concerning telehealth and communication risk management will emerge, and we will follow this closely and keep you apprised of best practices.
Physicians Insurance President Thomas J. Bryant, ARM, is a licensed property, casualty, life, accident, and health broker in all six New England states and was an adjunct clinical assistant professor in the School of Health Sciences at Bryant University during the period from 2016 through 2018. Most recently Tom developed a video presentation on malpractice basics for Harvard Medical School fourth-year students, and he has participated in NEJM Resident 360 virtual panels on topics related to financial matters important to early-career physicians.
Is it time to examine your current policy? What you don’t know can hurt you. For more information on how Physicians Insurance can support your practice and help you mitigate risk, call 800.522.7426.
Please email Meghan Stanley at mstanley@mms.org with any concerns you would like to see us cover in this space.
posted March 10 2021, revised May4, 2021
