By John Alec Stouras
Firstly, I hope you have been doing well during the quarantine. If you feel like you haven't been in some health capacity, you are not alone. There has been an increase in mental health crisis calls and other disorders during the pandemic. "Our society is definitely in a collective state of trauma," stated Johnathan Porteus, Ph.D. and licensed psychologist. For the link to the quote and information, click here. Now more than ever, we need healthcare services when they are being stretched thin. If you are a small business that works in the healthcare industry, or even if you are as far from healthcare services as possible, you need to know about the laws and functions of telehealth, and what it means for your business practice because it'll ultimately hold your business over during this period and will likely be the future.
Also, if you are a medical provider, telehealth is imperative because you do not need to use PPE's (personal protective equipment) to communicate with the patient. It is a great feature, especially during a pandemic of the size and scale we are experiencing. Alright, let us define telehealth for those who may not know.
Okay, What is Telehealth?
Telehealth is a type of system where health services are distributed over a digital platform, usually by video conference. They are helpful and often used for therapy ("Teletherapy"), psychiatry ("Telepsych"), and other services that can be given over video. Telehealth is primarily for communicative health services, and with that, there are apparent limitations like the fact that I couldn't have foot surgery over a video conference. States have laws that also define telehealth. In California, the law defines telehealth as a "mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation . . . and self-management of a patient's health care while the patient is at the originating site and health care provider is at the distant site” (California's Business and Professions Code § 2290.5).
The states have different requirements depending on the business type and purpose, as well as very different laws. There are two sections below: one on if you are trying to offer Telehealth opportunities to your employees, and the other if you are trying to launch a telehealth ancillary to your business. The rest of the sections will help you navigate certain nuances of the telehealth industry.
Are You A Small Business Trying To Offer Your Employees Telehealth Opportunities?
You likely fall into this bin. If you are a small business and are trying to offer Telemedicine services to your employees, then we are in the best time for you to do so! Your employees need it, and it improves your bottom line because it is generally cheaper. You'll likely have to consult your insurance provider about your small business group plan to see what type of telehealth services are going to be covered.
Are You A Healthcare Business/Organization Trying to Convert to Telehealth?
As stated above, telehealth is likely necessary for your healthcare business or organization. If not, and you need some convincing, we can start there.
The Research Says: Extreme Effectiveness
Because around 84% of US households have computers, and the average cost of a virtual visit to the doctor is significantly lower than that of in-person care, the benefits are noticeable both for busy business customers/executives but also during pandemics. There are still challenges to overcome with telehealth, however. One is that with the added technology (power) comes great responsibility. Now that you'd have an extra layer of technology, you have to keep in mind if patient information is compromised. Additionally, because of the technology, there are many laws, such as HIPAA (Health Insurance Portability and Accountability Act), which regulate how sensitive health information is handled. A good starting place for FAQs is this article named: 10 Things To Know About Starting Your Telemedicine Practice. Click here for the article. A critical point in the report is the importance of knowing that you have to be licensed in every state (your clients are in) to practice medicine.
Logistics: Service You Are Using, What Needs to be Telehealthed?
You also have to consider what online services you'll be using to host your telehealth visits. This is imperative because of the HIPAA law prior, but the relaxing of the law gives you a greater option. If you are doing telehealth directed to consumers, there are different options. One could be RingCentral, which is owned by Zoom. The reason I bring RingCentral to mind is that their Small Business Blog has a step-by-step startup guide for launching video conferencing for telehealth on their service right here! Also, if you aren't satisfied with their explanations of hosting, you can choose other services. Some video services are more tailored to telehealth services like Teladoc and American Well. You can find a list here. The upside for choosing them is that they had HIPAA in mind when looking to create a software that had compliant safety and security controls, so they likely have extremely secure servers and massive support teams just for you, with medical personnel in mind. Always keep costs and security in mind when choosing a service.
Because everything cannot be "telehealthed," you have to assess which services you can bring online. Maybe first-time patient consultations you are able to bring online. Therapy and Mental Health treatment, by far, can be put online and are in high demand due to the pandemic. Other services, like tending to broken bones or other surgical operations, still have to be in person and likely will always be. Nevertheless, choosing what segments need to be telehealthed will be an essential first step as it will help identify what staff your facilities need to train for using the specific service you plan to have as your telehealth server.
Keeping the Law in Mind
Depending on the state in which you intend to launch your telehealth service, it is essential to identify the state-specific laws since they vary from state to state. It can get quite sticky when it comes to telehealth. Because of this, I have linked some telehealth resources for you to peruse before launching operations. One is the Telehealth Resource Center (right here). If you have a business in California, The California Telehealth Resource Center has trainings, workshops, checklists, and much more to help you launch a telehealth center for visitations (click here). Further, the California Telehealth Resource Center keeps you up-to-date on new legislative and regulatory updates.
Telehealth laws are similar in some ways but different in others. One commonality among a lot of states is a state non-discrimination policy on companies and insurers to make sure to rid out discrimination on benefits between telehealth and in-person services. However, laws can differ in the minutiae when you get into the weeds of the legislature. One example would be Iowa's telehealth law versus California's telehealth law. In the definitions, Iowa requires both interactive audio and video for "telehealthcare services," and also does not include in its telehealth law anything about Asynchronous store and forward technologies. However, California calls "telemedicine" two-way, real-time communication between the patient and the physician at a distant site and must include, at minimum, audio, and video equipment. Though similar, the law has its differences in the way it can be interpreted, as California's definition for telehealth was just that it is the model of health care services via information and communication of technologies to provide specific medical assistance and needs.
Because telehealth is a relatively recent invention, the interpretations and kinks in the laws haven't fully been ironed out yet. Also, there is a lot of argument around "payment parity" in some state laws, which means that the cost of a telehealth visit may cost the same as an in-person visit. Because of the ambiguity, you will need a well-read lawyer who knows a lot about the subject area of healthcare, and telehealth law would pay off in dividends. Epstein, Becker, and Green are a large firm that does Health Care & Business Law; you can find them here.
HIPAA Still Applies, The New Notification of Enforcement Discretion Regarding Covid-19 and Remote Telehealth Communications
HIPAA, the Health Insurance Portability and Accountability Act, applies now more than ever. The Department of Health and Human Services (HHS) has stated that any healthcare provider is encouraged to notify patients that third-party applications potentially introduce privacy risks, and providers should enable all encryption and privacy modes when using such applications.
Nevertheless, if you are providing telehealth services, you should know about the Notification of Enforcement Discretion Regarding Covid-19 and Remote Telehealth Communications. The Office of Civil Rights under the HHS announced that they would be a little more lenient on putting penalties for violations of the HIPAA privacy, security, and breach notification rules during the COVID-19 pandemic. They still have the discretion to implement the penalties. Still, they really want to make sure that everyone is receiving medical assistance, whether it has to be through forms of communication that are not as secure as third-party applications that are intended for medical health communications.
The Last Key: Stay Organized and Monitor
The last piece of advice is to stay organized. Being organized can be difficult during the pandemic, especially considering you'll be launching a new business system that likely will be operating differently than your in-person clients. Because of this, you're going to have to take action to make sure everything goes smoothly. One will be to make sure your in-client calendars and telehealth calendars are in sync or are physically the same calendar system. If you need to keep sensitive client documents, then make sure you are saving your documentation and placing them in secure files and cabinets.
As stated by the Rural Health Information Hub, a supported service by the Department of Health and Human Services, ". . . continuous program monitoring is important to help identify potential points of improvement. Regular evaluation of the program allows the implementation team to identify areas of high and low performance and therefore make a change as needed. This information may be provided in data reports and patient satisfaction surveys." Click here for more information. Having a plan for monitoring the quality of care and satisfaction of care is going to be integral at the launch of your telehealth services.
As always, if you need help, seek help! The resources above will get you started at making sure your small business is telehealth ready. Keeping tabs of developments in the law around HIPAA implementation, and telemedicine laws at the state level will give you an edge on business and legal developments. Just remember, for you and your employees, health is all we need.
Are you interested in launching or sustaining a pandemic proof small business? Spot issues, take action, stay safe, and thrive in a post Covid-19 world with Legalucy. Learn more at thelucyreport.com
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