As I reflected on the topic of this blog post, it occurred to me that the question of provider quality rarely comes up when talking to hospitals and health systems who are considering adding telehealth as an additional way to access care. However, what is a more important aspect of your care than the overall quality of the telehealth providers treating your patients? Not all providers are created equal and not all providers possess the skills to deliver care in a virtual setting.
In fact, even some physicians are weary about adding telehealth to their services due to concerns about quality of care.
When you as a hospital are hiring providers, you jump through many hoops to make sure you’re hiring quality providers who adhere to the medical and cultural standards of your organization. However, if you’re looking to contract with a telehealth vendor and use their providers to staff your own service, you are relying on them to also take the time to vet “your” medical staff. It’s important to figure out what that process is and learn more about the standards they uphold their clinicians to. Hint: Not all virtual care providers are created equal.
In this blog post I’ll review a few important metrics that you should ask about when evaluating a telehealth service that has the option to outsource provider staffing.
- Medical experience
- History and background check
- Chart review
- Clinical guideline adherence
- Patient satisfaction scores and direct feedback
- Wait times
- Medical resolution rates
- Antibiotic prescription rates
- Quality assurance programs
Similar to primary care practices, providers can span from physicians, advanced practice providers or physician assistants to nurse practitioners. Depending on the type of virtual medical care you provide it can also include mental health specialists, physicians who focus on pediatrics, or even dermatologists.
In addition to medical backgrounds and degrees, you should also inquire about the length of overall medical experience, time spent practicing in facilities, and time spent practicing virtually.
Average length of tenure with that telehealth service provider will also be important to gain an understanding of turn-over rate and the general experience a group of providers has on a platform. Every platform is different and will require a certain amount of time to train and become comfortable with the technology in addition to guidelines and unique practice rules and guidelines used while treating patients.
As with any medical provider, lawsuits and poor outcomes will impact the types of medical practices that hire them. Practicing online must still uphold providers to high standards and shouldn’t become lax on past poor experiences due to the modality of care. By upholding telehealth vendors to standards just as high as your own organization’s you’re improving telehealth across the board.
Although chart review can be time consuming, especially when there is a large number of providers to keep tabs on, it ensures that the care being provided is appropriate which can vary widely in an online format. Regular chart reviews by medical directors can also help make changes to processes or policies to encourage greater care for all patients using the service in addition to your in-person facilities.
The medical world is constantly changing, and so are guidelines created to assist physicians in their decision-making processes. This couldn’t be more true within the virtual healthcare sector. Evidence-based guidelines should be something that is provided to physicians and advanced practice providers staffing the service. If those providers aren’t using the guidelines, they aren’t practicing good telemedicine.
Guidelines serve a purpose, they create routine and set a medical practice standard which creates control and quality across the spectrum. No matter which provider is seen, a patient should be able to expect the same quality of care along with similar treatment options for regularly seen medical conditions.
Regularly auditing and ensuring adherence can also contribute to identifying problems and solutions within guidelines, effectively improving overall quality of care over time.
Average patient satisfaction scores collected after each visit can help determine general performance of a physician. But, also important is direct feedback. By regularly reviewing comments and reviews by patients through post-consult surveys, telehealth leadership teams can parse out inaccurate scoring and also gain a better understanding of “bed-side” manners for each physician. Negative feedback should be particularly taken note of to allow for an analysis of trends such as condescending attitude or bad care.
Wait times when compared to the entire group can be a reflection of someone who is or isn’t making an effort to make sure they’re available right away. Most telehealth providers are seeing patients from their home. Being able to audit when a provider is busy at home vs. taking care of patients can reflect on whether a provider is truly paying attention to medical needs. Look for lower average wait times. If they seem higher than anticipated, you may consider this as:
- Providers not fully committed to the service
- An understaffed provider network
It’s important to note that average wait times will also take into consideration the amount of time spent with each patient. If certain consults are running longer than normal, it can impact the wait time for the next patient in line.
Patients use telehealth services to have their symptoms treated remotely and without having to set foot inside a provider’s office. While some conditions cannot be treated virtually, medical resolution rates should hover in the 80-90% range if the service is clearly being marketed as an online urgent care service. If that’s the case and patients are still frequently referred to in-office settings, clinical guidelines may not be being followed appropriately and could be a cause for concern.
Additionally, you should ask what the protocol is for in-person follow up and how those referrals are handled, if at all. Telehealth providers should be appropriately trained to help the patient find the best provider and even help them get connected.
Traditionally, telemedicine has been associated with over prescribing antibiotics which is bad for society as it leads to an increased resistance rate to certain bacteria. If everyone gets it, in a generation or two, those antibiotics are no longer effective. This is important because there are a limited number of antibiotics that we as a society have available to us, which we all depend on for true bacterial infections.
Previous research conducted by JAMA found that there was, in fact, overprescribing taking place during telehealth consults, especially for pediatrics. The average antibiotic prescription rate was 60-80% for specific diagnoses. Take careful consideration when reviewing these numbers and look for providers who are closer to the 20% mark.
Providers who can recognize viral symptoms can more accurately diagnose patients. In addition, providers who have the ability to refer patients to in-network practices for imaging studies when necessary will improve prescription rates and patient outcomes dramattically.
Regular peer review of prescription rates can help provider teams naturally keep their rates in check.
Quality Assurance Programs
Digging in on key characteristics that define good providers shouldn’t be an afterthought and shouldn’t be hard to acquire from telehealth vendors. Regular quality assurance programs lead by the organization’s medical director or chief medical officer should gather all information and be readily available upon request.
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