Lafayette General Health (LGH) has actively fought COVID-19 in Lafayette, Louisiana since early March 2020. LGH began screening and testing hundreds of people per day through a partnership with a sister hospital, reduced visitors and required all employees entering the facilities to take their temperature.
“We’ve cared for many patients with respiratory illnesses and had about 475 positive COVID-19 cases over the last four weeks,” said Fallon Strother McManus, MD, chief medical information officer.
Creating convenience and continuity across the continuum of care
To help reduce exposure to the virus and slow its spread, the organization significantly increased video visits.
“We had telehealth-specific contracts with certain payers prior to COVID-19,” said John Kleyla, RN, MBA, director of enterprise systems. “When this pandemic hit, we had a huge demand from physicians and practitioners who still wanted to see their patients but not have them come in.”
LGH rapidly deployed Amwell in about three days to more than 185 providers across 40 to 50 practices, ranging in specialties from orthopedics and oncology to primary care services.
“When we onboarded 185 providers, we went from zero scheduled visits in the last month to 5,200 telemedicine visits using the Amwell platform,” said Michael Dozier, senior vice president of information systems, chief information officer.
LGH had been using Amwell for telehealth in its urgent care clinics since December 2019, allowing providers to see patients on demand 365 days a year. LGH averaged four to six urgent care video visits per day prior to the COVID-19 crisis. Now, the organization averages 40 to 50 urgent care patients daily and 284 scheduled visits daily, totaling 6,529 telemedicine visits from mid-March to mid-April.
“We're using Amwell in our Health Anywhere telemedicine app for both urgent care and scheduled clinic visits,” said Dozier. “The patient can access their physician, primary care, their cancer physician, whoever it might be, and the minor urgent care telemedicine visit allows them to talk to a nurse practitioner or provider 24 hours a day, 365 days a year.”
Integrating the telehealth platform with LGH’s Cerner Millennium® electronic health record (EHR) has created convenience and continuity of care for patients and providers.
“One of the main benefits of integrating Amwell with Cerner is along the patient continuum of care. If a patient has a medical history and visited one of our organizations in the past, we’re able to follow those allergies and histories,” said Kleyla. “You're not just dependent upon what the patient tells you in the urgent care visit; we have full access to their medical record.”
Providers can document in the same system they're accustomed to, so they don't need to learn a new platform.
“Providers can leverage all of the same rules and safety measures we have in our EHR,” said Kleyla. “When prescribing, they’re in the tool they use every day.”
Managing revenue capture and billing
LGH leaders have also seen the revenue capture and billing benefits of integrating a single telehealth platform into their EHR. They created an MPage® to document virtual visits and process claims.
“We can bill our payer directly,” said Kleyla. “We don't have to invoice them, we just put the bill on the claim, and it goes out. For the payer, they don't have to create a separate system just to deal with us. In our telehealth program, they can process our claims like they typically would.”
Leaders educated physicians on documentation and charge capture in the new telehealth environment.
“That was a big piece we could manage with our revenue cycle team, just making sure the correct charge is going in all these different areas. Many doctors weren’t familiar with the charge process for telemedicine before this effort, so we put together exactly what they could and couldn't charge for,” said Edwina Mallery, RHIA, assistant vice president of information systems.
Implementation and adjusting to a new normal
When LGH expanded telehealth to 185 providers, they had to prioritize who would get access first.
“We looked at our most vulnerable populations and determined which groups were the most at risk if they were to contract COVID-19,” said Fallon Strother McManus, MD, chief medical information officer. “Those populations include oncology patients, internal medicine—because of the elderly, pediatrics and those who are pregnant.”
“Having those core teams and a CMIO who worked with the physicians on the provider education was paramount to our success. Getting that education out quickly and having immediate buy-in while not having issues up front made providers want to use telehealth services.” – John Kleyla
In order to accommodate the volume, LGH repurposed some of its IT staff. Within the system, one team helped configure clinics and another built providers and schedulers. A third team rapidly deployed devices, including iPads, so clinicians could see patients virtually.
When LGH introduced the new technology, having dedicated provider education was key.
“Having those core teams and a CMIO who worked with the physicians on the provider education was paramount to our success,” said Kleyla. “Getting that education out quickly and having immediate buy-in while not having issues up front made providers want to use telehealth services.”
Providers quickly adapted to the new normal after education.
“Keeping an open line of communication with the doctors was helpful, as far as jumping on any issues quickly to allow them to continue seeing patients. I know that's what's keeping them going back and using video visits every day.” – Fallon Strother McManus
“I was proud of our doctors and how graciously they adopted the new technology, and how they were so willing to keep trying,” said McManus. “They accepted the change quickly with open arms, which made my job easy. Keeping an open line of communication with the doctors was helpful, as far as jumping on any issues quickly to allow them to continue seeing patients. I know that's what's keeping them going back and using video visits every day.”