Patient First adds telehealth, COVID-19 testing services

Regional urgent care provider Patient First is offering telehealth appointments for its patients in Pennsylvania, and drive-up COVID-19 testing at a number of its locations in the state.

In a press release the health care company said that telehealth services are available for anyone 18 or older who was previously a patient at one of the Patient First brick-and-mortar clinics in the past five years.

Patient First now offers telehealth services and COVID-19 testing. PHOTO/SUBMITTED –

Patients can call ahead to determine eligibility for a telehealth appointment. Eligible patients will be connected to a physician who will review medical history and conduct a virtual exam.

If a prescription is needed the physician can electronically transmit it to the patient’s pharmacy.

For patients who have insurance that covers telehealth visits, Patient First will bill the insurer. A routine visit will cost $75, and $35 for a follow up, for patients without telehealth coverage.

Covid-19 testing

Patient First has also begun offering drive-up COVID-19 testing at a number of its locations.

Sites with drive-up testing capabilities include the location on Schoenersville Road in Bethlehem; Papermill Road in Wyomissing; Jonestown Road in Harrisburg and East Germantown Pike in East Norriton in Montgomery County.

Testing is by appointment only.  Appointments are made by calling a designated testing center.

Patients will be asked about symptoms and risk factors to determine if they meet screening criteria based on guidance from the Centers for Disease Control and Prevention. Criteria include the presence of COVID-19 related symptoms such as shortness of breath, coughing and a fever.

Those who work in health care or need a test to determine eligibility to return to work or to obtain needed health care treatments, such as cancer treatment, are also eligible.

Samples are sent to a third-party reference lab for testing.  Results will generally be available in about two to four days and will be accessible on Patient First’s Patient Portal.

Most testing is covered by health care insurance. The cost is $90 for those who are self-paying.

Testing is scheduled from 9 a.m. to 1 p.m. and 2 p.m. to 6 p.m., seven days a week.

Why telemedicine’s rise could outlast the pandemic

A series of changes in Medicare over the last month allowing health care providers to receive reimbursements for telemedicine services was something providers thought would take years.

Prior to the nation’s outbreak of coronavirus and the social distancing protocols that came with it, hospital systems in the region were already using video conferencing software between doctors and patients, referred to as telemedicine. But reimbursements from third party payers, particularly Medicare and Medicaid, were much less than they would be in an in-person doctor’s visit if they were reimbursed at all.

Providers and hospital systems could see the benefit of allowing their patients to stay home during a visit, but the lack of funding for telemedicine meant that it was generally reserved for patients with limited mobility or in rural regions with limited medical services.

In the past month, the health care industry has had to completely change how it looks at telemedicine after a string of regulatory rollbacks by the Centers for Medicare & Medicaid Services (CMS), a federal agency that oversees Medicare and Medicaid programs across the country.

To promote social distancing and to protect at-risk patients from contacting COVID-19, the agency introduced leniencies on HIPAA requirements to allow providers to use a variety of video software while conferencing with patients. It also opened the door to reimbursements of telemedicine that are much closer to what a provider would make during an in-person meeting.

“Prior to CMS’ update, you got paid nothing. Providers would only be paid a marginal amount if they were in what is considered a ‘medical wasteland,’” said Heather Modjesky, senior administrator and director of community outreach at Conestoga Eye, an ophthalmology practice in East Hempfield Township, Lancaster County.

Access broadened

CMS announced it would be broadening access to Medicare telehealth services on March 17 as a response to President Donald Trump’s national emergency declaration on March 13.

“Under this new waiver, Medicare can pay for office, hospital and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6,” CMS wrote.

Both Penn State Health and UPMC Pinnacle have systems in place to connect patients with providers through video conferencing, but were not using it to the extent they can now.

“We have been providing telehealth to our ALS patients for a long time here,” said Dr. Chris DeFlitch, Penn State Health’s Chief Medical Information Officer. “Providing telehealth to that population so they can stay at home and still work with their physicians and specialists is a big deal.”

CMS’ regulation changes related to HIPAA compliance give more freedom to providers when it comes to the video conferencing they use in telehealth. For smaller providers, that means they can use apps like Facebook Messenger and Skype that wouldn’t have been compliant with HIPAA regulations before the change.

Hospital systems that already us their own HIPAA compliant software, can expand their telemedicine offerings using the systems already in place.

Rapid change

Within a week of increasing its focus on telemedicine, UPMC Pinnacle’s online ambulatory visits increased 820% and the system trained more than 650 ambulatory health providers and specialists to use its telehealth program, said Dr. Christian Caicedo, president of the Dauphin Region for UPMC Pinnacle

“I’ve been following telemedicine and supporting it for many years and I’ve seen the barriers to developing it,” Caicedo said. “I can tell you that once coronavirus is under control and we are back to business as usual, health care will not look like it did six weeks ago.”

While the uses for telemedicine have increased, some specialties benefit from the service more than others, with visual specialties like dermatology having more uses than specialties or check-ups that require physical exams.

For an ophthalmologist like Dr. David Silbert, of Conestoga Eye, telemedicine can be the default way he sees patients, with in-person meetings reserved for physical checkups such as when a patient has low eye pressure.

For providers, there is a learning curve when it comes to working with sight and sound, and doctors sometimes need to rely on creative ways to understand what a patient is feeling, said Caicedo.

“What the doctors are learning while doing this is, how do they gather the info via a video visit without being in the room,” he said. “How do you assess someone with belly pain without having to touch them? You can do things like asking them to stand and jump on one leg. Does that make your belly hurt?”

Bridging the digital divide

One problem that remains for providers and systems relying on telehealth is the  number of patients who don’t have access to reliable internet or laptops, said Dr. Michael Seavers, program lead for Healthcare Informatics at Harrisburg University.

“We have to talk about the digital divide,” Seavers said. “Some of the population that needs telehealth the most doesn’t have access to it. We aren’t 100% that everyone has the ability to do telemedicine.”

Seavers and Nancy Mimm, an assistant professor of nursing at Harrisburg University, said that the increase in telemedicine could be a driving force in the U.S. making the internet a basic need and could increase governmental focus on improving rural health care.

The boom in telemedicine is currently a temporary one, according to CMS, which has stated that the rollbacks are directly related to the COVID-19 pandemic and are not permanent.

But many in the health care industry don’t think it will be that easy to roll back, noting that telemedicine can keep patients from catching other viruses while waiting in a doctor’s office, and save time and resources when traveling to a far off specialist.

“I don’t see it peeling back and since the public, government and payers have seen a potential benefit from it, I think they will start to insist upon it,” said Mimm.

Third-party payers such as Capital Blue Cross and Highmark BlueCross Blue Shield have also temporarily expanded their eligible telehealth services, which normally depend on the benefits someone has, in accordance with CMS’ waiver.

If CMS were to make the changes permanent, Seavers believes other insurers could also move to provide similar reimbursements for telehealth compared to in-person visits permanently.

“CMS creates a lot of red tape in some ways but also creates a lot of breaking down of barriers for reimbursements,” he said. “Here in central Pa., if Highmark starts doing something Medicare is doing and Capital isn’t, well guess what they will have the pressure to do it as well.”

Schreiber Center will need ‘significant community support’ to stay open

Zach Groff works on climbing and balance during a session with Jesse Krueger, an occupational therapist at Schreiber Center for Pediatric Development in Lancaster. – SUBMITTED

Relying on Medicaid reimbursements and fundraising to keep the lights on, Lancaster County-based Schreiber Center for Pediatrics has a difficult path ahead of it, depending on when it can reopen to patients.

The East Hempfield Township pediatric physical therapy clinic closed on Tuesday following orders from Pennsylvania Gov. Tom Wolf for the state’s non-essential stores to close for two weeks.

While Schreiber could be considered essential, the clinic decided to follow through with the state’s orders during the temporary window, said James DeBord, president of Schreiber.

“Because we serve so many medically fragile children and because of general concern and those of us seeking compliance with CDC guidelines, even if we had remained open we were seeing cancelation rates upwards of 60-70%,” he said. “The model can’t work with only 3 out of every 10 children showing up.”

Schreiber provides physical, occupational and speech therapy services to kids with disabilities, developmental delays and injuries.

This year, the nonprofit had an operating budget of $5.1 million—$2 million raised from community funding and $3 million from program revenue, primarily from Medicaid reimbursements.

The reimbursements are already some of the lowest in the health care industry with Schreiber losing $65 on average for every hour of service, but without that revenue, DeBord said the clinic will be looking at “cataclysmic” losses.

The clinic also expects to take a hit on its fundraising efforts after it was forced to postpone its annual Schreiber Gala, Schreiber’s biggest fundraising event of the year.

Depending on the time it takes to reopen, the financial losses from the closure could be impossible to recover from, said Dan Fink, director of marketing and public relations for Schreiber.

“Our next steps will be an all-out effort to raise money – not just to balance our budget, but to remain in existence,” Fink said. “This isn’t about covering the dollars we lost from the Gala or covering a shortfall. We will need significant community support to stay open.”

On the patient end, Schreiber sees approximately 500 children a week on average, many of which go on to receive multiple services at the clinic. DeBord said that because of the closure, many kids who were on the verge of a breakthrough with their therapists could regress because they can’t come into therapy.

Schreiber could alleviate the problem by connecting patients with its 60 therapists through telehealth conferencing, but DeBord said that the state would need to pass legislature to allow private insurers and Medicaid to cover telehealth for therapy services.

The clinic previously announced last December that it would be expanding its East Hempfield Township facility by 20,000 square feet, but will be postponing the expansion until further notice.

Select EMS agencies get more care options under test of new Medicare model

A new Medicare payment model being tested on three midstate EMS agencies will offer more options for caring with patients covered under Medicare

The Centers for Medicare & Medicaid Services (CMS), a federal agency that oversees Medicare and Medicaid programs across the country, announced 205 ambulance care organizations that will participate in its new Emergency Triage, Treat and Transport (ET3) Model late last month.

The model drew 210 applicants nationally and CMS chose 205 applicants from 36 states and the District of Columbia.

The local participants include: Harrisburg-based Community LifeTeam EMS; Camp Hill-based Geisinger Emergency Medical Services, formerly known as West Shore Advanced Life Support Services; and Hershey-based Milton S. Hershey Medical Center.

Currently, Medicare only pays ground-based emergency ambulance services when they transport patients to specific types of facilities, with hospital emergency departments being the most common. The new model, which is set to begin this spring and last over a five-year period, will increase the options that participating organizations have with patients, the department wrote in a press release this week.

“For a patient who calls 911 for emergency medical services, the only path for the EMS agency to receive reimbursement for the call is to transport the patient to the emergency department,” said Paul Christophel, executive director at Geisinger EMS. “If a patient can be treated at home and EMS resolves their issue, the EMS agency does not receive reimbursement”

Participants in the model will continue to receive Medicare payments for transporting the Medicare beneficiary to an emergency department, but they would also be covered if they take that patient to a primary care doctor’s office or urgent care clinic.

CMS doesn’t plan to limit the alternative destinations that the EMS agencies can may use, as long as the treatment is provided by Medicare enrolled providers, a CMS spokesperson said in a statement.

The organization could also receive payments for treating the patient at the scene or through telehealth to connect the patient directly to a physician.

Geisinger EMS already treats its patients at home when appropriate, according to Christophel, but the change in model would allow the EMS agency to receive reimbursement for such treatment.

Delivering the Medicare beneficiary to a primary care doctor where fees are cheaper than an emergency room will save both EMS agencies and their Medicare beneficiaries money, said Scott Buchle, program manager at Penn State Health Life Lion EMS.

Patients with less severe conditions like colds and seasonal flu can still be delivered to an emergency department under the current model—conditions that aren’t always covered by insurances and can incur costs on the EMS and its patients, he said.

Through the new model, EMS agencies will be reimbursed for taking Medicare patients to hospitals, physician practices and urgent and walk-in care centers, said Craig Skurcenski, vice president of emergency medicine at UPMC Pinnacle.

“While this new program authorizes payment for alternative care destinations, our primary goal continues to be proper and appropriate care for all patients,” he said. “This will be ensured by patients having a consultation with a licensed provider prior to determining where a patient will be transported.”

Once CMS outlines the rules for the program, EMS agencies will be able to negotiate agreements with local urgent care centers and prepare to leverage technology such as telehealth in their ambulances, Penn State’s Buchle said. Penn State Health’s Life Lion EMS will be looking at bringing Medicare patients to Penn State Health clinics when that patient has a primary care physician within the system.

“In Dauphin and Lebanon counties, the Life Lion units would be allowed to transport to our University Physician Center clinics if the patient has a primary care provider at one of those locations,” he said. “We can also work with our existing telehealth resources within Penn State Health to help provide the care needed.”

Along with the 205 EMS agencies, CMS said it plans to offer funding for up to 40 two-year cooperative agreements between it and local governments or their 911 call centers in regions where a participating agency practices.

The funding would help a local government or call center afford to put a nurse, nurse practitioner or physician assistant in a 911 center to help direct patients to the right care, said Buchle.

The two-year cooperative agreements are a test to see if call centers and the approved EMS agencies can work together to avoid unnecessary transportation even further than what the new model can provide.

“The model will test whether these new options for emergency services will work synergistically to improve quality and lower costs by reducing avoidable transports to the emergency department and unnecessary hospitalizations following those transports,” the department said in a statement.

Hershey Medical Center’s sexual assault examiners join telehealth program

Penn State Health Milton S. Hershey Medical Center’s registered nurses trained in sexual assault examination will be offering remote care to patients in rural regions.

The Derry Township-based medical center is partnering with the Penn State College of Nursing to offer its examiners to the college’s Sexual Assault Forensic Examination Telehealth Center. The telehealth center targets Pennsylvania’s rural counties and provides sexual assault victims with experts in sexual assault examination over the internet.

During the telehealth process, a remote sexual assault nurse examiner offers support to the on-site nurse and patient by ensuring best practices and proper evidence collection.

The partnership will give the telehealth center more trained examiners to offer to Pennsylvania hospitals.

The medical center’s examiners are trained in medical, psychological and forensic examination related to sexual assault and are on-call at the medical center’s emergency department 24 hours a day.

“Historically, our nurses have provided specialized, compassionate care to victims of sexual assault. It has always been our priority to provide a safe space for these patients while documenting the effects of their trauma,” said Marie Hankinson, vice president of nursing for emergency services at Hershey Medical Center. “By partnering with the College of Nursing’s unique telehealth program, Penn State Health continues to be a leader in new and innovative treatments that better serve our patients.”