Welcome to our first kickoff call. My name is Carolyn Millet, and I am staff with the Academy. I'm going to be leading you through this first kickoff meeting. We have about 90 minutes to kind of walk through some of the program logistics and walk through the baseline survey results. This is our agenda for tonight. We're going to do an introduction, and I'm going to talk you through kind of the key elements of this pilot program. I am going to introduce you to two of our physician liaisons, Drs. Todd Roland and Kevin Carnaro. We are going to do a bit of a deep dive into the baseline survey. You should have received the survey reports from me earlier today. If you didn't receive those reports, my email address is going to be in the last slide, so please do email me. You probably also received a number of emails from me already, so feel free to reach out. We are going to do a little 15-minute breakout session, allowing you all to introduce yourselves to each other and discuss your improvement project and what you're hoping to gain from this program. And then I want to spend some time reviewing our next steps and going over just any questions that you may have. We are going to have that Q&A time at the end, but I do want this to be as collaborative as possible for the group. We have two Academy staff online, Britt Galvin and Jose Lopez. They're going to be monitoring the chat, so if you do have questions, feel free to enter them into the chat box and feel free to engage with each other through the chat box as well. Britt and Jose can interrupt me if there's something quickly that I need to respond to on the fly, but they may also be able to respond to your questions more immediately, so just keep an eye out for their responses. I do want to go over an overview of what our plans are for this program. As I said, this is a pilot program, so we're kind of learning as we go, and I think we're adjusting as we go, so definitely keep in mind that some of this may fluctuate a little bit, but we're going to try to keep to this timeline. So just to give you a little background on the program, this summer, members were actually the ones that kind of identified this project as a need. We had a couple of members through a FYS forum community just identify that they were spending a lot of time putting in a lot of resources into learning telehealth, and wouldn't it be nice if that could translate to MOC for credit through a PIP. So we thought that was a great idea and responded through developing this pilot. As you know, we launched our registration in October, and that was the same timeline that we launched our baseline survey. Right now, obviously, we're at this December kickoff. There are going to be a couple of steps immediately following this call that we'll be reaching out to you about. So the first is we're going to be launching a FYS forum group specific to the practice collaborative, and then we're also going to be sending you a very brief survey to just indicate to us what your improvement project is. So I'm going to talk about those two steps in much more detail at the end of this presentation. The next phase in the new year is going to be really the bulk of the collaborative content, and that's going to be two collaborative calls in the first quarter of the year. The first is going to be in January, and we'll be introducing that date or announcing that date very soon. The second call is going to be sometime in March, and in between those calls, we're going to be collaborating over the FYS forum group. So that'll give us the opportunity to start dialogues and share resources freely without having to wait for a call. Following that second collaborative call, we'll launch a exit survey, which will be very similar to the baseline survey. Really, that tool is going to be the indicator to ABPMR that some improvement has been achieved. So that's going to be very important to create that data that we'll be submitting to ABPMR in May. So next, I wanted to introduce to you our two physician liaisons. So far, this program is very staff-driven, but with a keen eye towards the need of our physician members. As such, we really felt that we needed to enlist the help of a couple of physician leaders in this space. The first is Dr. Todd Rowland. Dr. Rowland is the chair of our Telehealth Innovation Workgroup, which is a brand-new workgroup that's really kicking off its work in 2021. Dr. Rowland, I believe I saw, is on the line. Can you unmute yourself, and do you want to introduce yourself quickly? Yeah. I'm really excited to see everybody getting together and talking about telemedicine. Obviously, this has been quite an unusual year, and a lot of us have kind of gotten pushed into telemedicine through various circumstances. I've worked in medical informatics, in addition to being a PM&R physician, for the last 20 years. And so many of us have been working on telehealth, telemedicine, remote care for many years. And I'm also a chief medical officer for a company called Vital Flow Health, which does remote physiologic monitoring for respiratory health. So it's pretty exciting to see the stuff that's going on, and I'm happy to help in any way that I can with the Academy. Great. Thank you so much. Our second physician liaison is going to be Dr. Kevin Carnaro. Dr. Carnaro is the co-chair of the Musculoskeletal Care Area for BOLD. Dr. Carnaro, are you on the line yet? I am, Carolyn. Yeah. Obviously, great to be here as well, along with Todd. Happy to work with Todd on this initiative, and Carolyn, and the staff at AAPMNR, and obviously all of you who are participating in this process. I co-chair the Musculoskeletal Care Area with Jared Cottrell, and this year, obviously, has been one of various trials. But we've, as a community, and a PMNR community, have really excelled in multiple areas. And one is obviously telehealth, and particularly with musculoskeletal conditions. Many of our members have done a wonderful job. And so we're here to learn from all of you on what's worked well and create a platform that we can all use together going forward. So thank you, and excited to be a part of this with all of you. Thank you so much. So what we're hoping to use Dr. Carnaro and Dr. Rowland for is they're really going to provide us that clinical experience as we develop some of the survey work that we're doing, and then also as we're developing the content for our collaborative sessions. So we'll run our topics by them and just get additional input that's got that more clinical focus. Additionally, if participants have questions that fit much more squarely in the clinical space, we'll be reaching out to them so that you're not just getting a staff response, you're getting that clinician response as well. So we really appreciate that help very much. So next I'm going to move on to a survey overview. As I said, the survey reports went out earlier today. Those reports are reflective of the 57 participants who completed the survey by our initial deadline. We do have survey data from a couple of additional participants who completed the survey since that time. So the breadth of what's captured in this survey, there is even more experience on this call and in the collaborative. So that's really exciting for us too. So a quick look at the demographics. We were really pleasantly surprised with the diversity represented in this group. So we have participants from 23 different states. There were a couple states that had higher participation, but generally speaking, it's a really great range. Similarly, the number of years out of residency showed a great range. We have a lot of members sort of sandwiched into that kind of mid-career age range, which is fantastic. In terms of board certification, there weren't a ton of surprises there, just given that we are focusing on musculoskeletal conditions for this collaborative. So we did have a certain percentage of members who are subspecialty certified in pain, sports, and electrodiagnostic medicine. Also kind of surprising to me, to be honest, was the breadth and range in the top five practice settings. So we're really capturing a lot of different practice types in this collaborative. So I think wherever your practice is, you're going to find at least several colleagues in this group that are having similar experiences to you. We did ask a couple of questions about previous and current telehealth practice. And this was also very telling. I mean, obviously COVID has really changed practice, and you can see that middle column at the height of COVID. We had 51% of participants were practicing telehealth on almost, you know, between 75% and 100% of their population. 23% of the participants provided telehealth services prior to COVID-19. I was actually surprised that the number was that high. I have not heard a ton of physiatrists that I work with regularly who offer telehealth regularly. So I was pleased to see that there are some participants in this group who have had pre-COVID experience with telehealth. I think that's going to be very helpful to the rest of the group. We do also have a wide range of people who are expecting to provide telehealth in the future. So some of that 23% isn't going to go back to never doing telehealth anymore. They're going to take it on, and they want to take it on for the future. Obviously, we're not quite at the height of COVID in the way that the lockdowns were sort of more prevalent earlier in this year. So currently, or at the time of the survey, people were providing telehealth more in that 1% to 25% range. And that's really the range that people are looking towards in the future. So that's kind of an exciting place to be starting this collaborative. I think that'll really give people the chance to kind of work towards goals for what they're expecting for the future. We did also ask a couple of questions about whether or not people are seeing new and established patients. We know there are some restrictions. Once COVID restrictions have lifted, we know that there may be some payer and just regulatory restrictions regarding new patients. So it was nice to see that 68% of people have conducted telehealth visits with both new and established patients. So I think that's potentially a real great area for sharing lessons, you know, how to deal with a new patient via telehealth. So moving into the barriers, there were a few barriers that were sort of top identified in the prior to COVID-19 space. Not surprisingly, reimbursement is one of those very high concerns. There were also institutional barriers and lack of leadership support identified. So systems that don't want to implement telehealth due to potential costs or liabilities. Regulatory and payer restrictions was also identified. And then just technology issues, which really was a theme throughout the survey in general. Moving forward, people are still expecting reimbursement to be a concern, and I think that's completely appropriate. We know that a lot of the waivers and expansions that have been associated with telehealth during the pandemic are going to revert back. So finding a way to address that moving forward and address the potential lack of payment once COVID is over is a huge issue. Regulatory and payer restrictions were the second most identified issue. I think, again, that is very appropriate to be identified. We know that there are issues with licensure and restrictions based on rural status versus non-rural status. So potentially looking at those is a huge possibility moving forward, especially for work that the Academy can do. And then patient inability to access due to lack of resources was also identified. I think we've seen this in some of the more open-ended responses throughout this survey, that there is some concern about patient facility with technology. So that's certainly something that we can discuss in one of the collaborative meetings. So we did share in this presentation quite a bit of the detailed data, which you can also find very clearly laid out in the detailed summary report that was sent today. So patient history was actually the area where most people who participated in the survey really had taken that on already. So 93% of people had taken a patient history via telehealth. And this was one area where participants felt some comfort and felt that they were successful at it. So 45% of people ranked themselves as being five, which was extremely successful. We had far fewer people concerned that they weren't able to take a history via telehealth. There were some challenges with technology identified, and there were some challenges just in the ability for patients to open up. So that's something that we could talk about strategies for. So moving on to exams and treatment. Cervical exams was one of the types of exams that was most commonly performed by the respondents. 81% of respondents had done this service before, and 65% had also done treatment via telehealth. You'll start to notice a pattern here, which obviously we identified as well, which is most people ranked. We had this scale of how successful are you in performing this? How successful do you feel in performing this? Extremely unsuccessful, unsuccessful. Number three was neutral, and you'll see that the average response in almost all instances hovered very close to three. So there wasn't a ton of confidence in the respondents that they were really successful in achieving a quality exam via telehealth. Some of the concerns surrounding that were poor video quality, an inability to perform the exams to have a confident diagnosis. There were also a number of respondents for whom cervical exams were not a part of their typical practice. And again, kind of along the same lines when it came to treatment, quite a few people saying that they were either neutral or uncomfortable providing with their success in providing treatment. And really, a lot of the responses regarding treatment were reflective of a lack of confidence in the diagnosis that they had made via telehealth. So again, that's an area that we can address. And still, there was a portion of the respondents who did not typically provide this service, or for whom they didn't get that type of patient since the pandemic. So moving on to shoulder, again, similarly, this was one where most of the respondents had provided this service, both the exam and the treatment. And again, this was an area where we averaged around three in terms of how successful people were with this. Very few ones, very few fives, a lot of people sort of hovering in that mid-range with their comfort and their success. Some participants basically had the same response for all of these questions when it came to challenges. And those really focused on the inability to perform the neurological and physical exams with confidence. And that was across body areas, so you'll see that as a pretty standard response. So I think that's absolutely an area where we'll be looking for ideas sharing among the collaborative participants. There were a couple of sort of more unique technical issues, like issues setting up the camera, especially, I think, as we get to body parts that are harder to display. It will be helpful for us to kind of share some tips on how to instruct patients on where to set up cameras and what sort of workarounds can be set up for that. And, you know, another thing that's pointed out in some of these is the inability to perform some of the procedures that our members are typically performing when not doing things via telehealth. So, for example, on this slide, it's noted unable to perform injections. I think some people, you know, quite a few of our members, if they identify an issue, they will then perform the procedure the same day as their visit. So I think the inability to be able to provide the patient with that treatment immediately is certainly a concern for some of our members. So moving on to elbow, this gets into a space where we did have quite a few people who do not provide this type of service. So these no's that you see in green here, the 58% and the 61% for treatment, a lot of our members just are not seeing patients with elbow conditions or haven't seen them since the pandemic began. However, this was one where there was maybe a little bit more success in doing these services. So no ones for the success with elbow exams and quite a few fours in this category. And like I said, 55% of respondents had no patients with this issue since starting telehealth. So I do think there are some conditions that potentially patients have not been seeking treatment for during the pandemic. And again, quite a few fours for the treatment. So there is some success in treating elbow injuries via telehealth. So that may be an area that we want to have some of these successful people share their tips. Again, very similar barriers for this one. Unable to perform neurological and physical exams and unable to perform injections. Wrist and hand treatment exams and treatment. This was another one where we had about half of participants do not either do not offer this service or haven't seen this service or this condition since the pandemic began. And for this one, the bulk of people really felt sort of neutral on their success in offering these exams. I'll just sort of move quickly through this because a lot of these responses were pretty similar. And again, threes and fours primarily for treatment for those who do provide the service. Thoracic exams, pretty similar numbers to the wrist and hand in this category. And again, for most people, this was a neutral area for them. They were not really confident in their success. For thoracic, there was a note about localizing pain and how difficult it is for patients to reach. Just pointing out specifically the challenges of this body area, difficult area to assess in person, even more so virtually. So potentially an area that we want to discuss some strategies down the road. And pretty similar in this for this category. Again, unable to do injections via telehealth, obviously. So that's something that would have to be referred out, which not everyone was comfortable doing. And we'll get to that data shortly. CPR exams were probably the area where most, the body area where most people were providing this service, both for exam and treatment. This was one of the areas where there was quite a bit more confidence in the four and five range about how successful doing an exam was. There was a point here about patients not being very comfortable just robing for the exam. I think, you know, obviously there is a sort of comfort and understanding in a doctor's office that this is a one-on-one encounter, potentially the nurse is there, but that's, you know, obviously it's not being filmed. Not that I think, you know, confirming a lack of recording with some of these visits may be helpful, but we can also just talk about some strategies for how to make a patient more comfortable treating that telehealth encounter as though it's in a doctor's office. This was another area where identifying a way for the patient to hold the camera accurately for visualization is an issue. So this is definitely an area where we'll want to talk about strategies as a group. And then in terms of treatment, you know, there was a note here about chronic patients, and I think you'll see that in some of the overall takeaways. Chronic patients were some of the patients that this group felt the most successful with and the most confidence with, so that's something that we can discuss in more detail. And pelvis and hips, this was sort of a medium range, you know, in terms of how frequently people are providing this service. A note about just that upper body regions are far easier to see and to examine, and, you know, it's hard to kind of handle the technical component of a pelvis and hip exam, so clearly that is a challenge. And especially if the person is seated, obviously that was pointed out. So, again, this is definitely an area where we'll want to talk about strategies. Knee exams, this was a sort of medium frequency provided service, provided service, and similar to pelvis and hips, difficult for patients to place the camera. And some of the reflex and strength exam, I think there, you know, there were some comments in the more general area about some techniques for that, so I think we'll highlight that as a space that we want to focus on in one of the collaborative sessions. I think there are some options for different exam workarounds that could be helpful to some of the people who are finding these challenging. Similar to wrist and hand, ankle and foot was not as commonly performed by our physicians, and very medium confidence, no ones or fives. There was some concern about seeing the joint well and positioning the camera, really for anything below the waist, there was a lot of concern about how to position the camera. And then concerns about ability to provide diagnostic and therapeutic injections. Concussion assessment and treatment, this is a really interesting one. Only 25% of participants had conducted an assessment for concussion via telehealth, and only 21 treated concussions via telehealth, but there was far more comfort and success in doing so. So we had no twos, no ones, and 64% feeling pretty successful. So I know many participants said that they didn't have this as a part of their practice, but for those who aren't doing concussion assessment and are interested, I think we clearly have some participants on the line who can do this well and can share some of those tips. Similarly with treatment, threes, fours, and fives in terms of success. So that was exciting to see. We did ask some detailed questions about ordering, so testing and treatment. A lot of comfort in x-ray, physical therapy, MRI, medication, and physical therapy, in-home physical therapy. Injections was 56%, and I'll be interested to hear more from from the participants about that. It occurred to me that perhaps the lack of comfort was the fact that there's some lack of comfort in bringing patients in for injections during COVID, or the lack of comfort in referring patients out for COVID if our physicians weren't doing them themselves. But potentially there's some discussion on that. Another possibility is just that there is that lack of confidence in the exam to confirm the need for an injection. Just a couple of highlights in the care successes. Again, as I pointed out earlier, this does seem to be best or has been identified as best for a check-in when things are going well or no change. And really nice to get that insight into the patient's home life. So, seeing what's going on in the background really gives a different picture than the patient just in the clinic. Post-procedure assessments and visits to review imaging have been a good use of telehealth. So, there's sharing screen options, ability to share education. So, that's helpful. Highlighting long-term patients as a possible real target area for telehealth services. And then some challenges. A lot of the challenges really fell into this category of physical exam. How to conduct that diagnostic exam. And then obviously the limitations around being able to provide that interventional procedure. There were also some notes about inability to pick up patient demeanor, behavior, movement, as well as you could in person. So, that seems like an area where we should do some idea sharing among participants. And then just technology difficulties, limitations on the part of the patients. So, we do know that just depending on patient populations, there may be disparities that result in lack of access to technology. And then there also just may be some issues with facility with technology. But then also there are just Wi-Fi issues that occur for anyone and everyone, especially during the pandemic. So, those are all things that having backup options that we can discuss on a future call will be helpful. We did find that 66% of people are happy with their current platform that they're using for telehealth. We know that a certain percentage of people are interested in finding a new platform, but some of those people are not necessarily going to be the primary decision maker when it comes to implementing a new telehealth platform. So, we did have here a list of different platforms that we knew some people were using, and it does look like a lot of people are using Zoom. So, this may be an area where people want to explore for their improvement project, identifying a new platform that meets HIPAA compliant requirements for post-pandemic telehealth. And then we did have 13% of participants who are monitoring patient satisfaction with telehealth. So, there were a few different options provided, including Press Ganey, which is commonly used, and then Epic has a questionnaire. So, that's something that we might want to discuss in more detail, just trying to incorporate patient satisfaction tracking with telehealth visits. In terms of satisfaction with the overall telehealth program, 56% of participants were somewhat satisfied with their current program, and 19% are either extremely dissatisfied or somewhat dissatisfied. So, we'll obviously be looking at ways to increase that satisfaction with telehealth programs. And then we did ask, out of a certain list of categories, what areas people are most focused on trying to improve, and methods and successful practices for how to perform certain services was really at the top of that list. So, that's exciting. And I think, obviously, the data we collected really can inform that. There was a large percentage, as well, who's interested in expanding understanding of telehealth coding and billing practices. So, that's likely going to be something that we want to provide resources to you on, potentially through some of our FIS forum resources, and then also, we can think about how to incorporate some of that learning into the collaborative, as well. All right. So, that's the conclusion of the survey review. Before we do breakouts, is there anyone that has a quick question about the results that we'd like to talk about now before you forget it? Or we can, obviously, also wait for the Q&A. And you can feel free to unmute yourself if you would like to. If not, we can just go straight into the breakout discussions. The collaborative calls that we're going to have in January and March are going to be far more collaborative, as opposed to me just talking at you. But we did want to kind of get a taste of that on this call, since this is our kickoff. And we'd like for you all to introduce yourselves. We'd love for you to introduce yourselves to one another, share your current experience with telehealth to date, and then share what you're hoping to learn or improve upon as a result of the breakout sessions. And we'd love for you to share your experience with telehealth, as well. So, we're going to go ahead and get started. We are going to do like a quick 10-minute report back. We'll break out for 15 minutes, and then have you please designate a speaker from your little group of four or five. And that person will call on that person to report back on just some of the themes from your little chat. All right. I think Jose is going to start those breakout rooms. All right. Welcome back, everybody. So, we did have 10 groups. So, I'm going to ask the designated speaker just to introduce yourself and just share a couple of key takeaways over the next 10 or 15 minutes. Group number one, do you want to unmute yourself? Hey, everybody. My name is Dave Spanier. I do basically musculoskeletal medicine at the Seattle VA. And our group had a variety of practitioners from across the states. So, good job, Jose, in getting us a wide smattering. People were using everything from Zoom to Doximity to Doxy.me. And then at the VA, we use VA Video Connect. One comment that seemed to resonate was tough getting patients to sometimes engage. It's often despite a lot of prep time with staff ahead of time to get people up to speed from a tech standpoint and troubleshooting that, you know, when it comes time for the appointment, half the time we're doing phone calls because they're not showing up in the rooms. The other, we also struggled with a lot with physical exam. We sort of raised the point kind of reduced to a primary care level of physical exam with a lot of things, just whatever we can observe and kind of dissatisfying. This was my opinion. I didn't get consensus on this. I don't want to speak to the group, but it's dissatisfying when I don't really have a firm diagnosis and I feel like I'm just going to pawn them off to a physical therapist and hope that a diagnosis is made and that there's communication and we can move forward, but pretty satisfying. I hope I covered group one. No, that was fantastic. Group number two, do you want to unmute yourself? Okay. I think I was anointed as our speaker. We also had a nice mix. We had a few of us who were private practice people and a few who were academics, but it still was very clear the combination of the productivity pressures and the technical issues are pretty significant barriers in the long run. And certainly the little bit of hesitation right now from regulatory agencies to extend in particular, the reimbursement issues would be a huge barrier for long-term continuation of this. There were a lot of technical issues as well that seemed to be a barrier, certainly from the provider side. So we didn't get a chance much to get into the examination issues, but that was something that I know we dealt with in our practice and found the necessity of trying to get as standardized and as Dave said, avoiding doing a primary care exam to help our patients. That's my general take. Great. Thank you. Group number three. Hi, my name is Eric Chen. I practice at the University of Washington in a sports and spine practice. Our group had a pretty good mix, some academics, some private practice. I think our discussion sort of echoed a lot of the same themes that were spoken about in the PowerPoint. Similar experiences with difficulties for a great physical exam. We all, both, all of us felt that probably a little bit more useful for follow-ups and imaging follow-ups and check-ins as opposed to initial consults. And then there was a little bit of a discussion about what is the future going forward for telemedicine? Is there going to be a big demand for it or is it going to be used more as a convenience type modality for patient encounters? Great. Interesting. Great. Number four. Hi, I'm Sasha Ilkovich. I'm in private practice doing MSK, PM&R in Madison, Wisconsin. And I'm actually working with a group of family physicians. And we had a good breakout session where we're having some technical issues, but we were able to figure them out and communicate through chat. So we talked about, you know, kind of the things that everybody else talked about, some limitations with the physical exam, especially, and especially like more subtle parts of the exam that are harder to do by telemed. And, you know, sometimes patients have technical issues where you have to spend a lot of time trying to track them down. And then you end up talking on the phone with them. And then we talked about various hybrid models to help reduce risk of exposure, which probably won't be relevant once the pandemic is over, hopefully. Yeah. So. Great. All right. Number five. Jose, do you, just in case the group didn't remember their number, Jose, can you read off the names for that one? Sure, so we had Dr. Heidi Prather on there, Sanjay, Suzanne, Dr. Brzezic. This is Heidi, I can talk for us. None of us could figure out what group we were, sorry. No worries. Excellent, thank you. So our group had people from hospital systems and in community practice, and we had a major expert on our panel who came out of retirement to start a telehealth company, trying to keep people out of nursing homes. So we had a good breadth of people on our call. We kind of, we talked a little bit about the positives because we discussed how PM&R might lead the way in discussing what is good about telehealth, because at some point, you know, it's either gonna get mandated what we can or can't see in telehealth in the future. So we talked about the beauty of the shared screen and getting the time to actually explain a lab or a test result imaging to the patient in detail, that patients really like that. We did like, if you did get to see a new patient, we liked having the time for just the history because it became the only thing you could do really well. We talked about that we should lead the way in talking about the importance of being able to see inside someone's home when you're doing an evaluation because we make a lot of assumptions about that as physiatrists about their home environment. We got to actually see it and, you know, there were more disparities going on that I realized myself. So those were things we thought were really good. Our expert who has a company working on telehealth pre-pandemic said that they've been, have a program in place to share old computers. So if people don't have access to get online, that they had a program in place for that, which sounded very positive. And then we were in the middle of discussing poor reimbursement when we got pulled out. So I think obviously that's on the minds of everyone if we're gonna spend a lot of time doing this in the future. Great. Dr. Prather, I'm sorry, we do have a question. Curious about who started the telehealth company that was in your group. Oh, Dr. Rizal, he's on, he's on. Let's see if he'll unmute himself. Yeah. There he is. It's Dan Brzezak. Yeah, we started 98.P-O-I-N-T-6. I would suggest that y'all look at that website and see what we're doing. We're doing primary care right now, but moving into the rehab field. Great, thank you. And group number six. Hi, I'm Curtis Kirkland. I'm in Allen, right outside of Dallas, Texas. Our group shares a lot of the same issues that others have as far as telemedicine, kind of the connections and asking which platform works better. And most agree that Doximity seemed to be easier to use, although most had used Doxy.me as well and some other platforms. One of the things that, just like Dr. Prather said, coming, how are we going to use this in the future? Or would people still continue to use this in the future? And the responses were like, well, we don't know revenue, things that you get from an office visit that you wouldn't get from a telemedicine visit. For instance, some of us are in interventional practices like revenue for drug screens. Are the reimbursement rates going to be lower once we get out of the pandemic for telemed visits versus office visits? What's the conversion rate, right? Going for people to actually do injections and other therapies if they don't see you in office. And also just the kind of human touch connection that some people need. They come to the doctor's office and that may be the only time they maybe speak to someone outside of their own family, right? And so it may be a challenge for some practices continue to use telemedicine post pandemic, maybe more for, I guess, established and follow-up appointments versus kind of new patients. That's pretty much what we got. Great. Group number seven. Hi, I was designated speaker. I'm Anna Sorrells. I work in Cleveland, Ohio. We also had a little mix of different types of practices, private VA, academic outpatient. One of the topics that came up was the different payers or types of patients that we see is important. Whether or not you're in a rural area, urban, if your population is mostly Medicaid, virtual might not work out, especially for new visits because you get a lot of no-shows. If patients feel like they have to go somewhere and they are responsible for being somewhere physically different, then they maybe have more responsibility and they feel that desire to go somewhere. But if it's like telehealth from their bedroom, maybe they forget more easily. They don't really care as much. There's a lot more no-shows for that patient population. Also, it's important to know your patients. If you feel like you can trust them to do adequate discussion of their health, any skin issues. But if you have a patient population where you're really not sure that what they're telling you is enough or they're missing some crucial information, such as if you see a lot of amputees, you might not be able to catch subtle differences on camera to their skin that they wouldn't notice. So it's really important to actually lay your eyes on them in person. How we also talked about how reimbursement is gonna look. I think that's basically gonna be the main driver. And I also mentioned, I wonder how the new billing changes is gonna reflect starting in January in this, is it gonna be easier? Is it gonna be more difficult? Can we build same levels? Is it gonna be financially worth it to do these? And I also liked the comment that I just saw that snow days used to have a lot of no-shows, but now they can be all become virtual and it's really not such a lost visit. Or I have a lot of COVID quarantining patients who I can see virtually now, things like that. So there's some definitely perks. Great, that's very helpful. Thank you. Group number eight. Hi, I'm Dr. Hallie Robbins and I am in New York right now. My practice is based in Utah and I'm also in Massachusetts. So I am exactly the kind of person for whom telemedicine works very well if it works at all. And that's been part of the challenge is because of COVID constraints. I haven't been back to Utah since November. I was going to be working in subacute rehab. So I am the outlier in every single way from where most of the people in my group, it was a great group and we were talking about how most people prefer when they have the opportunity locally to do in-person, especially for the first visit. They typically like to do follow-up in, telemedicine is okay, but even so dwindling numbers compared to where it was several months ago. And so it might be more like a half day or two a week rather than routine. And out of 18 to 20 patients, one or two a day might be telemedicine for another provider. So definitely majority not. What became interesting in our conversation though was that it wasn't just because of difficulties with getting people there, but often the difficulty for instance of saying, move your arm to the right. What right? And so we started talking about language skills and educating the clinician as well as the patient provider how to best make the experience work and how to give better instructions. And that's one of the things that my background does provide for. And I'd like to offer that as a service to the academy in terms of developing skills for improving telecommunication instruction, both directions. The other thing, and I'm fascinated in terms of Dr. Bruzek saying that he has mostly primary care because that was the other thing our group talked about is this crack that rehab doctors fall in where it's almost entirely primary care for telemedicine and tele-rehab is almost entirely the therapists. We fall right between and the lack of visibility and ways for us to provide tele-rehab as physicians was one of the glaring conversation points. That's fantastic, thank you. Group number nine. Hello, can you hear me? Yes, okay. Yes. All right, so I'm Angela Ryan and I had a group, I'm in private practice in Connecticut, a small private practice of musculoskeletal, actually a general rehab practice and chronic pain. And in our group, we had mostly, we had two others that were in academics, one in the Midwest and one in the West Coast. We spent a lot of time just talking about our experience to date and as has been discussed before with the difficulty with physical exam and we are definitely interested in exactly maybe what Dr. Robbins was talking about, any ways to kind of improve physical exam and tele-health. We do feel as has been discussed that there's definitely ways where it should go forward. Chronic patients or returning patients, we felt that was very helpful. New patients, it's kind of straightforward. Definitely, I think there is a comfort level in treating those patients. However, you don't always know when you have a new patient and how straightforward they're going to be. And I think, yeah, and it's also some of the difficulty, I guess, with the communication too with sometimes language barriers, speaking to people with another language is hard enough in person, it's even harder over tele-health. That was another difficulty we had. And I think we're just also wondering, yeah, going forward where it probably should stay with us in some capacity, but really maybe identifying how best to do that is and in what clinical situations would be important. Great, thank you. All right, last but not least, group 10. This is Todd Roland. I don't know that we've picked a designated person, but I'll go ahead and volunteer a little bit. The other thing that I would add, and we talked about a lot of the things. One thing is we talked about leadership support from the organization and whether that was present or not. And one of our participants is at Duke and Duke had been doing telemedicine before. And it sounded like they had a lot of support for the physicians, there was actually training, so really good support is what I was hearing. The other part that came out, if I got it right, was reviewing MRIs with shared screens on Zoom was really actually better than it would be in person, just the experience, especially if the patient had a bigger computer screen on the other end. Great. All right, well, that was very informative for me and I'm assuming it was very informative for everybody else I think really shows that there's a lot of consistency in some of the things this group is looking for. So I think that we're really set up well to create some great content and identify some great speakers for our first session in January. All right, so I'm just gonna go over a couple of our next steps before we wrap up in 15 minutes. So the couple of next steps to expect ahead of the holidays, we're gonna be launching a new FIS forum group, which I'll go over in more detail in the next couple slides. And then you will get a link to a survey which will probably remain open until January just because the holidays are gonna hit right in the middle of the time to do the survey to just submit your project improvement goals. So, and then we'll talk about the January collaborative meeting, which as I said before, we're gonna finalize the date for that very soon and you'll get a calendar invite with a link for that meeting. So the FIS forum community, which I actually believe launched just a couple of hours ago, is the tool that we're gonna be using to share resources. So PDF education files and so forth. And then also it's the place where we're gonna be encouraging participants to share tips, discuss issues, talk through different things through the dialogue options in FIS forum. So the way our notifications are set up, you will receive an automatic email notification when anyone posts to that discussion board. So unlike some of the communities that you may have set up, the all member community for FIS forum and so forth, this is gonna be set up to automatically email you. You can change those settings if you wanna keep it to daily digest, for example, or only get a more consolidated email. You will have access to post files if you would like to share resources through that forum. And certainly you'll have the option to start chats and to respond to dialogues as well. So this is the FIS forum page for our state advocacy committee, just to show you kind of an example of what your page will look like. It will be the telehealth practice collaborative FIS forum page. And there is an app as well. And we can share more resources on this after the call, just in case you're not as familiar with FIS forum. But here are the instructions for how to download the app. Some people do like to use the app just as if you're looking over at this on the right-hand side of the screen, you'll see just this option to select your notifications. So this is where you would be able to get sort of a notification on your phone when something's been posted to the group. We're hoping that this group is used frequently. So emails for every notification may start to feel like a lot. So you're welcome to change that setting. And we do just have a reminder that FIS forum is designed for member dialogue and exchange. It's not intended for commercial or self-promotional content. So this is just sort of an overview of what to expect with that improvement project survey. It's obviously gonna be a far shorter survey than the baseline survey. This really is just designed for you to describe your improvement project. So we'll include several options of what might serve as an acceptable goal, but you'll be asked to sort of fill in the blank here, indicating what goal you'd like to work on. So the example here is improve my ability to conduct an effective assessment of the shoulder. We do want this to be something that's measurable so that you can consider how to meet the goal and then work towards it over the couple months of the collaborative. So in this example, the metric selected is a personal rating of the success in my ability to perform the exam on a scale of one to 10. The current status is a two. So not really able to perform the exam and we're looking to jump to a level four. This is a clinical improvement project. Your goal does not have to be clinical. So if you'd like to focus on selecting a new telehealth platform over the duration of the collaborative, that's an option. If you'd like to work on communication tactics for patients and learn some new communication tactics, that's an option. If you want to establish a new clinical workflow for your telehealth visits or establish a backup plan when someone's internet connection is out, for example. Those are all totally acceptable. We just chose to highlight a clinical example in this slide. So the survey will also ask you to identify a couple of steps that you're going to be taking to meet those goals. So in this example, it was integrate the use of a spouse, roommate, or caretaker into the telehealth exam process and then also evaluate the home environment during the telehealth visit. So like I said, that survey will come out to you in the next week or so and we'll ask for that to be returned in the new year. If you do have any questions when you're completing the survey, you can feel free to reach out to me and I can follow up with you just to help you kind of narrow down how to make it a very measurable goal, which is something that we needed to be in order to submit this work to ADPMR for credit. So in terms of our January meeting, I think we've kind of touched on a little bit of this. We're going to be identifying some themes obviously based on this discussion today, but also based on the survey. We are going to be reaching out to a couple of different participants from the learning collaborative and asking you to share your stories probably in a five or 10 minute type context where then discussion will follow from the full collaborative. And the goal is going to be really, once we know those improvement projects that you've submitted via the survey, we'll be tailoring the content to helping you meet those improvement goals. All right. So that's all the content that we have prepared for tonight. We do have eight minutes left for any question and answer. And obviously my email is up on the slide. I welcome any reach out following the call today. And then obviously for the duration of the program, you're welcome to reach out to me with questions. Does anyone have any questions right now? I can also look at the chat to see if there were any questions or if it was just more dialogue. And we can pull some of these recommendations from the chat and make sure those are saved and shared through the FIS forum as well. Well, if there are no questions, I hope everyone on the East Coast is staying safe and warm and we can certainly end a little early.

telehealth pilot program

kickoff call

baseline survey results

physician liaisons

barriers

patient engagement

telehealth coding

improvement projects

FASFORM community

patient satisfaction