Health Law Talk

Introduction (00:01):
Welcome to Health Law Talk, presented by Chehardy Sherman Williams health Law, broken down through expert discussion, real client issues and real life experiences, breaking barriers to understanding complex healthcare issues is our job.

Conrad Meyer (00:23):
So I guess when this is a new extension that we’re looking at here on Medicare telehealth, is that what I’m looking at?

Rory Bellina (00:32):
Yeah, yeah. It came out just a few days ago. I think it was set to expire back in, well now we’re in March, so it was set to expire at the end of this month and everything, not everything, but the majority of what was being extended during the Covid pandemic time has now been extended again. So I’d love to just jump in and talk about what the extensions are and what they mean for different providers. But

Conrad Meyer (00:59):
What happened before though, wasn’t this the COVID-19? I mean, when they amazingly cut through the red tape in a week.

Rory Bellina (01:07):
We’ve talked about that so many times and how much a lot of our providers and us particularly, really liked all of the waivers that they gave during covid because if you remember before, for so many different things, you had to go in person to get these different services or there had to be documentation of in-person visits, some things had to be done, even if it was like a televisit per se. You had to have video, you had to have two-way communications and then Covid hits, and there was kind of a, like you said, cutting the red tape. I think access for patients was really good during that time.

Conrad Meyer (01:50):
I just find it amazing if there’s been no fraud and abuse. If we look at the,

Rory Bellina (01:56):
I’m sure there has. I’m

Conrad Meyer (01:56):
Sure there has been. I haven’t followed it, but I mean, if there’s been no fraud and abuse and this has worked

Rory Bellina (02:00):
Well

Conrad Meyer (02:01):
And now we’re what, five years past covid?

Rory Bellina (02:03):
Five years.

Conrad Meyer (02:04):
Five years?

Rory Bellina (02:05):
Yeah, we just made the five year anniversary.

Conrad Meyer (02:06):
So why are we ruining a good thing? I mean, what’s the basis for this? Why are we going back to the old regime, I guess if it’s worked

Rory Bellina (02:17):
And Yeah, I don’t know the reason for extending these extensions. I think that those are conversations that we’re obviously not a part of. Those are all happening in dc but I think that my speculation is that the government CMS, these different agencies are seeing that it’s working, that these allowances that they’ve put in place have been working really well for patients.

Conrad Meyer (02:42):
Well, it wasn’t just telehealth. I mean, for example, I think I did something recently for remote monitoring I think on that and whether or not you need to be direct or general supervision. And so I think that came into play. But this is interesting because I, I remember a client of mine calling me and saying, oh, this is going to sunset coming up in March.

Rory Bellina (03:06):
Right, right.

Conrad Meyer (03:07):
And what’s the answer to the question? And the answer back just a few months ago was, well, guess what? March it’s going to go away, so we’re going to have to go back to the way it was, and now it looks like we get

Rory Bellina (03:18):
To go through September. Now another, I think we have another six months on these,

Conrad Meyer (03:21):
But why are we doing this? Really? I mean, six months I feel like we just, Hey, let’s do another six months. You know what? Let’s do another six months. Why not just say if it’s not broke,

Rory Bellina (03:31):
Have we, has the government had enough time to say, let’s just make these permanent.

Conrad Meyer (03:36):
Can we doge this? I don’t know. It is so stupid. If it’s working, there’s no fraud and abuse. Everyone likes it. It gives access to patients. Why are we taking it away?

Rory Bellina (03:48):
I think that there is so much politics involved in this on the national level, and my speculation is that with the new Trump administration that’s come in, there was, if you think of when that administration started in the end of January to now, that was really only two months to figure this out, and we’ve got a new director of HHS and then we have a new secretary.

Conrad Meyer (04:11):
Yeah, but do we really think Kennedy knows what this is?

Rory Bellina (04:14):
Well, that was my point. My point is that he’s,

Conrad Meyer (04:17):
You think Robert Kennedy, I like the guy, but do you think he knows what this is?

Rory Bellina (04:23):
That’s my point. You’re stealing my thunder. I make it No, no, no. To do that.

(04:28):
That’s my point is that he’s probably really only been in office for a month and has a ton of homework and things to catch up on, and I think that he and his team and CMS, they have a lot of new people at CMS, they’re having to catch up on, okay, what are these extensions? What was given? What’s working, what’s not working? These were set to sunset this month, March. We don’t have enough time to figure out are we going to let them sunset, so let’s give it another six months. So my speculation is that probably when this sunsets, then maybe this is the time period that they need to work to make these extensions more permanent.

Conrad Meyer (05:09):
Well, if you look, I mean they had something with this telehealth modernization Act of 2024. I guess it died. I mean, I don’t know what happened with that, but that was a permanent fix. But I’ll be honest with you, I haven’t looked at it. I mean it, is it dead? I mean, did it die in committee? I mean, I don’t know, but are we going to see a new push in 2025 for maybe?

Rory Bellina (05:30):
I think that a lot of the big healthcare organizations are going to push to make these things permanent, and now that there’s the new administration in, they’re going to use their connections and their lobbyists to make these things permanent. There just wasn’t enough time to do it between January 20th and now March 21st. So they’re given another six months. But so

Conrad Meyer (05:49):
What does it do? I mean, I know we have a general idea about what it does, but

Rory Bellina (05:53):
I mean, I think overall the thought behind all of this, if we go back to 20, was easier patient access to providers, especially in rural underserved areas. And these extensions are going to continue to allow that like they did during covid. I know one of the big ones was the telehealth services. A lot of times pre covid, we’ll say there were those geographic and site restrictions on if you needed a service or a prescription or whatever it may be through telehealth. You could only be in certain geographic rural restrictions where you just didn’t have access to a provider or your access to a provider was physically so far away that geographic and site restriction was essentially lifted. So you could still get these services, but anyone could get them. You didn’t have to live in such a rural area. And I think that that was a big draw and has continued to be a big draw to get patients access.

Conrad Meyer (06:55):
I can see that. I would like to have to give the patients, I think patients like it.

Rory Bellina (07:01):
Absolutely.

Conrad Meyer (07:01):
I think if you were to poll patients on everything from not just telehealth, but mental health, mental telehealth, having the ability to stay at home and hop on a video call with a provider who is able to provide that in-home care, who doesn’t like that?

Rory Bellina (07:20):
And if you think of the efficiencies that if NAB would’ve been put in place with Zooms, Skypes, Google meets everything that they’ve allowed to be used, as long as it’s secure, you’re now able to see so many more patients. And do you really need a patient driving 30 minutes into the hospital to see their internal medicine provider because they’ve got a sore throat or they’ve got some sort of virus and they need a Z-Pak. Do you really need them to come into the hospital to wait to go through a triage for a check-in, then get put in a waiting room, have the nurse come in and do a set of vitals when most of that, if nothing has changed and the doctor is comfortable with that, they could just do a video visit with you or even audio just in some cases and say, Hey Conrad, what’s going on?

(08:08):
You’ve got a sore throat. You’re congested. Let’s start you on this medication and you’re in and out in five minutes. The patient, it’s great because the patient didn’t have to take off of work, drive in, do that visit, wait through all those steps, leave, get the prescription. Now it’s you do the visit from your home or your office. You say, what’s going on? The doctor scribes it over and on your way home from work, you pick up your medication and no one really misses a beat from the provider side. I think they’ve loved it. I’ve talked to a bunch of providers and a lot of them really, really like these telehealth visits because they still have their in-person visits for things where they need to touch the patient per se. But for these simple things where they could just do it over the phone or over a video call, I think they like it. I think that it streamlines their day. Now, the administration probably of the hospitals loves it. They could fit more patients in and you just have a doctor in his office doing these visits and talking about what’s going on, making the script, and then they could go on and do from a volume perspective, they could do a lot more visits.

Conrad Meyer (09:16):
Well, I think it’s interesting to see the board’s perspective of this and how that has evolved. Because I remember, gosh, I mean what, eight, 10 years ago? I mean, I think you still need a special purpose telemedicine license if you’re out of state, but I think the initial visit had to be an in-person visit, and then the subsequent treatment plan that’s changed, that’s changed.

Rory Bellina (09:42):
The initial visit can now be virtual,

Conrad Meyer (09:43):
Can now be telehealth. Right. And I remember looking at that. I said, man, and that was purposeful. I think that was purposeful because they wanted to keep the home turf and keep the home docs. And I get that. I do. I get it. But I think it shows me the evolution of where the board has looked at technology and patient interaction and has seen the light. But I think still it’s interesting to see, I haven’t seen it yet because I know from talking with the investigator at the board level here in Louisiana, we had a conversation about this. The standard they’re going to hold all these providers to even the special purpose telemedicine license guys out of state is that your initial visit needs to have the same standards as if it was an in-person visit. Okay, now that’s a good point. But my question is how do you do that when you don’t have your blood pressure cuff? You don’t have your scope or otoscope, you don’t have your stethoscopes, you can’t listen. So I think someone needs to have a real conversation in the room saying, well, that’s really not going to happen.

(11:00):
But anyway, but I get it. I like the legislation. I just think that how much time are we wasting? If these measures are really good, why not just make it permanent, cut the red tape like you did in covid? Because I mean, think about that. Think about the amount of time it takes for these bills to get passed and all the comment and the end committee and that committee when Covid hit and this came out, they did it in what? A week? A week. So why do we have all this crazy inefficiencies? So just do it. Just do it.

Rory Bellina (11:38):
I don’t think that the board is going to be,

Conrad Meyer (11:41):
Not the board, but the feds, the feds on CMS side because if they do it, the commercial payers will follow and then the state and their board will follow. So everything, I hate to say it. I mean everything is led by the Fed.

Rory Bellina (11:55):
I think that it would be too complicated, and I don’t know how a federal agency or even a board could come up with a list to say, here’s the things you could do through telemedicine, and here’s the things where you need an in-person. I think that that would take forever to get figured out.

Conrad Meyer (12:13):
No, just let it go. Just open it

Rory Bellina (12:15):
Up. I think ultimately what a lot of the state’s boards do, ours as well, Louisiana as well, is they ultimately say, okay, Dr. Conrad, if you’re saying that you are meeting the same standard virtually, then you would be If the person is in person and you’re comfortable and you’re willing to put your license on the line that you did a visit and you evaluated that patient and all they need is a zpac for their sinus infection. If you’re comfortable with that, then, but if you think for any reason that this person needs to come in to be seen and you can’t write that script through a visit and then scribe it over, then again that’s your call. I think it would be too granular.

Conrad Meyer (12:59):
So put it back in the doctor.

Rory Bellina (13:00):
I think that’s what they’re going to have to do. I don’t think that they Well,

Conrad Meyer (13:03):
I agree with you. I think I totally agree with you. So in other words, it’s more just because we want doctors to have autonomy, then put it back on them and say that if there’s an adverse outcome,

Rory Bellina (13:14):
You have to make the call

Conrad Meyer (13:15):
And you did a telehealth visit, or you’re in the actual visit, you’re on a zoom call or whatever medium you’re using, and you realize that, man, I really might need to see this patient in person. You as the doctor need to make that call.

Rory Bellina (13:31):
That’s your call.

Conrad Meyer (13:31):
That’s your call. And if you don’t do it, then we’re going to fault you.

Rory Bellina (13:35):
I don’t think, yeah, I don’t expect to ever see a list. I’d be really surprised if I would because it would be similar to the

Conrad Meyer (13:42):
I can do

Rory Bellina (13:43):
That. Yeah, it would be similar to the medical marijuana things where it started with a list of, here are the

Conrad Meyer (13:50):
14, how silly that is. Here

Rory Bellina (13:52):
Are the 14. I got to tell you that.

Conrad Meyer (13:53):
That’s so stupid. The whole thing with medical marijuana is stupid.

Rory Bellina (13:56):
Well, that’s going to be another, we got to talk about that another time’s.

Conrad Meyer (13:59):
So should people just pay the $200 and they get their medical marijuana? It’s like getting marijuana, but you have to pay a gatekeeper.

Rory Bellina (14:06):
It’s stupid. But think of how that started. It’s so stupid. Think of how that started in Louisiana. It started with, if you

Conrad Meyer (14:12):
Wanted

Rory Bellina (14:13):
Therapeutic marijuana, there were 14 things you can get it for, and that was it. And then that evolved. Well, now it’s anything that evolved. And they added a catchall, I think it’s number 16 in Louisiana.

Conrad Meyer (14:25):
I don’t even know what that is.

Rory Bellina (14:25):
And it was basically anything that the doctor believes would need it for. Can you do a

Conrad Meyer (14:30):
Telehealth visit to get medical marijuana?

Rory Bellina (14:32):
Yes. Therapeutic marijuana. Are you kidding me? Are serious? Absolutely

Conrad Meyer (14:34):
Serious. I didn’t know that. Yes, absolutely you can. How in the world is anybody? I mean, look, I don’t do drugs in Louisiana, but

Rory Bellina (14:39):
Therapeutic. But

Conrad Meyer (14:40):
Yeah, how in the world is anyone in this entire state who really, if they really wanted a gummy or the whatever, not paying the $200 to get a script, they can do that

Rory Bellina (14:52):
Well in the

Conrad Meyer (14:53):
Like a $200 screening fee or something. I mean, the doctors would make it back on this.

Rory Bellina (14:57):
It’s cash only because you’re not billing insurances for it. Yeah, that’s

Conrad Meyer (15:00):
Correct. And you could do it by telehealth. I mean, you could literally have 50 patients in a day line up and you could Wow.

Rory Bellina (15:07):
But it goes back to the doctor does the visit and says, Conrad, what’s going on? I can’t sleep. I’ve got anxiety. I’ve got back pain. Whatever it may be. The doctor’s comfortable with it. And they write that in Louisiana recommendation. It’s not a script, but they make that recommendation for therapeutic marijuana. Ultimately, if anything goes wrong with that patient, the board’s going to come back and say,

Conrad Meyer (15:34):
I would love to know the pmp. Run the PMPs on the prescriptions by those docs for the medical marijuana to see how many they do a month. It must be staggering. Literally must be out of this world. They have these little clinics, and that’s telehealth. So now you can do it by telehealth if you want.

Rory Bellina (15:56):
Oh my God. Yeah.

Conrad Meyer (15:57):
That’s just amazing to me. So one thing, anyway, I’m getting off. I’m, I’m going over route here.

Rory Bellina (16:03):
Shifting from the benefits that the providers, the physicians have,

Conrad Meyer (16:08):
Well, the patients have the benefit too.

Rory Bellina (16:09):
The patients absolutely have the benefit, but it’s expanded also to ancillary services. So I think those are even harder to do through telemedicine, but it even expands availability for PTs, OTs, speech language pathologist, those could all be done via telehealth.

Conrad Meyer (16:27):
How do you do PT and telehealth? Help me understand that. I get it. I mean, you have to physically be with the patient, right? Pt, ot, I mean, I get it. Maybe to checkup on ’em and say, oh, did you do your leg lifts? I mean, I guess so.

Rory Bellina (16:40):
But

Conrad Meyer (16:41):
I mean, I like convenience. I want it in the home. I like it. I think it’s good. I think it helps people, especially people who might not have the access. Now you’re giving them access. I would just like to see if the fraud and abuse side, in other words, which has been

Rory Bellina (17:03):
Unsurprisingly quiet, that we haven’t seen a lot of OIG. We’ve seen some

Conrad Meyer (17:09):
With telehealth.

Rory Bellina (17:10):
With telehealth, and we see what we find out about the cases that the OIG G publishes, and we see the cases that make a big splash in the news where this practice was seeing 500 patients a day and they were just churning them out. And there’s fraud, waste and abuse in those cases. But I think that for a lot of these, if you’ve got a speech language pathologist and you’ve got a child or an adult who has speech problems and they’re able to do a video call with that patient and that patient is far away and maybe can’t get into the clinic and they’re able to get that same therapy as if they were in person, I think that that seems to work. And that’s been fine. They’re continuing the reimbursement for audio only visits. So again, adding access for a while, it had to be video, it had to be live video to a communication. Some patients don’t have a smartphone, some patients don’t have a computer with a camera

Conrad Meyer (18:10):
Are, wait a minute, wait minute. Are we still calling telehealth audio only phone calls?

Rory Bellina (18:15):
I think

Conrad Meyer (18:17):
The definition of

Rory Bellina (18:18):
Change the phrase telehealth, if you ask 10 people, you’re going to get 10 different definitions on what

Conrad Meyer (18:23):
Telehealth is. No, but I’m talking about in Louisiana for the definition of telehealth, does it include audio only?

Rory Bellina (18:27):
Yes. I did not know that. Yeah.

Conrad Meyer (18:29):
Wow. Okay. I thought that was exempt from that.

Rory Bellina (18:33):
No, there’s audio only allowed services via telehealth.

Conrad Meyer (18:37):
Okay, well lemme throw this out at you. So what happens if I call my doctor and say, look, I need to get a script for whatever, I need a Z-pack because for whatever, blah, blah, blah. Would that be viewed as a telehealth visit or is that just me calling to get another script?

Rory Bellina (19:02):
I don’t know the answer to that.

Conrad Meyer (19:03):
That’s a tough one, isn’t

Rory Bellina (19:04):
It? Yeah,

Conrad Meyer (19:05):
Because I mean, there’s no video.

Rory Bellina (19:06):
There’s no video. But it’s

Conrad Meyer (19:09):
Because before, and I dunno if that changed before that was considered not a telehealth visit.

Rory Bellina (19:15):
Yeah, I’m not sure. I think there’s in

Conrad Meyer (19:18):
That it’s not relevant,

Rory Bellina (19:19):
But I think there’s on, is it a refill versus a new visit and you’re just talking to the doctor on the

Conrad Meyer (19:23):
Phone, but this right here, I think this what we’re talking about, this extension that just got passed from the six month thing, I think get the people in the room that make the decisions to decide are we going to make this permanent or not? Because I think this is just what are we going to do in six months from now? Do another six months.

Rory Bellina (19:45):
I think we’re going to see more permanency in this. I think that right now they just needed more time. Think of the benefit it’s given though to mental health patients that again, didn’t have the time or access to go in for an evaluation or a visit with their psychologist or psychiatrist, and now they can do that from home or from work. I mean, think of how beneficial that’s been. I mean, that’s a big one because those visits aren’t quick. Those are 30, 45 minutes an hour. Now if you can do those virtually and you don’t have to go to the clinic, wait in the waiting room, same thing. Wait to see your psychiatrist, a psychologist for a check-in, and now you could do that virtually. I think that’s great.

Conrad Meyer (20:30):
I

Rory Bellina (20:30):
Think so too. I don’t have any reservations or issues with that. I really don’t. The eligibility criteria that’s been expanded on for what can be done for this, I think has been really good. I think overall it’s been great. What do you

Conrad Meyer (20:51):
Mean by that? I’m excited for it. You mean in other words, more providers coming into the fold for telehealth?

Rory Bellina (20:58):
Yeah, absolutely. I think that when you looked at providers pre covid where they could only see a patient and you had to carve out 30 minutes for them and then you had to build in the waiting time, it clogged up a lot of systems.

Conrad Meyer (21:13):
You mean the inpatients?

Rory Bellina (21:14):
Yes. Now the fact that you could line them up through telehealth visits and they schedule at their convenience, I think that’s been great. I don’t know any providers that have really complained about it.

Conrad Meyer (21:27):
I’m just waiting. I mean, wouldn’t it be interesting to see if technology comes as far Rory as there’s some sort of a certified home health kit, meaning in other words, a blood pressure cuff, not like something you put on that connects to your wifi that when you can go ahead and do the telehealth visit, that the doctor can assess your blood pressure. He can listen to your lungs, he can take your temperature, he can get basic vitals and use that and somehow, so that way if you wanted the kit, you can just order it off of Amazon and it’ll link to your provider. And so that way, that’s got to be happening. Now. I can’t believe we don’t have the ability to, I mean, we have to sure have this so that way. I know that one point, I saw this, they were going to have these mobile stations, telehealth stations

Rory Bellina (22:23):
Where you go in and do those. We

Conrad Meyer (22:25):
Just go in and it was like a booth, like your old phone booth. But then in the booth they got all this whizzbang stuff and you can do telehealth visit in the mall if you

Rory Bellina (22:32):
Wanted.

Conrad Meyer (22:34):
That never took off. I don’t see ’em. Maybe they someplace they did. I don’t know. But I think I agree. I would like to see this become more evolved and I would like to see this become more expanded because I have a feeling that the in-home or the home care model of you wanting to have care in your house is going explode, especially with the boomers. I’m going off a little off topic here, but I’m watching humanoid robots. How is that going to affect long-term healthcare in the long-term home health industry? Right. I mean, so combine that with telehealth and remote visits. I mean, you could technically have everything taken care for you in your house

Rory Bellina (23:25):
Forever.

Conrad Meyer (23:25):
You’ll not need to go to assisted living. You’ll not need to go to a nursing home, if you will. You could stay in your house.

Rory Bellina (23:34):
Right. It’s been surprising for me that we haven’t seen much pushback from the payers and push aside CMS on that because they’re on board with us right now, or they have to be on board. But I haven’t seen pushback from the Blue Crosses, the Aetnas, the Uniteds, Cigna.

Conrad Meyer (23:54):
I’m sure it’s there. I don’t know. We’ve seen, I haven’t seen it. I haven’t asked though, but

Rory Bellina (23:59):
I would even ask. I would’ve thought that if, we’ll say Blue Cross in Louisiana, it’s one of the biggest payers here, one of the biggest non-federal payers here in Louisiana. I haven’t seen real concern or pushback from them on this. Now, it could be because they’re able to now. I mean, they’re paying more for claims because there’s more claims out there because more patients are doing these telehealth visits, but maybe they’re seeing a better return on it. Maybe it’s keeping their patients healthier, so they’re having to pay out less in the long run. Five years is a long time, but we don’t know the long-term effects of all of these visits is the availability of a patient to be able to go in and see a provider and get a prescription for a Z-pack virtually. How does that pay off in the long run from that patient developing something much more serious years down the road where Blue Cross is going to have to pay out a lot more?

(24:59):
Or if you think of the instance of a patient that schedules a telehealth visit and says, Hey, I know I can’t get in to see you in person for six months, but I was able to get this telehealth visit. I’ve got this lump in my neck and I’ve noticed it. It’s gotten bigger. I really don’t know what’s going on, but I just wanted to call and tell you through the telehealth visit that doctor is going to say, let’s go get you in for imaging right away, and then let’s reevaluate if they’re able to catch that tumor or that cancer, whatever it is on a lot earlier stage and not have to pay out oncology claims 5, 10, 15 years later. I think that’s a benefit to the payers. And I think that maybe they’re thinking that getting more access sooner, access quicker and easier access for their beneficiaries, essentially you and I, that they’re looking to see that this is going to save them money in the long run, what they care about

Conrad Meyer (25:52):
Ultimately. Well, I get that. I mean, but you can take that example right there and turning into a diabetic, a pre-diabetic, and you could have life coaches, telehealth, life coaches, telehealth, fitness coaches, dieticians, all those things. And you could even do online shopping now. So you could put everything in telehealth if you wanted to.

Rory Bellina (26:14):
You could

Conrad Meyer (26:14):
And have it monitored in a program that is a comprehensive, I think Blue Cross does this already, and I forgot what they have a name Omega, I think it’s called the name. I don’t know. But I’ve never done it. I’ve never seen it. But I mean, I think you could utilize this. I don’t think it’s going away.

Rory Bellina (26:33):
Not going away. I don’t think It’s not only going away. I think it’s going to get more and more courage. Courage. My wife, for example, recently switched insurances and went from one, I think it was maybe United to Blue Cross or Blue Cross United. I don’t know which way it went, but she got her typical cards that we all get in the mail, but then she got another set of cards, and it was like a third party company. I think it was Teladoc or something like that.

(26:57):
It was encouraging her for simple things. Now these are all doctors that the insurance company has negotiated a race with, but they give you a website and essentially what your account number is. And they say, if you’ve got something simple and you don’t think you need to go to the hospital for it, use our service, use these teladocs that we have, maybe we can catch it earlier. I think it’s saving the insurance company’s money because they’re not having to pay a hospital bill for an inpatient visit to a hospitalist. They’re able to sign you up with one of their teladocs, and it’s a cost savings for them too. So I think that’s another reason why I think the insurance companies are embracing it and why we’re not seeing pushback from them.

Conrad Meyer (27:39):
I’d like to see on the flip end of that, on the other side of the provider side. In other words, are we watching provider revenue decrease because of this? In other words, if you’re not seeing patients and you’re not doing active test, is there ancillary revenue decreasing? I’d like to see. I haven’t analyzed that, but I guess it would be

Rory Bellina (28:00):
Are not, are the providers, make sure I understand the question. Are the providers in the hospitals not making as much money because you’re

Conrad Meyer (28:08):
Now a telehealth,

Rory Bellina (28:09):
You’re doing a visit and it’s a script for a Z-Pak versus you going into the hospital, you’re getting a hospital bill, you’re getting a lab bill,

Conrad Meyer (28:18):
Or just your e and m visit. I mean, can you code a low? I am sure you have to code a lower level e and m visit on a telehealth than you would, and I mean potentially in person on an EM level. So I like to know how that looks on the provider revenue side. I haven’t asked anybody, but I guess you would counter that with the volume.

Rory Bellina (28:39):
That’s what I was going to say. I think that more patients, whatever loss of revenue there is from not getting all of those services, getting that in-person bill, getting that lab bill, I think that is offset by the volume of, yeah, Conrad scheduled a telehealth visit. We did the visit. He complained that he was having a sinus infection. We prescribed him a Z-Pak virtually. It was already at his pharmacy that afternoon. We didn’t make as much money on Conrad during that visit than we would’ve did in 2019 pre covid. However, we were able to see four Conrads in that same amount of time. We were able to see four patients just like Conrad with simple things where we didn’t need all of that in that same period of time. And so I think that the loss of revenue is probably balanced or even outweighed by the more visits you’re able to get in. And I think that that is, and since we’ve shifted and we’re talking about cost now, cost savings, well, we’ve gone

Conrad Meyer (29:48):
All over the place.

Rory Bellina (29:49):
I

Conrad Meyer (29:49):
Get it. I get it.

Rory Bellina (29:50):
But think of the cost savings, Conrad, if you’ve got a doctor sitting in a room like this who’s just knocking out these telehealth visits, think of the hospital cost savings of, you’re not incurring as much front desk staff. You’re not incurring as much MA costs or RN cost to do.

Conrad Meyer (30:08):
Oh, no, I get that. I get that. But what does that, I’m looking at it from the provider eyes. In other words, if I’m a doc and I’m trying to make money and I am used to a certain standard of living, and I’ve gone into this and I’m watching my revenue decrease consistently,

Rory Bellina (30:24):
I don’t know if it’s decreasing.

Conrad Meyer (30:26):
I dunno, answer to that. Think it’s not decreasing. Curious. I’m trying to look it from their

Rory Bellina (30:30):
Eyes. Yeah, I think it’s not decreasing because it’s made up by the volume.

Conrad Meyer (30:34):
I would love to have someone on the show to tell me this. I would love to

Rory Bellina (30:36):
Find out how their practice has

Conrad Meyer (30:38):
Changed. Yes, yes, yes. Maybe we could try to work on that.

Rory Bellina (30:42):
I’ve got some people, I think that would be good. I know some providers, some internists, hospitalists that we could get on to discuss what was your practice like pre covid when your day was lined up with 50 patients and you had to see those 50 patients every six minutes, turn those rooms, get them in and out. Verse now you see a hundred patients. You’re not coding as high of a charge, but you’ve got more of them. Has that really affected your revenue? You can get some people to discuss

Conrad Meyer (31:14):
That. I’d like to see that.

Rory Bellina (31:15):
Yeah. But overall, I was excited to see this. I think our clients are excited to see this.

Conrad Meyer (31:21):
I agree.

Rory Bellina (31:23):
Again, besides the outliers that are defrauding, but that’s going to happen all the time. That’s really nothing New. People that want to find a way to beat the system, they’re going to do it regardless. So I think overall, this is a good extension and I’m excited and hope that it’s put in a permanent place.

Conrad Meyer (31:42):
I think so. I mean, only time will tell. We’ll figure it out. Time will tell. And you know what? Let’s work on getting someone here, because I think honestly, getting someone to tell us the financial impact and maybe, you know what? I can reach out on the payer side. I think I know somebody on the payer side or someone in

Rory Bellina (32:00):
The hospital admin side.

Conrad Meyer (32:02):
That would be really interesting. I want to know, you know what? I really want to know how hospitals, right, and systems have implemented telemedicine within the system, right? I mean, do they have dedicated rooms that docs can use at the facility? Are they letting them do this at the house? I mean, I don’t know, but I’d be very interested to see how hospitals, because most physicians are employed now, so what are the systems doing to embrace telehealth? And we’ll see six months from now, who knows? I don’t know what’s going to happen. Maybe somebody in HHS will say, Hey, this is a smart idea. We’ll continue it permanently. We’ll see

Rory Bellina (32:43):
All. Alright,

Conrad Meyer (32:44):
Until next time,

Rory Bellina (32:44):
Let’s wrap it up.

Conrad Meyer (32:46):
Alright.

Introduction (32:49):
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