TELE-HEALTH VISITS

Effective Date: 
Wed, 04/01/2020
Revised: 
Mon, 01/04/2021
Policy: 

Telehealth visits are provided at UCSC Student Health Services to meet the needs of students who are unable or not recommended to have an in person appointment at UCSC Student Health Services.  Telehealth includes online contraceptive requests.

For Primary Care

This is a clinician-patient encounter conducted via tele-health whereby a patient is able to consult with a health care provider and receive medical advice, evaluation, and/or treatment to the extent possible given the absence of a physical exam. The appointment duration is limited to 20 minutes, although it can be extended to 40 minutes on a case-by-case basis. This encounter is for non-urgent medical concerns that do not require immediate assistance.

 

Types of telephone visits:

New medical concern
Follow-up of a medical concern that was previously evaluated through an in-person visit at the student health center.

 

This also meets the need for access to contraception via UCSC Student Health Services provision of 0nline oral contraceptives ( ocp ).  See separate policy and procedure.

Procedure: 

Patient access to telephone visits:

Web-booked: patient schedules a telehealth visit by logging onto My Health e-Messenger. 
Scheduler booked: patient interacts with a scheduler and a scheduler puts them in a specific provider’s schedule (for follow-up) or the generic telehealth provider schedule (for new issue)
Nurse advice line booked: patient speaks with a nurse through the nurse advice line and it is determined that the patient would benefit from additional consultation with a clinician. The nurse would book the patient in a specific provider’s schedule (for follow-up) or the generic telehealth provider schedule (for new issue).

  • Health care providers available for this encounter: physicians, NPs, and PAs
  • Eligible patients: enrolled students with UCSHIP - there is no co-payment
  • CruzCare and No SHIP will be charged a fee (see below)

E/M codes:  

  • Physician/QHP Telephone Encounter ( 5 to 10 minutes)    99441  
  • Physician/QHP Telephone Encounter (11 to 20 minutes)   99442  
  • Physician/QHP Telephone Encounter (21 to 30 minutes)   99443 

*QHP stands for “qualifying health care professional” which can be nurses, NPs, and PAs

Process:

  • Initial patient information is collected via patient questionnaire or via advice nurse. 
  • Patient completes telehealth consent in advance, but if this consent was not completed, the clinician will need to obtain this consent during the telephone visit.
  • At the appointment time and/or within 20 minutes of the appointment time, the clinician will contact the patient on the phone number provided on the patient questionnaire or advice nurse note. A total of two call attempts will be made. If the clinician is unable to reach the patient after two call attempts, the clinician will send a secure message to the student inviting them to reschedule the appointment. 
  • If contact is successful, the clinician will introduce themself and verify the patient’s identity using name and date of birth. If the telehealth consent was not completed on the form, the clinician will review the following points:
 I understand that I am to be evaluated using a telehealth visit type (i.e. telephone visit).
 I understand that I have the right to refuse this type of evaluation at any time during the appointment 
and am aware of alternatives to this type of evaluation (e.g. in-person visit at the clinic, going to 
urgent care, or going to an emergency department).
 I understand that there are limitations with this type of visit and that I may need further evaluations 
in the future.

The clinician will then proceed with the clinical encounter. During the encounter, the clinician will review medications, allergies, and problem list. 

If lab tests need to be ordered, the clinician will confirm with the patient which lab they want to use (e.g. on campus vs. off campus). If an off-campus lab is requested by the patient, the clinician will order the lab tests using the same procedure as for the on-campus lab (excluding in-house labs). Lab tests done off-site are limited to blood/serum and urine tests. No swab tests can be ordered if done off-site. The clinician would send a secure message to Health Information Management with the subject line “Outside Lab Orders.”  Health Information Management (Medical Records) will prepare a pdf copy of the lab requisition and will send the pdf to the patient via secure message. The patient would print out the copy of the lab requisition and bring their insurance card / app to the Quest Diagnostics lab location of their choice. The charge/cost for outside labs is subject to a $300 deductible.

If prescriptions need to be ordered, the clinician will confirm with the patient whether they want to: pick up the prescription from the campus pharmacy, have the prescription mailed by the campus pharmacy, or pick up the prescription from an off-campus pharmacy. If the patient would like the prescription mailed from the campus pharmacy, the clinician will confirm with the patient if they would like a 90-day supply (if clinically appropriate) and include “mail order” in the Comments section of the prescription. The clinician will confirm the patient’s mailing address if they would like the prescription to be mailed by the campus pharmacy. The clinician will confirm the name, address, and phone number of the off-campus pharmacy if the patient wishes to pick it up from a local pharmacy.  On-campus pharmacy copays are less than off-campus pharmacy copays.

If a referral needs to be submitted for a provider or specialist, the clinician will confirm with the patient whether they want to be seen within the Santa Cruz area or outside of the Santa Cruz area. The clinician would submit a referral using the usual process. In the “Clinical History/Referral Reason” section, the clinician would specify that the patient would like to be seen in xxx city/town. If it appears that the student may need to see multiple specialists (e.g. physical therapy, sports medicine, etc.), then submit one referral to “General Care.” This referral is a more flexible umbrella referral that covers primary care and different specialists. The “General Care” referral can also be submitted if a patient needs to see primary care in their area. 

If the patient would like to submit a photo to assist with clinical evaluation (example: facial acne), there are two options: 1. The patient can send the photo to Medical Records, using the secure message system in Health e-Messenger.

2. The clinician would send a secure message to the patient. The patient would then reply to the message and attach the photo(s).

After the encounter, the clinician may send a secure message to the patient to summarize the encounter, post patient handouts on the patient portal, and/or provide additional information (e.g. lab orders, prescriptions, precautions, etc.). If the encounter is straightforward and/or brief, this after-visit summary does not have to be sent or if sent, it can be brief.

The clinician will document the telephone visit using the “PC Telephone Encounter” template. A section can be inserted into the Telephone Encounter Template (e.g. UCSC Respiratory or Urinary Symptoms) to assist with documentation.  A diagnosis and E/M code are required. The clinician would select the E/M code according to the duration of the encounter (telephone call duration, care coordination, and decision-making). The clinician can use the check boxes in the Plan section of the chart to communicate what is needed to the MA.

LOGISTICS OF CHECKING IN THE PATIENT AND DOCUMENTING

When the clinician is ready to start the encounter, the clinician would right click on the appointment to “Check In” to turn the appointment red and then right click again to “Start Visit” to turn the appointment blue. With the appointment highlighted, the clinician would go to Open Chart (on the right upper hand corner of screen). The clinician would open the telephone encounter that is associated/attached to the appointment. 
After the telephone call and note are completed, the clinician would right click on the appointment to “Check Out” to turn the appointment green.

IF A PATIENT IS A “NO SHOW”

The clinician would document in the chart the two times the calls were made. 
Diagnosis would be “No Diagnosis” (this is a default option in template) and E/M code would be “No charge.”
The clinician would send a secure message to the student inviting them to schedule a new telephone visit if they would still like to be contacted. 
No show fees are not charged for missed telephone visits.

IF A PATIENT IS TAKING LONGER THAN THE ALLOTTED 20 MINUTES

The clinician has the following options: 

Notify the student that the appointment time is up and that additional concerns can be addressed through another telephone visit or in-person visit if more appropriate.
Notify the charge nurse that the current telephone visit is taking longer and ask the charge nurse to assign the next scheduled telephone visit to another clinician who may have an open slot in their schedule.