Introduction: The unprecedented COVID-19 pandemic has thrust telehealth into the center stage of health care, leading to a dramatic increase in utilization of telehealth services. The impact of telehealth on patient satisfaction during the current pandemic is yet to be fully understood. Objective: This study aimed to identify patient perspectives and behaviors toward virtual primary care appointments at a telehealth-naı¨ve institution during the COVID-19 pandemic and establish the rate of missed appointments to help guide future implementation of telehealth services. Methods: Patients at a primary and specialty care clinic, seen between March and May 2020, completed a survey analyzing nine commonly used satisfaction metrics. The rate of missed appointments was recorded and compared with analogous cohorts of in-person office visits. Results: The no-show rate of telehealth visits during the COVID-19 pandemic was 7.5% (14/186), lower than both the no-show rate of 36.1% for in-office visits (56/155) (p < 0.0001) and a pre-pandemic in-office no-show rate of 29.8% (129/433) (p < 0.0001). Surveyed patients who experienced telehealth visits (n = 65) had similar satisfaction compared with those surveyed who attended in-office visits (n = 36) in seven of nine metrics. No statistically significant differences were identified in the satisfaction metrics with telehealth visits performed on video (n = 26) versus the phone-only format (n = 38). Patients aged 65 years or over were less likely to have a video component to their virtual visit (1/12, 8.3%) than those under age 65 (25/44, 56.8%) (p = 0.0031). Discussion/Conclusions: Telehealth offers significant benefits for both patients and providers, strongly supporting its widespread utilization both during and following the COVID-19 pandemic.
Study Objectives: The American College of Emergency Physicians (ACEP) Geriatric Emergency Department (GED) Guidelines recommend the inclusion of geriatric-trained staff and geriatric equipment in the ED to provide optimal care to older patients. However, the Guidelines and the GED Accreditation process led by ACEP do not provide instructions on how to justify these increased costs to emergency departments. We modeled the costs of staff and equipment and propose a budgetneutral system for a GED. Methods: Average staff salaries including the cost of fringe benefits (30% rate) were obtained from a Midwestern hospital with an academic ED of 80,000 annual visits. Average payment for services provided was obtained from the hospital's billing department (geriatric consultations) as well as the 2019 Center for Medicare & Medicaid Services therapy reimbursement rates for moderate complexity therapy evaluations in a Midwest state (https://www.stratapt.com/medicare-fee-calculator). We assumed that all patients were insured by Medicare and/or Medicaid and that hospital personnel work 8-hour days with 4.5 weeks of vacation (237.5 working days/year). We used our ED triage numbers for January 2019 to determine the average number of patients per day who answer "yes" to the triage question, "Do you use a walker, cane or other device to help with mobility?" as an estimate of need for a mobility device while in the ED. Results: For staffing estimates, a nurse practitioner billing at an 85% reimbursement rate for unsupervised geriatric consultations would be budget neutral at 7.1 consultations in the ED per workday. A pharmacist stationed in the ED billing medication management codes for outpatient medication reconciliation would be budget neutral for salary costs at 7.7 consultations per workday. Physical and occupational therapists can also be budget neutral; however, payment for these consultations are generally included in diagnosis-related group (DRG) reimbursements for admitted patients, so not all consultations in the ED would be independently billable. For mobility equipment estimates, electronic medical record data from January 2019 demonstrated that 19% of patients endorse using a mobility aid at ED triage, or about 41 patients per day, with an average length of stay in an ED bed of 8.3 hours. Assuming uniform distribution throughout the 24-hour day, 14 patients would require a mobility aid at the bedside at any given hour.
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