FAQ
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What is 'Rheum Without Walls'?
Incorporated in June 2021, Rheum Without Walls is a 'digital first' clinic whereby you or your family member is assessed through a fully enabled audio -visual experience utilizing Zoom embedded into a telemedicine-first EMR platform. It is also meant to be a shift away from the 'fee-for -service' model of care.
We are also the first of two nation-wide Beta -Testing practices for Rheumatology Tele-medicine accreditation by CMS's deemed agency ACHC.
Are patients able to be seen In-Person?
After the first virtual visit, you will discuss with your physician about follow-up. This can take the shape of either a physician or nurse house call or office visit. If you or your family member that you represent is non-ambulatory or requires costly care-takers for transportation, then a physician house call would be the preferred follow-up. Conversely, the doctor might offer to come to an office location for procedures such as ultrasound guided musculoskeletal diagnostics, aspiration or injection of joints. We also network with local orthopedic practices to arrange for more acute procedures if indicated. You may check our website for updates on office locations.
Do you infuse biologics in your office?
No. Rheum Without Walls is a deliberate shift away from fee-for -service. We believe in offering patients all the choices that they can utilize under their respective insurance plan including home infusions that are more convenient and safer given a 1:1 nursing ratio. Our office does not buy or bill for any drugs and does not profit from the sale of pharmaceutical agents. We are agnostic in our prescription practices and also agnostic about the site of infusion. Patient preference and convenience matters first. We are also less exposed to non-medical drug switching due to this stance.
What is non-medical drug switching: Non-medical switching is a strategy that Closed health insurer groups with in-house pharmacies and physicians or fee-for -service independent practices use to control their costs and maximize profits by forcing stable patients to switch from their current, effective medications to drugs that may not be as effective, for reasons unrelated to health. In other words,patients are forced to change medications for non-medical reasons, disregarding guidelines recommendation and patients’ individual needs. Where do your patients get biologic infusion therapies?
Are you a concierge type of practice?
No. We are not direct care or concierge medicine. Our patients are billed usual co-pays allowable under their insurance plans. We are contracted with most major insurance carriers. This list is updated periodically on the website as well. Although it is recommended that you verify your insurance independently as well.
Do you see uninsured patients?
Yes. We offer payment plans for self-pay patients. We keep a credit card on file for all our patients since we do not accept cash. We will occasionally accept payments by Check. We are also in the process of incorporating Crypto-currency payments via our website. This will be updated when available.
IF you are not fee-for-service and not concierge, how do you stay financially viable?
Removal of Policy Barriers post -covid and ongoing support of these policies has enabled efficiencies through technology evolution and remote monitoring capabilities. This allows us to remain lean and remove inefficiencies often found in larger health care systems. We are also engaged in conversations with growing firms that are focused on 'thinking differently' and have successfully managed delegated risk contracts. As a young startup, we are also realistic about managing these expectations and understand that a switch from Fee for Service to Value based care, especially in specialty care is still a couple of years from maturation. But the journey has just begun.
It is also now a well established fact throughout the tragedy of Covid Pandemic that fee-for-service models of care are mired in health inequity oftentimes locking out socioeconomically disadvantaged populations. Health care systems and private offices would preferentially fill up available clinic hours with more lucrative payers, often creating systematic biases in health care.
How are you moving away from 'Episodes of Care' to ' Risk Mitigation' strategy?
By moving away from Episodic care whereby you see a physician for 15 minutes only to be placed on a preferred formulary drug, our platform utilizes PROMs [Patient Reported Outcome Measures] with the help of our case managers that informs us of 'Emerging Clinical Risk' and allows us to intervene in a more intelligent and timely manner. To this end we are building collaboration with a network of therapists , rehab specialists and addiction specialists.
Dr. Salahuddin is also engaged with PainPremier[TM] , first launched at Johns Hopkins clinics to co-create RheumScored[TM]. Our patients are on-boarded after physician visits.
What is TeleHealth Equity?
Tele-health is NOT about going paperless or 'turnkey' solutions as seen during the pandemic. Structural changes are required in the design of the practice including payor contracts to allow for this model of health care delivery. It is not about technology or devices alone.
We know from PEW research that underserved communities do not have broadband but do have mobile devices which can be a means to democratize healthcare. Sometimes a video visit is necessary as well. But utilizing case managers that can reach across the digital divide and can patiently gather information on social determinants of health outside of the physician appointment in our principal care management platform is useful in that regard. This is why our physician visits are followed by a case manager review and phone call to our patient. We have a dedicated bi-lingual speaker who is also receiving ongoing training in measures of healthcare inequity and we are sensitive about building trust. Rheum WIthout Walls is a member of both 'tec' and NDIA where we advocate for increased broadband access as well as technology and device access for patients.
Do you share patient data and records?
At 'Rheum Without Walls' we believe in digital democratization and the patients' first 'right' to their medical charts and notes. They should have direct, free and unhindered access to their records without fear of intimidation or hurdles. Patient data that exists within various pools of health care systems is often locked in by these systems to preserve their monopoly. This is however changing quickly and will likely see legal structural reform in the future. We are advocates for open notes and have invested in exchanging our database with our local Health Information Exchange. This is an ongoing process and we are committed to making the exchange perfect so that any provider engaged in caring for our patients be it their primary care physician, other specialists etc.. have access to patient records.
Open exchange of records helps us build trust and safety in care. If our patients seek second opinions or are enrolled in research trials at academic university settings then we help facilitate that while they continue their care with us on an ongoing basis. We advocate for more Health Information Exchanges to Exist which will give power back to the patient and their independent, autonomous providers. We are open to engaging in dialogue with clinical informatics and private equity firms that espouse similar values.
Where do your patients get biologic infusion therapies?
We work with local hospitals, office infusion suites and also 304B centers to get our patients the drugs they need. We differentiate ourselves in being able to get patients' infusions at home as well. We believe in improving access to care, broadening patient choices and offering greater convenience. Patients have self-injected biologics for 20 years at home and CMS is clearly recognizing the importance of 'home infusions' as well which are safer for patients and reduce the overall burden of health care on society. Most infusible drugs now have either self-injectable or oral options available. There are also conditions whereby it is safer for patients to be infused at homes such as following C-difficile colitis or infectious complications in hospital. Home infusions are not new and existed pre-covid pandemic as well. But oftentimes patients are not made aware of these options and do not know to ask.
Who evaluates and creates a plan of care for your patients?
Our clinical visits are conducted by Board Certified and fellowship trained MDs. Case management and LCSW work is conducted in between MD appointments. At this point we do not have mid-level providers. If you are a Board Certified Internist or Fellowship trained in Rheumatology , Pain Management or Addiction then we look forward to connecting with you as we anticipate future growth.