demko ftp -wp 12.05.2014
TRANSCRIPT
Time for Telehealth: Critical Connection &
Foundational Cornerstone
Tamara Y. Demko, JD, MPH, ABDDirector, Florida TaxWatch Center for Health & Aging
Florida TeleHealth SummitWinter Park, FloridaDecember 5, 2014
The Promise of Telehealth
• Successfully used worldwide to deliver a full spectrum of health care services From pediatric endocrinology to emergency
management “Anything ending in –ology”
• Access to safe, appropriate health care when needed and before more costly interventions are neededReduction in emergency department
utilizationRural and non-ambulatory accessSpecialist consult as needed
The Progress of Telehealth
• World Health Organization – 25% responding countries have national telehealth policy/strategyMany more have telehealth programs (Mongolia,
Norway)Or use for specific topics (28+ countries use for
cardiology)
• United States21 states + Washington, D.C. legislatively mandate
private coverage 12 states + Washington, D.C. legislatively mandate
Medicaid coverage 43 states + Washington D.C. provide some level of
Medicaid reimbursement
Case-by-Case Building of ROIConvincing, But Fragmented
State System Telehealth Delivery
Patient
Condition(s) Metric 1
ROI Impact on
Metric 1 Metric 2
ROI Impact on
Metric 2
CO
Centura Health at
Home (CHAH)
integrated home telehealth
services with remote
monitoring and a clinical
call center
Congestive heart
failure, chronic
obstructive
pulmonary disease,
and diabetes Cost savings
$1000 and $1,500
per patient
Thirty-day
readmission rates
Reduced by 62
%
FL
Baptist Health South
Florida
eICU LifeGuard remote 24/7
physician monitoring Varied
Total Savings in 1
Year Snapshot
$15 million
($1,800/day)
Length-of-Stay (7 year
period)
Reduced 29%
ICU stay;
reduced 33%
hospital stay
FL
University of
Florida/UF Health
Florida Initiative in
Telehealth and Education
(FITE), videoconferercing
rural areas to UF specialists Diabetes (pediatric)
Total program
savings per year
(excluding
transportation
savings) $27,860
Hospitalizations of
children with diabetes
per year
Decreased
from 13 to 3.5
MA
Partners HealthCare
along with the
Center for
Connected Health
(CCH)
Connected Cardiac Care
Program (CCCP)
telemonitoring Heart failure Net savings $8,155 per patient
Heart failure hospital
readmissions
Reduced by 50
%
TX
CHRISTUS Health
System
Videoconferencing, home
monitoring (Remote Patient
Monitoring Solution (RPMS)
Pilot) Heart failure Cost of care
Decreased from
$12,937 to $1,231 Average admissions
Decreased
from 1.43 to
0.20
Florida Needs Telehealth
• Potential cost-savings = $1 billion with 1% reduction in charges across costly hospitalizations and emergency room visits (2012-13 AHCA data) –Critical Connections to Care
• Rapid population growth• Geographic disparities across 67 counties• Aging & disabilities populations• Public health preparedness• Emergency management access
Florida’s Efforts to Move Telehealth Forward
• Years of introduced legislation
• 2014 Legislative Session
• Board of Medicine
• Industry conferences and discussions
• Florida TeleHealth Workgroup
GAUGING FLORIDA’S STATE OF HEALTH
Population, Economy, Physical Well-being
Florida Compared: Demographics, Health, Business
FL CA GA NY TN TX VA
Population (7/2013) 19,552,680 38,332,521 9,992,167 19,651,127 6,495,978 24,448,193 8,260,405
Population Rank 4 1 8 3 17 2 12
% State Population 65+ (7/2013) 3,647,617 4,791,731 1,195,955 2,832,481 952,376 2,966,167 1,105,381
# Medicaid Enrolled in Thousands (6/2013 KFF - pre open enrollment data) 3,290.00 7967.7 1,536.30 5,141.70 1,305.60 3,644.20 851.4
Geographic Disparity (2012 report) 48 42 37 14 17 39 40
Disparity in Health Status (2013 report) 41 48 18 24 11 46 37
Chief Executive Ranking Best States for Business 2 50 10 49 3 1 11
CNBC Ranking Best States for Business 20 32 1 40 14 2 8
ALEC Ranking Best State Economic Outlook 16 47 9 50 19 13 11
Tax Foundation Ranking Business Tax Environment 5 48 32 50 15 11 26
Florida Lags Behind
American Telemedicine Association GradesCoverage and Reimbursement (C grade)
COVERAGE & REIMBURSEMENT
FL# States
Higher Grade# States Lower
Grade# States Equal
Grade# States N/A
*Overall Grade C 28 + D.C. 3 18
Parity Topics
Private Insurance F 21+DC 0 28
Medicaid C 24+DC 8 17
Medicaid Service Coverage & Conditions of Payment
Patient Setting F 38+DC 0 11
Eligible Technologies
F 22 0 26+DC
Eligible Providers F 26+DC 0 23
Informed Consent F 34+DC 0 12 3
Telepresenter C 36+DC 0 10 3
42+ Policy Decision PointsSpectrum of Options
Coverage, Cost, & Parity• Medicaid • Medicaid-Medicare dual eligibles• Patient costs• Private insurance coverage mandate• Private insurance parity vs. different
rates not comparable to face-to-face services
• State employee health plan coverage
Definitions, Locations, & Transmissions• Telehealth/telemedicine definition• Services defined• Distance/geography Restrictions• Originating site (e.g., clinician office,
home)• Distant Site• Live videoconferencing• Remote monitoring• Store and forward• Other permitted transmissions• Excluded transmissions
Policy Decision Points -Continued
Provider Related• Other health care practitioners• Out-of-state practitioners• Physicians/practitioners• Practice of medicine (what crosses into
practice)• Practitioner registration/telehealth registry• Practitioner sanctioning • Practitioner training• Prescriptions – Controlled
Substances/Legend Drugs• Prior relationship with patient• Professional Liability Coverage• Standard of care & quality of care• Supervision requirements• Telepresenter requirements
Technology, Privacy, Recordkeeping, Other• Equipment/technology requirements• Fiscal impact monitoring• HIPAA compliance/privacy• Informed consent• Interstate compact• Medical/health records• National licensure• Population Uses/Rules (e.g., prison
population)• Rulemaking Authority • Specialty Rules (e.g., eye care, mental
health)• State reporting (e.g., legislative, state
agency)• Statewide network• Venue/jurisdiction
Laying the Cornerstone
• Telehealth as foundational in health care delivery that works
• Long-term, sustainable health care system
Ability of licensed practitioners to deliver care
Ability of Floridians to get needed, timely care
TELEHEALTH CORNERSTONE CONFERENCE
What do policymakers need to know?
On what policy decision points can we achieve consensus?
What is needed to keep the discussion going while Florida refines decisions?
What barriers currently exist and how can we overcome them?
STATE OF THE NATION
American Telemedicine AssociationLatoya Thomas
Florida TeleHealth WorkgroupSoutheastern Telehealth Resource Center/
Florida State UniversityRena Brewer & Mike Smith
STATE OF THE STATE
3 Workshops – 3 LensesDifferent Angles for a Clearer Picture
• Lens 1, Subject Matter: Child health, aging & disability, access to care, chronic disease management/ emergent issues
• Lens 2 – Industry: Providers, practitioners, payers, business/innovation
• Lens 3 – Consensus-Building: Out-of-state providers, scope, financials, technology & innovation
Lunch Panel – How to Build TelehealthPolicy Discussion Highlights
Speaker Pro Tempore Matt Hudson
State Representative John Wood
Mike Smith – Florida TeleHealth Workgroup
Phillis Oeters – Baptist Health South Florida
Justin Senior – Agency for Health Care Administration
Dr. Mark Stavros – Florida State University
Tom Feeney – Associated Industries of Florida
KEY POLICY MESSAGES
• Not every issue requires legislation,
• There will not be consensus on all issues
• Top policy priorities going into the 2015 Legislative Session:
– defining telehealth/telemedicine and what telehealth success entails
– examining avenues for funding incentives and reimbursement
– revisiting logical and safe licensure options
– writing legislation to be technology neutral
KEY TAKE-HOME POLICY MESSAGES
– making it easier for practitioners who engage in telehealth
– leveraging existing technology (e.g., electronic health records)
• Legislation should – seek to make telehealth more available– avoid language that imposes arbitrary
restrictions – not detract from the current successful
provision of telehealth occurring across the state (First do no harm)
– consider the convening of an continuous advisory body while preliminary legislation goes forward
– Lay the cornerstone by moving on policy issues for which there is clearer consensus
NEXT STEPS: MOVING FROM CONFERENCES TO CORNERSTONE
It’s Time for Telehealth
Building ToolsRight Tool Depends on Job
• Policymakers– ROI data– Information & decision tools– Real people/constituents (bringing the message
home)
• Patients– Social marketing push/market demand– Safety & awareness
• Practitioners– Assurance of standards of practice within
specialty– Clear guidelines, including reimbursement
Building Tools• Providers
– Better understanding of costs (up front and long-term) & ROI
– Negotiating contracts & options
• Payers– ROI financial and outcome based
– Patient demand; contract demand; alternative business models
• Businesses & Innovators– Understanding of cost pass-through ESI,
utilization, & employee productivity
– Telecom successes, ROI potential
– Grant partners & contracts
Building Tools• Telehealth Champions (Everyone in this
room!)– Share your successes– Inventory & data collection– Find creative collaborations – Realistic policy expectations
• Walking before running• Getting creative• Avoid polarized silos • All-or-nothing bets
– Framing telehealth as win-win• Health care generally is zero sum• Telehealth can be uniquely different
Florida TaxWatch
Tamara Y. Demko, JD, MPH, [email protected]
Telehealth reports and conference materials are available at floridataxwatch.org