telemedicine – the virtual experience april 2017 · uber vs. taxi amazon vs. retailer netflix vs....
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u Telemedicine – The Virtual Experience
u April 2017
Telemedicine vs. Telehealth
u Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status.
u Telehealth The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.
Source: Health Resources Services Administration
Telemedicine vs. Telehealth
Telemedicine is real time two-way audio video communications and includes the application of video conferencing and store-and-forward.
Telemedicine vs. Telehealth
To facilitate the assessment, diagnosis, consultation, treatment, education, and self management of a patients healthcare
Disruptive Technology
New ways of doing things that disrupt or overturn the traditional business methods and practices
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Uber vs. Taxi
Amazon vs. Retailer
Netflix vs. Blockbuster
Telemedicine vs. Clinic
Competition
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Convenience
Access
Transparency
Cost
Telemedicine Price Transparency
Physician Office u Medicare = $68.05 u Average = $80.00
Telemedicine
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Telemedicine Corporations
Telemedicine Platforms
Subscription fee
Established patients
Global period
Supplement
Chronic Care Mgmt
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Telemedicine Trends
u Expanding Reimbursement and Payment Opportunities
u Continued Momentum at the state level
u Retail clinics and employer onsite health clinics on the rise
u Increased adoption in ACOs
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Telemedicine Growth u Patients will increase from 350,000 in
2013 to 7 million in 2018 u 22% of employers with 1,000 or more
employees offer telemedicine services and another 37% planned to by the end of 2015
u >50% of hospitals have a telemedicine Program
u Projected to grow at a compound annual growth rate of 14.3% from 2014 to 2020
u 2016 legislative session, 44 states have introduced over 150 telehealth-related pieces of legislation
Sources: Public Health Institute Center for Connected Health Policy, Beckers Hospital Review
Telemedicine MGMA Poll
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Technology Adoption
• American adults own a smartphone 64%
• American adults own a tablet computer 42%
• adults 65+ use the internet 59%
• Adults 65+ say health information is the top reason for getting online 53%
13 Source: Pew Research Center
• Users have a healthcare app on their phone 32%
• patients willing to have video visits with Physician 64%
• patients frustrated with wait times 97%
• patients prefer easy access to healthcare services over in-person interactions with providers
74%
Telemedicine Advantages
Convenience/Access
Patient Engagement
Remote Patient Monitoring
Patient Compliance
Reduced Hospitalization /ER Visits
Time Management
Decreased cost to patient and healthcare system
Telemedicine – Triple Aim
Value = Improved Quality
Care
Better Patient
Experience
Lower Healthcare
Costs
Telemedicine Challenges
Privacy/Security
Face to Face visit
Technology Limitations
Documentation
Reimbursement
Equipment
Regulations
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Telemedicine Technology & Application
Synchronous
Remote Monitoring
Asynchronous
Mobile Health
Remote Monitoring & Mobile Health
Otoscope Stethoscope
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Definition of Interactive
u Two-way, real-time (live) interactive communication between the patient and the distant site (consulting) practitioner via audio/video (Polycom or VTC) equipment.
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Definition of Store and Forward
Store and Forward is: asynchronous (not
live) transmission of medical information to be reviewed at a later time by a health care provider at the distant (consulting) site.
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Remote In-Person • Diagnoses, treatments
follow reliable standard protocols based on evidence-based medicine
• Suggested therapies are nearly always effective
• Physical exam not required, visual exam adds nominal value
• Diagnoses, treatments more complex, may vary within disease category
• Therapies may need careful selection and monitoring
• Physical exam or diagnostic test required to correctly identify issue and select treatment
• Intervention required (i.e., immunization)
Emerging Areas for Virtual Care
Management, Maintenance • Chronic disease checkups,
follow-ups • Care plan updates • Specialist consults Diagnosis, Treatment • Remote diagnostics • Self-guided interventions
Telemedicine Application
Telemedicine Reimbursement Considerations
u Arkansas Telemedicine Act (Act 887) u Arkansas Telemedicine Act (Act 203)
u CMS Coverage Guidelines
u Commercial Considerations
u Self Pay
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Arkansas Telemedicine Act (Act 887)
u Effective January 1, 2016 for commercial plans u Effective July 1, 2016 for Arkansas Medicaid
u Requires health plans to cover telemedicine the same as in person services
u Must be licensed in Arkansas
u Can be initial encounter with real time audio and visual telemedicine technology (amended August 26, 2016)
23 https://legiscan.com/AR/text/SB133/2015
Arkansas Telemedicine (Act 203)
u Effective February 20,2017 u Repealed code 17-80-118 u Defines professional relationship
– Can be initial telemedicine encounter
u Minor Arkansas Medicaid must be PCP u Held to the same standard as an in person encounter u Originating site is location of the patient at TOS u Provider must be licensed in Arkansas u Informed Consent, Records, Privacy
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Source: http://www.arkleg.state.ar.us/assembly/2017/2017R/Acts/Act203.pdf
CMS Coverage Guidelines
u HPSA Area
u A county outside of a MSA.
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u The offices of physicians or practitioners
u Hospitals
u Critical Access Hospitals (CAHs)
u Rural Health Clinics
u Federally Qualified Health Centers
u Hospital-based or CAH-based Renal Dialysis Centers (including satellites)
u Skilled Nursing Facilities (SNFs)
u Community Mental Health Centers (CMHCs)
u Physicians u Nurse practitioners
(NPs) u Physician assistants
(PAs) u Nurse-midwives u Clinical nurse
specialists (CNSs) u Certified registered
nurse anesthetists u Clinical psychologists
(CPs) and clinical social workers (CSWs).
u Registered dietitians or nutrition professionals
Geographic Location Originating Sites Practitioners
CMS Coverage Guidelines
Requires interactive audio and video that permits real-time communication at the distant site, and the originating site.
Professional Service Billing • CPT or HCPCS code for the professional
service along with the telehealth modifier GT
Originating Site Facility Fee • HCPCS code Q3014
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Are Telemedicine visits reimbursable?
Yes • As long as you meet the payor
requirements • Some telemedicine companies are a self
pay only program
No • Texting, email, and fax are not reimbursable
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Telemedicine Self-Pay
May have patients sign a waiver or ABN
May be attractive to patients in
high deductible
health plans
May use healthcare
savings account
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Telemedicine Coding
u Telemedicine is not a service provided, it is a mode of delivery
u The originating site is the location of the patient at the time the service is being furnished.
u The distant site is the site where the physician or other licensed practitioner delivering the service is located.
u Originating site use HCPCS code Q3014
u Distant site add modifier GT
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Telemedicine Privacy and Security
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u Authorized users u Secure communication
u Monitor communication
u Bandwidth
u Storage
u Business Associate Agreement (BAA)
Telemedicine Malpractice
u Obtain written assurances from carrier
u May create telemedicine policy
u Consider state lines
u Little history available
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Telemedicine Documentation
u Documentation requirements same as that any face-to-face patient encounter, with the addition of the following:
u A statement that the service was provided using telemedicine;
u The location of the patient; u The location of the provider; and u The names of all persons participating in the
telemedicine service and their role in the encounter.
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Telemedicine Considerations
u Telemedicine is still a complex area with individual state rules and regulations.
u Consult with a healthcare attorney who is versed in telemedicine in your state.
u There are different rules when telemedicine is provided across state line.
u Federal Laws
u Capital Investment
u Speed, Clarity, and Security
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Questions