Getting Paid for Telehealth. Nate Gladwell, RN, MHA Director of Telehealth University of Utah Health Care June 16, pm

Transcription

1 Getting Paid for Telehealth Nate Gladwell, RN, MHA Director of Telehealth University of Utah Health Care June 16, pm

2 Who We Are 4 HOSPITALS 11 COMMUNITY CLINICS 1,300 PHYSICIANS COLLEGES School of Medicine College of Nursing College of Pharmacy School of Dentistry College of Health $230.3m FUNDED 637 RESEARCH GRANTS $2.4b ANNUAL BUDGET University Neuropsychiatric Institute Huntsman Cancer Institute John A. Moran Eye Center Primary Children s Hospital (IMC) University of Utah Hospital University Orthopaedic Center Clinical Neurosciences Center South Jordan Health Center

3 UNIVERSITY OF UTAH HEALTH CARE SERVICE AREA 3 #VITAL2016

4 Telemedicine Telemedicine econsult/echo Virtual Visit TELEHEALTH

5 Connected Locations

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7 Why? Decant non-acute Go upstream for timely dx/tx Increase in Stroke/Neuro Referrals Why? Decant non-acute Go upstream for timely dx/tx Increase in Burn referrals MARKET PROTECTION

8 Nuts and Bolts Reimbursement Licensure Credentialing Medical Record HIPAA/HITECH Compliance FDA Approval EMR & Patient Portal

9 100.0% Most Common Objectives for Virtual Care 95.6% 80.0% 84.4% 60.0% 66.7% 40.0% 42.2% 42.2% 46.7% 20.0% 15.6% 8.9% 0.0% Availability of grant(s) Consumer engagement Financial incentives Improve access Improved patient outcomes Physician shortage Streamlined workflow Other HIMSS 2015 Presentation: EY Adoption Model

10 Reimbursement sources Other 18.2% Unsure 6.8% Direct contract 72.7% Commerical payers 61.4% Medicaid 61.4% Medicare 52.3% HIMSS 2015 Presentation: EY Adoption Model

11 Reimbursement: Commercial Payers Slow Shift to Virtual Care Reimbursement No consistent standard As of June 2016, 29 states and DC mandate insurance companies to provide coverage for telehealth Some payers are partnering with non-health system innovators WellPoint/American Well s LiveHealth Online Scaled across 44 states Covering real-time video, telephonic, and secure chat visits for non-urgent care consultations Cigna/MDLIVE Covering several large employer groups Offering video and telephonic consults with internal medicine, primary care, and pediatric MDs UnitedHealth Group/NowClinic Scaled across 22 states Uses American Well s platform to offer real-time video and telephonic interactions for non-urgent care consultations Example Commercial Insurers Paying for Telehealth Aetna/RelayHealth Covered in all states where participating doctors are also enrolled in RelayHealth Web-based doctor-patient service collects copays from patients through online portal and submits web visit claims to Aetna and sends copay reimbursements to physicians Highmark/Blue Cross/Teladoc 2012 Pilot with 10,000 members Covered minor illness and well visits, designed for patients to use for non-urgent consultation, during travel, when a doctor is not available, or for minor pediatric care Source: Center for Connected Health Policy, American Action Forum,

12 Reimbursement: Government Payers? Medicare Specific Criteria Must be Satisfied to Qualify for Reimbursement 1 Geographic Location of Receiving Site Must be provided to an eligible beneficiary in an eligible site Site must be located outside of a Metropolitan Statistical Area Are You Eligible? 2 Type of Health Provider Delivering Service Physician Nurse practitioner Physician assistant Nurse midwife Clinical nurse specialist Clinical psychologist Clinical social worker Registered dietitian or nutrition professional 3 Type of Institution Delivering Service Office of a physician or practitioner Hospital Rural health clinic FQHC 1 Skilled nursing facility Hospital-based dialysis center Community mental health center Visit the HRSA 2 Medicare Telehealth Payment Eligibility Analyzer website. Federally qualified health center. Health Resources and Services Administration. Sources: Medicare Telehealth Payment Eligibility Analyzer, U.S. Department of Health and Human Resources, Cardiovascular Roundtable research and analysis.

13 Reimbursement: Government Payers Medicaid Coverage Completely variable by state Utah as an example As of January 1, 2015: all telemedicine encounters covered Still working on Store and Forward and Remote Monitoring ACO Model adds some variability Federally qualified health center. Health Resources and Services Administration. Sources: Medicare Telehealth Payment Eligibility Analyzer, U.S. Department of Health and Human Resources,

14 Licensure Portability 7 States Interstate Commission Member and Resident States Designate state of residence in a member state Apply to resident state they verify Fee to resident state Member state may issue fee Sent to member state of application Issued by member state Allows full medical practice If loss of resident state license loss of all No Action Referenced 6/3/16

15 OTHER METHODS OF FUNDING Grants» Pro: Available, high dollar amount (USDA >$10M per year)» Cons: sustainability, vendor-pushed, little business plan rigor State funding efforts» Pros: determined need and funding locally, funds attached to clear budget items and reporting» Cons: typically small $$ and hard to evoke change Meta Problems» Difficult to change behavior on a grant» When monies run out then what? Protocols? Technology? 15 #VITAL2016

16 TAKEAWAYS Third party reimbursement is improving Commercials are interested and dabbling CMS» ACOs, APMs are including telehealth» Medicare Challenge Social Security Act Grants and Supplemental Monies» Pros and Cons 16 #VITAL2016

17 Questions? 17 #VITAL2016