Telehealth in Alaska. Cindy Roleff, MS, BSN, RN-BC Telehealth Program Development Manager AFHCAN / ANTHC

Transcription

1 Telehealth in Alaska Cindy Roleff, MS, BSN, RN-BC Telehealth Program Development Manager AFHCAN / ANTHC

2 Why Telehealth? Patient Empowers them with additional choices Satisfaction Decreases disparities Increases health care provider availability Improves quality of care (larger team) Decreased cost (time away from work and uncovered travel expenses) Provider Reimbursement (innovative payment models) Travel savings (esp. important to federal entities) Collegiality / education

3 Do I need telemedicine? Frequent need for specific specialty or subspecialty services Education/provider to provider consultation You service remote areas where you could potential see patients via telemedicine Primary care Care oversight Financial benefit to keeping patients local

4 How do I start? Define the need be specific Capability assessment Equipment Connectivity Support Feasibility assessment Telehealth policy and law Reimbursement Create a business plan IN ALL STEPS: know and use your resources!

5 National Resources: ATA Telehealth Resource Centers***** National Telehealth Policy Resource Center Center for Telehealth and e-health Law National Telehealth Technology Assessment Resource Center National Conference of State Legislatures Medicaid/Medicare/CMS

6 Local/Regional Resources: Local / Regional AK Collaborative for Telemedicine & Telehealth (AKCTT) UA Courses AK Medicaid Northwest Regional Telehealth Resource Center (NRTRC)

7 National Resources

8 American Telemedicine Association (ATA) Telemedicine outcomes and case studies Telemedicine standards and guidelines: core standards, videoconferencing, diabetic retinopathy, telerehabilitation, telemental health, etc. Working groups Public policy news and activity General telemedicine news Education information Products Liability insurance information

9 American Telemedicine Association (ATA)

10 American Telemedicine Association (ATA)

11 American Telemedicine Association (ATA)

12 American Telemedicine Association (ATA) State Policy Toolkit contents Features of good telehealth policy Medicaid coverage/reimbursement All states allow for some reimbursement 39 states cover some for telemental health 18 states cover some home telehealth 12 states cover some remote patient monitoring 7 states cover some store and forward services Private insurance coverage discussion Specific talking points in support of telehealth How to rebut arguments opposing coverage Model legislative language & a proposed state action plan

13 Telehealth Resource Centers Central website includes learning modules on: Telehealth operations Reimbursement Legal & Regulatory Marketing Training Program Development

14 National Telehealth Policy Resource Center

15 National Telehealth Policy Resource Center As the federally funded and designated National Telehealth Policy Resource Center, the Center for Connected Health Policy (CCHP) is charged with the responsibility of providing technical support in telehealth policy to 12 regional telehealth resource centers (RTRCs) nationwide, and serves as an independent national resource on telehealth policy issues.

16 National Telehealth Policy Resource Center Policy overview: Medicare Limited set of telehealth services, provider types, geographic locations and facility type Mostly live video NO store and forward except CMS demonstration programs in AK and HI Policy overview: Medicaid Only 4 states don t cover live video telemedicine Only 9 do reimburse store and forward 11 reimburse for remote patient monitoring Limitations similar to Medicare Downloaded 4/9/14

17 National Telehealth Policy Resource Center Policy overview: State Laws and Reimbursement: AK Pending Legislation HB 53 This bill would stipulate that a physician who prescribes 120 mg of opiates per day to a patient must consult with a pain management specialist. The consultation may take place between the physician and pain management specialist through the telephone or could be an audio visual evaluation conducted remotely with the patient present. AK Pending Legislation SB 80 Allows the Medical Board to issue a license to out-of-state physicians or podiatrists to practice telemedicine in Alaska under certain circumstances. Downloaded 4/9/14

18 National Telehealth Policy Resource Center Legal Issues Licensing: per state boards. Most require license in state where patient is seen Credentialing & Privileging (contract/individual) Online prescribing policies vary. Issues include: Patient provider relationship Adequate physical exam Accuracy of patient s history (self reporting) State medical board licensing requirements Malpractice not much info/advice out there yet Downloaded 4/9/14

19 National Telehealth Policy Resource Center Health Information Technology FCC mhealth FDA regulates medical devices (including software) Center for Connected Health Policy has a whole paper on the FDA and Mobile Medical Apps HITECH (Health Information Technology for Economic and Clinical Health Act) provides opportunity for incentive payments if meet meaningful use criteria Downloaded 4/9/14

20 Center for Telehealth and e- Health Law

21 Center for Telehealth and e- Health Law The Center for Telehealth and e-health Law (CTeL) has established itself as the go-to legal and regulatory telehealth organization providing vital support to the community on topics such as: physician and nurse licensure; credentialing and privileging; Medicare and Medicaid reimbursement; and private insurance payment policies.

22 Center for Telehealth and e- Health Law Legal resource team Expertise on: Credentialing and privileging E-prescribing Physician licensure Reimbursement Resource Directory

23 Center for Telehealth and e- Health Law Publications Research library: CTeL has conducted extensive research in all 50 states on: Pharmacy Laws Pertaining to Telemedicine and e-prescribing Prescribing Laws for Medical Devices and Diagnostic Testing Internet and Telemedicine Prescribing: Survey of Individual State Policies and Regulations Physician Licensure Consultation Requirements Stark and Anti-Kickback Policies and Regulations Privacy and Security: Medical Record Access Laws Foreign Medical Graduate Licensure Report

24 National Telehealth Technology Assessment Resource Center

25 National Telehealth Technology Assessment Resource Center The National Telehealth Technology Assessment Resource Center aims to create better-informed consumers of telehealth technology. By offering a variety of services in the area of technology assessment, the TTAC (pronounced "tea-tac") aims to become the place for answers to questions about selecting appropriate technologies for your telehealth program.

26 National Telehealth Technology Assessment Resource Center User reviews Video clips Innovation watch Toolkits: how technologies work and how to assess them for use in telehealth programs. Toolkit examples: mhealth App Selection Digital Cameras Mobile Blood Pressure Tympanometers Videoconferencing Endpoints Etc.

27 National Conference of State Legislatures

28 National Conference of State Legislatures Telehealth and Rural Health Care Delivery overview 10 percent of physicians practice in rural America Nearly 20 percent of the population lives in rural America Licensure: AZ/NM provision allows out-of-state physicians to provide services with consent NV/UT exempt out-of-state, licensed providers from full state licensure requirements, allowing short duration or specific event services Most states, however, still have restrictive licensure laws, making use of interstate telehealth technology challenging. Downloaded 4/9/14

29 National Conference of State Legislatures State Coverage for Telehealth Services Telehealth services covered by Medicaid program: 43 states plus D.C. Private insurance: many states are now requiring they cover telehealth services (parity laws): 19 states and D.C., AZ projected to do so Jan 2015 Parity Laws require health insurance plans to provide coverage for telemedicine services to the same extent that the services would be covered if they were provided in-person Stipulations may apply (patient in rural area, may limit the types of services, etc.)

30 Downloaded 4/9/14

31 Medicaid/Medicare/CMS

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34 Medicare CY MLN/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf

35 Medicaid Telemedicine is viewed as a cost-effective alternative to the more traditional face-to-face way of providing medical care (e.g., face-toface consultations or examinations between provider and patient) that states can choose to cover under Medicaid. This definition is modeled on Medicare's definition of telehealth services (42 CFR ). Note that the federal Medicaid statute does not recognize telemedicine as a distinct service. Systems/Telemedicine.html Downloaded 4/9/14

36 Medicaid.gov choose Alaska

37 Local Resources

38 AK Medicaid

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43 AK Collaborative for Telemedicine & Telehealth (AKCTT) Mission: The Alaska Collaborative of Telehealth and Telemedicine (AKCTT) is a statewide, non-profit, non-partisan forum committed to developing a coordinated, interagency approach to standardized telehealth care delivery in remote and urban Alaskan communities. AKCTT will facilitate efficient, effective, and aligned telehealth practices that reduce costs and improve access among healthcare providers.

44 University of Alaska Courses Overview of Telehealth and Role of the Coordinator Become a Certified Telehealth Coordinator Become a Certified Telehealth Program Manager To register, go to For more information brudzinski@uas.alaska.edu

45 Northwest Regional Telehealth Resource Center (NRTRC) Resources: Toolkits: A Guide to Getting Started in Planning Training Programs Privacy & Security Policy & Legislation Marketing Reimbursement Referrals & Networking Northwest Regional Telehealth Resource Center (NRTRC) C/O Telehealth Services 1233 North 30th Street Billings, MT Phone: (406) Toll Free: (888)

46 AK Examples

47 API

48 ANTHC Funding: tribal organizations, federal Special tribal reimbursement policies Potential new reimbursement model

49 Providence Alaska

50 Providence Kodiak

51 Questions