Telehealth. Telehealth? 6/1/2016. A tool for enhancing health care, communication and information.

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Corey Beasley
6 years ago
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delivery care services and support, at using a distance. electronic communication and information.

quality does not change from urban to rural settings.

1 Telehealth June 2016 Telehealth? A tool for enhancing health care, public Providing/receiving health, and health education health delivery care services and support, at using a distance. electronic communication and information. Definition: National Telehealth Resource Centers Consortium The general concept of health care quality does not change from urban to rural settings. The focus remains on providing the right service at the right time in the right way to achieve the optimal outcome. National Advisory Committee on Rural Health and Human Services Report, Health Care Quality: The Rural Context 1

Networks Services Other Activities but also be prepared for the not-so-distant

2 Telehealth: Telemedicine Remote Monitoring Store and Forward Direct to Consumer/Primary Care Mobile Health (apps based) 1. What is going on today? Networks Services Other Activities but also be prepared for the not-so-distant future! Next generation of telehealth services Accountable Care Organizations Others? 2

3 Common Applications In/Out Patient Specialty Services Dermatology Mental Health Cardiology Infectious Diseases Pediatric Services Endocrinology Wound Care Pulmonology Oncology Trauma/ER Stroke Care and more Common Apps (cont) Telepharmacy TeleHome Health (home monitoring) Case/Disease Management Remote ICU Monitoring Family Connections School Care Education staff, provider, family, community Other Applications Dialysis Support groups Speech therapy Remote ultrasounds Pre-commitment assessments Sign/Other Language interpretation Dietary counseling Rehab services Supervision PTSD/TBI 3

4 A BIG Push! Health Systems: Nebraska Medicine Catholic Health Initiative (CHI) Avera Health Sanford Health Mercy Virtual (St. Louis) Mercy Des Moines UnityPoint University of Missouri others Independent Providers: Specialty clinics Telehealth-focused companies Others? 4

Telehealth as a tool : Modality in the provision of healthcare Not be viewed as a stand-alone service Incorporate into standard, daily practice Can improve resource utilization Patients Providers 2.

5 Telehealth as a tool : Modality in the provision of healthcare Not be viewed as a stand-alone service Incorporate into standard, daily practice Can improve resource utilization Patients Providers 2. Rules and regulations? Licensing Credentialing Privileging Reimbursement Prescribing HIPAA Licensure Physicians Nurses Pharmacy Others Update: Multi-state Physician Licensure Compact Nurse License Compact 5

6 Credentialing CMS Rule!? Hospitals can accept the credentialing of telehealth specialists from their home facility. Can also be done by remote radiology practices (i.e Nighthawk) HOWEVER: By-laws made need to be addressed Reimbursement CMS State Medicaid Third party payers Private Pay Medicare Current Status Must be seen in a rural location in an eligible facility by an eligible provider for an eligible, billable service (code) Resources: Medicare Learning Network Telehealth Services Fact Sheet Am I Rural Go here to determine if you are a qualified location. 6

7 Medicaid State specific Each is slightly different Usually following most of Medicare s lead BUT, often no facility fee allowed Other Payers Some states have mandates for coverage (20+?) Otherwise Aetna Blue Cross Etc. Private Pay Prescribing Need to know your state s specifics: Can you? What if that patient is in a different state? What do you need to watch out for? CTeL has a report that provides more details on this. 7

8 HIPAA & Security Adhere to the standard rules for your practice. May have internal network (IT) expectations It is not all about the technology it is about the PROCESS! Others: Fraud/Abuse Stark issues Malpractice Documentation? Following practice standards? Liability (for NOT using?) 3. Technology Interactive Video? Desktop Video? Store-and-Forward? Remote Monitoring? Tablets? Smartphone? Room Sensors? 8

9 Finding What s Right Identify your need Accessing Specialty Services Reducing CHF re admissions Match the technology to the need! Does it meet the need for today? Future? Does it play well with others? Who are today s partners? What about tomorrow? Technology Petting Zoo Where do you go to learn? ATA Conference but Talk to your peers In state Out of state What do they use? How do they use it? Likes/Dislikes What do they WISH it would do? 4. What are the expectations? Patients/Families Communities/Partner Facilities Graduates/In coming Workforce Payers Federal Government, etc. Healthcare Reform 9

10 Organizational Access to add l care resources Staff competency Community perception Service stability Patient Experience Peer-to-peer interactions Budget-Related Stretch a tight travel budget Work-force retention Increase ancillary services Service continuation/expansion Enhance the quality of care Market-leader Cost of NOT having Lost Market Share? Professional isolation/burn-out Loss of hometown dollars Behind the Times Patient Care Liability High Quality patient experience 10

Assisted living centers Workplace based clinics School based clinics In-school Services:

11 So what are the opportunities? Expanding services (traditional) Expanding service locations Residential/group homes Assisted living centers Workplace based clinics School based clinics In-school Services: Clinical/Behavioral Assisted Living Photo Credit: Evangelical Good Samaritan Society Workplace Telehealth Services Photo Credit: Mayo Clinic Health Connection 11

Group Homes Photo Credit: LifeScapes School Based Telehealth Services Photo Credit: CRHI, MY Health e Schools https://youtu.

12 Group Homes Photo Credit: LifeScapes School Based Telehealth Services Photo Credit: CRHI, MY Health e Schools So, what else is happening? Conveniencefocused services In home services Nontraditional services Mobile services 2A 12

13 5. Now what? What s your plan? Write it out Share it with your stakeholders Gain buy in Who are your partners? Outreach services Referral pattern Community partners Where to go for more information? Lots of options Local/national Changing Environment Improved understanding Increased Needs Expectations Technologies Working to address similar issues: Lack of access to needed services Need to reduce costs Desire to improve outcomes Customer/patient convenience and experience 13

14 Telehealth: Support clinical needs and strategies Help to identify the requirements/needs of affiliate sites Respond to the interest from many departments/ services Challenges: Needs vs. Interest vs. Capacity vs. Strategy vs. Time Infrastructure/network reliability Standardize (as much as possible) implementation and processes Telehealth The NextGen ACO Patient-Centered Medical Home Integration with the EMR Chronic Disease Management Pay for Performance/Outcomes Not, Paid for Volume CMS Innovation Grant Develop and test new care delivery and payment model, utilizing remote patient monitoring in the home for 3,300 complex diabetic patients discharged from Nebraska Medical Center/Bellevue Medical Center Focus: - Lower readmissions & ED visits - Lower overall costs per patient - Improved patient self-management & control of chronic conditions - Improved provider-to-provider communications 14

Outcomes: Percentage of patients with A1c>9 Pre intervention = 40.72 % Post intervention = 14.43% High satisfaction Also: Helping patients connect to social services. Numbers: (as of Jan.

15 Outcomes: Percentage of patients with A1c>9 Pre intervention = % Post intervention = 14.43% High satisfaction Also: Helping patients connect to social services. Numbers: (as of Jan.2016) 661 patients enrolled 203 active participants (uploading data) 259 completed 90 day appointments Daily upload data percentages 61.9% to 89.1% Nebraska Medicine Current: Psychiatry Adult Adolescent Chadron State College Geriatric (since 2009) 60 nursing homes and hospitals Patients visited qrtly. Endocrinology 5 sites (Telehealth + outreach) Other Language Services ICU Remote Support 15

Cardiology Bariatrics Urology Men's Health Radiology Pathology Urgent Care Parity Map: Map Credit: American Telemedicine

16 In Development: Tele Stroke 2 locations (NebMed & BMC) Additional locations planned in 2016 Others (not in order) Oncology & Tumor Board Trauma Burn Perinatal Health Nephrology ENT Speech Pathology Epilepsy Multiple Sclerosis Tele ICU Kidney Hepatology Cardiology Bariatrics Urology Men's Health Radiology Pathology Urgent Care Parity Map: Map Credit: American Telemedicine Association FSMB Compact States Wyoming South Dakota Utah Idaho West Virginia Montana Alabama Minnesota Nevada Iowa * Illinois is pending 16

17 Resources: Telehealth Resource Centers Regional telehealth network providers American Telemedicine Association State Offices of Rural Health State Rural Health contacts Office for the Advancement of Telehealth Federal Office of Rural Health Policy/HRSA Contact: Mary DeVany Director of Telehealth

Creative Solutions to Challenging Access Issues. The State of Telehealth in Our Region

Creative Solutions to Challenging Access Issues The State of Telehealth in Our Region Nebraska Hospital Association - October 25, 2017 Telehealth: Telemedicine Remote Monitoring Store-and-Forward Direct-to-Consumer/Primary