TelenutritionA New Frontier

Transcription

1 Starting Or Telentrition Jorney TelentritionA New Frontier ROBIN AUFDENKAMPE, MS, RDN, CD Who s idea is this anyway? When do we leave? Where are we going? Why this direction? What eqipment will we need? Who s picking p the tab? Why haven t we left yet? How are we getting there? Are we there yet? APRIL 2015 Who s idea? When do we leave? Mary Ann Hodorowicz, MBA, RD, LDN, CDE Joanne Shears, MS, RD, LN Presented in 2012 Called for: more research more pblications

2 Pblished Research on Telentrition Peer Reviewed Jornals & Academic Jornals (EBSCO) Tele-medicine = 5,167 Tele-medicine = 7,423 Tele-pharmacy = 24 Tele-pharmacy = 36 Tele-ntrition = 0 Tele-ntrition = 1 The Direction? Telehealth The se of electronic information and telecommnications technologies to spport long-distance clinical health care, patient and professional healthrelated edcation, pblic health and health administration. Telehealth will inclde both the se of interactive, specialized eqipment, for sch prposes as: health promotion disease prevention diagnosis, consltation therapy ntrition intervention /plan of care non-interactive (or passive) commnications - over the Internet, video-conferencing, or fax lines, and other methods of distance commnication for broad-based ntrition information. Academy of Ntrition and Dietetics Or Direction? Telentrition The interactive se, by a RD or RDN, of electronic information and telecommnications technologies to implement the Ntrition Care Process: Ntrition assessment Ntrition diagnosis Ntrition intervention/plan of care Ntrition monitoring and evalation - with patients or clients at a remote location, within the provision of their state licensre as applicable. Academy of Ntrition and Dietetics A Direction of Progress

3 Potential Revene & Docmented Prodctivity Based on 10 otpatient dietitians in pediatric clinics. Each RDN spends ~2 hors per week commnicating with patients via phone or hrs/wk 80 hr/m min. increments x 4 wks/m x 4-15 min. x $ hrs/m min. $8,000 per month Transition No show and Cancellation appointment time. 5 app/wk 20 app/m min. increments ements X 4 wk/m x 4 15 min x $ app/m min $2,000 per month 100 hrs/m in docmented prodctivity. ~$120,000 per year in potential revene. Methods of Telentrition I How are we getting there? Telentrition Services Face to Face adio visal medim Phone calls Video learning modles Tele-bddy monitoring systems Mobile applications Controlled Environment Real-time commnication = Synchronos The primary method of Telentrition Consists of practitioner and patient present at the same time, bt in different locations. Reqires two sites: originating site - location of the patient distance-site - location of practitioner Live, interaction video conferencing reqires high qality, reliable, and secre telecommnications. Whenever possible tilize a designated Telehealth space. Ensre adeqate lighting and sond. Remove all cltter. Check in yor rearview mirror.

4 Technology For Telentrition HIPAA Secrity: Sets national standards for the secrity of electronic protected health information Compliant Software Broadband Internet - reliable rate of data transmission Encrypted internet connection to prevent interception Bsiness grade videoconferencing Vsee Secre Video Vidyo Hipaachat Talk to an Expert Non-Compliant Software HIPAA Considerations Encryption: for secring the chat sessions and the voice and video phone calls for the safe transmission of ephi. Wire Tap: the need for a platform that can prevent wire tapping. Bsiness Associate Agreement (BAA): an agreement eement with pro providers that yo sed for yor ephi is a reqirement of HIPAA. HIPAA Reqirements: Provide archives of chats. Provide adit trails of sage. Provide notifications in case of a breach. Provide administrative emergency access to previos os chat histories. Skype FaceTime Methods of Telentrition II Store and Forward = Asynchronos Transmission of digital images for diagnosis or assessment, commonly sed in radiology and dermatology. Forms of edcation Prepared learning modles Interactive edcation modles Prerecorded teaching videos

5 Who are my travel bddies? Stakeholder System wide Crrent Telehealth administrators Compliance Coders & Finance Schedlers Information Technology Services Patient Edcation Services Commnications/Marketing Project team Project Sponsor Project Owner MD Champion Facility ITS Rles of the Road - New CMS Provisions Permit hospitals and CAHs to implement new credentialing and privileging process for physicians and practitioners providing telehealth services. Removal of nnecessary barriers to telehealth may enable patients to receive medically necessary interventions in a more timely manner. Enhanced patient follow-p in the management of chronic disease conditions. Provide more flexibility to small hospitals and CAHs in rral areas and regions with limited spply of primary care and specialized providers. Travel Eqipment & Spplies? Gap Analysis Complexity Analysis Strategic Plan Bsiness Case Licensre Provision RDs or RDNs in states withot licensre laws mst be credentialed and privileged by the traditional rote, by each hospital in which they practice. Practitioners providing patient care services in other states mst be licensed and/or meet other applicable standards that are reqired e prac ioner ion is by state or local laws in both the state where the practitioner located and the state where the patient is located. ed.

6 Athorized Distant Site Practitioners Physicians Physician assistants Nrse practitioners Nrse midwives Clinical nrse specialist Clinical nrse anesthetists Clinical psychologist Clinical social workers Registered dietitians or ntrition professionals. ionals. Verify Locations? Medicare reimbrses for Telehealth services when the originating site (where the patient is) is in a Health Professional Shortage Area (HPSA) or in a conty that is otside of any Metropolitan Statistical Area (MSA). Patient location matters It s not the distance from the provider Healthcare provider shortage area Poplation of an area Location Finder Athorized Originating Sites Physician or practitioner offices Hospitals Critical Access Hospitals Rral Health Clinics Federally Qalified Health Centers Renal Dialysis Centers (Hospital or CAH-based) Skilled Nrsing Facilities Commnity Mental Health Center Check with commercial payers Who s picking p the tab?

7 CPT Codes Billing CPT codes are owned and written by The American Medical Association Physicians are providing a service and need a corresponding code for billing. Reimbrsement CMS ses CPT codes & creates their own codes Jst becase yo have a CPT code doesn t mean yo re going to get reimbrsed. If yo bill an insrance company or CMS and yo are not reimbrsed yo mst bill the patient. G codes Modifiers Restrictions Clarifiers New codes are approved by Demonstrated improved otcomes Lobbying Government mandate Medical Ntrition Therapy Codes Face to Face Interaction Telephone Interaction Ntrition Assessment (5 - mintes) Ntrition Follow-p (11-20 mintes) Grop Medical Ntrition Therapy (21-30 mintes) only Online assessment and management service provided by a qalified non-physician health care professional, internet or electronic commnications. Medicaid is the exception. Medicare will only pay for "face-to-face, interactive video consltation services where the patient is present. CPT Code Modifiers Sper-bill Telehealth Modifiers - valid when billed with HCPCS codes Provider does not sbmit the bill: clients can sbmit for reimbrsement Healthcare Common Procedre Coding System (HCPCS) GT synchronos interactive adio and video CPT GQ asynchronos telecommnication system - transmission of data Alaska and Hawaii are the only two states approved for asynchronos telecommnication reimbrsement. Q3014- code filed by originating site.

8 Example - Ntrition Assessment Bill Medicare Codes don t se modifiers Bill Billed by Dietitians simltaneosly G Medicare- Individal Medical Ntrition Therapy G0406, G0407, G Follow-p in-patient TeleHealth consltations G0108 and G Individal and grop diabetes self-management training (DSMT) services, with a minimm of 1 hor of in-person instrction to be frnished in the initial year training period to ensre effective injection training G0420 and G Individal and grop kidney disease edcation (KDE) services Q3014 Local PCP office (originating site) generates a bill sing this code GT (GT modifier)- Dietitian generates a bill sing this code. Billing and Medical Record Docmentation Reqirements (adapted from AHIMA Practice Brief) Billing Reqirements Time based codes mst have docmentation of time. Docmentation mst spport the billing codes. Codes are not reported if the telephone/internet discssion lasts less than 5 mintes. Billed by the Primary Care Provider G Face-to-face behavioral conseling for obesity G Annal, face-to-face Intensive behavioral therapy for cardiovasclar disease Billing and Medical Record Docmentation Reqirements (adapted from AHIMA Practice Brief) Medical Record Docmentation Reqirements Patient name and Identifiers Patient location Date of service Referring physician Conslting RD/RDN location Type of evalation performed: Note that the conslt was held via Teleservices. Informed consent, if appropriate Medical Ntrition Therapy note Recommendations for frther treatment. A consltative report shold be roted to the referring physician in a timely manner. All electronic commnications in regards to the conslt (faxes, digital pictres, etc.) shold be added to the patient s medical record.

9 Are we lost? A Jorney rney of NO NO Dietitians don t get lost, we discover alternative rotes and destinations. Otpatient MNT-Telentrition Code Inpatient MNT- Telentrition Code Registered Dietitian/Ntritionist to provide Medical Ntrition Therapy (MNT) services per 15 minte increment. May inclde: follow-p ntrition assessment consltations and ntrition edcation with patients remotely via phone or schedled appointments from an Intermontain Telehealth Site or an athorized Telehealth setting. Not to inclde- initial ntrition assessment in cases where the patient has never physically been seen. Registered Dietitian/Ntritionist to provide Medical Ntrition Therapy (MNT) services per 15 minte increment. May inclde: initial ntrition assessment and follow-p consltation, as well as, ntrition edcation to patient remotely via schedled appointments from an Intermontain Telehealth Site or an athorized Telehealth setting. Medical Staff mst be present with the patient to assist with visal confirmation or physical assessment. Charge Code: ; icentra #: Charge Code: ; icentra #: Note: Note: Completion of initial ntrition assessment mst take place in a setting with face to face capabilities. Clinical docmentation mst spport this time-based charge. Initial ntrition assessments in cases where the patient has never been seen physically are exclded from this service. This charge is cash only. Does not need to be face to face time Clinical docmentation mst spport this time-based charge. This code does not have an associated CPT, no options to bill a third party. This code does not have an associated CPT. There is no charge for this inpatient service.

10 Opportnities - Additional Resorces Qestions?