The Telemedicine Train is Leaving the Station: Don t be left behind

Transcription

1 The heart and science of medicine. UVMHealth.org The Telemedicine Train is Leaving the Station: Don t be left behind Prepared by Norman Ward MD, Chief Medical Officer, OneCare Vermont Natasha Wither, DO, Chief of Primary Care, Porter Medical Center Todd J. Young, Network Director of Telehealth Services

2 Our Goals Understand the lingo Understand the logistics Understand the clinical paradigm Understand the health reform and business implications 2

3 Today s Agenda OneCare s Role in Telehealth Program Development and Technology A Physician s Experience Group Exercise What are your barriers to telemedicine? Wrap Up 3

4 OneCare Vermont s Role in Telehealth Norman Ward, MD CMO OneCare Vermont onecarevt.org

5 Telemedicine is a critical component of effective population health management OneCareVT.org OneCareVT.org

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8 Current FFS Telemedicine Billing Opportunities Commercial permissible with justification documentation Vermont Medicaid permissible with justification documentation Medicare o Originating site not in Metropolitan Service Area o Originating site not in patient s home o Permissible to support (for example) Hospital/ICU/stroke care Consultation at nursing homes Distant site with Vermont licensed clinician OneCareVT.org 8

9 Medicare Next Generation ACO Program (Vermont Medicare ACO) Telemedicine Waiver Program 2018 Originating site may be patient home and in Metropolitan Service Area (Chittenden and Franklin counties) Contemporaneous audio/video connection Special G codes and Evaluation and Management codes Billable E and M services enhance primary care (and specialty care) billing events/rvus Billing for these services counts against total cost of care OneCareVT.org 9

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11 Basic Steps Verify attribution of patient in program - marker in EMR Assess broadband or cell signal at patient location Determine need for technical assistance with patient at originating site Use appropriate codes Compliant documentation of E and M services in EMR Patient held harmless for services provided in error by clinician OneCareVT.org 11

12 Other Services and Considerations Store and forward images assessment and diagnosis o Dermatology o Ophthalmology Opportunity for improved patient satisfaction scores access, convenience Training the ACO Network o Clinicians o Community agency staff o Patients/families Attestation document by OneCare Vermont participants who want to bill for telemedicine waiver services Clinician compensation model considerations OneCareVT.org 12

13 Med icare Telemed icine Fees

14 UVMHealth.org Program Development and Technology Todd Young Network Director of Telehealth Services at UVM Health Network

15 What is Telemed icine? Video visits between provider and patient Online exchange of medical info between provider and patient Using connected devices to monitor key vitals for acute and chronic care at home. 15

16 What is Telemed icine? econsults Video consult from provider to provider concerning a patient Online exchange from provider to provider concerning a patient 16

17 Why Telemed icine? Patients Providers Hospitals Create access for patients Convenience for patients Provide better outcomes for patients Create access for providers Convenience for providers Create competitive services Expand service offerings for communities. Create competitive services for patients 17

18 Who can perform Telemed icine? Physicians Advanced Practitioners Registered Nurses Psychologists Nutritionists Social Workers and Counselors 18

19 Where can Telemedicine be performed? Hospitals and Nursing Facilities Clinics and Medical Offices Schools Homes Hotel Rooms Libraries 19

20 Can you get paid? Yes but there are conditions Medicaid pays for video visits. Medicare only pays for site to site. Patients attributed to OneCare expands eligibility Private Payers operating in the State of Vermont are covered under the parity law. 20

21 Clarifying Terminology Telemedicine, Telehealth, ehealth, or Virtual Care Hub or Distant Site Spoke or Originating Site Synchronous or Live Asynchronous or Store and Forward 21

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23 Take an Agile Approach Plan Develop Pilot Adjust Scale Manage 23

24 Things to address in your planning Program Definition and Purpose Workflow Technology Licensure and Credentialing Security, Informed Consent and Compliance Billing and Scheduling Documentation and Communication Testing and Rehearsal Training and Education Support 24

25 Start a Pilot Follow up visits for established patients using video visits is a great place to start. Select Patients with established relationship Select patients who are digitally literate and have a connected device Select patients that have travel issues Select patients with the right insurance coverage 25

26 Develop you r process Create your team Use flow diagrams to document your current workflow for in person visits Modify the diagram to reflect the changes Document and train the workflow Rehearse the workflow Pilot the workflow 26

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29 Don t be afraid of the technology For video visits pick a HIPAA compliant cloud based video conference platform. - HIPAA compliant and secure - Works on PC s, tablets, and mobile devices - Easy to use - $14.99/mo/host 29

30 Resources to help Northeast Telehealth Resource Center is a free resource to assist in developing telemedicine programs. ATA is the largest membership organization supporting telemedicine. Network with your local health systems and partners. 30

31 UVMHealth.org A Physician s Experience N atasha Withers, DO Chief of Fam ily Med icine Medical Director of Primary Care Services at Porter Med ical Center

32 The heart and science of medicine. UVMHealth.org Telemedicine at Porter Medical Center- Prim ary Care Prepared by Natasha Withers, DO, Medical Director of Primary Care Services at Porter Medical Center Sarah K. Chistolini, Telehealth Program Strategist

33 What Bristol Did Created a video visit program where: The platform Zoom is used Patients are at home, with their own devices A specific patient population is served Visits are scheduled Patients are registered and consented Visits are documented and billed

34 How Bristol Did It Stakeholder meetings to identify: Billing and reimbursement Prior Authorization process Reminder calls Patient satisfaction Clinical meetings to identify: Registration process, including obtaining consent Training (staff) Education and materials (patients)

35 Program Evalu ation Our success was evaluated by: Patient engagement (volume) Patient satisfaction scores Miles saved Efficiencies created in the schedule Reimbursement for these services 35

36 Lessons Learned Consent must be obtained (verbal or written) Patients must have broadband internet or 4G and access to a device to participate Patients appreciate the option BCBSVT and VT Medicaid will provide payment for this service VT Medicare will not pay for this service 36

37 Thank you UVMHealth.org

38 Group Exercise - What are your barriers? UVMHealth.org

39 What are your barriers? As a group identify your top barriers for starting a telemedicine program within your organization. - Individually use 5 minutes listing barriers you believe exist in your organization - As a group use the next 5 minutes to discuss and choose the top 3 in your group - As a group use the next 5 minutes to develop strategies to overcome those barriers - Choose a member of the team to report out findings - Discussion of top perceived barriers 39

40 Qu estions UVMHealth.org

41 Medicare Next Generation ACO Telehealth Expansion Waiver Purpose Eliminates the rural geographic component of originating site requirements Allows the originating site to include a beneficiary s home Allows use of asynchronous telehealth services for dermatology and ophthalmology Benefits Extends access to consults from specialists More convenient for patients who prefer to remain in their home, with less wasted time in the waiting room Increases patient engagement with more frequent contact with medical, behavioral/mental health and nutrition providers Statewide Reach in 2018 ~50,000 Medicare patients in OneCare s network are eligible Site Criteria Access to HIPAA-compliant technology and equipment Electronic medical record capable of maintaining required documentation (e.g. photos, visit documentation, etc.) High engagement from leadership/decision makers Willing to operationalize processes

42 Sample Readiness Assessment Survey Policies and Procedures Business Associate Agreement Private Payer Reimbursed Codes 42

43 Ad vantages of Telem ed icine Convenient access for patient/family Travel distance Agoraphobia Weather Convenient access for clinician providing services Convenient in support of community providers and Skilled Nursing Facility Wound care Behavioral assessment interview, diagnosis, and treatment planning Billable E and M services enhance primary care (and specialty care) billing events/rvus Billing for these services count against total cost of care