WELCOME TO TELEMEDICINE, TEXAS OCTOBER 26TH, 2017 RURAL HOSPITAL INFORMATION TECHNOLOGY CONFERENCE
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1 WELCOME TO TELEMEDICINE, TEXAS OCTOBER 26TH, 2017 RURAL HOSPITAL INFORMATION TECHNOLOGY CONFERENCE
2 1 Agenda Agenda 1 Introductions & Overview of St. David s HealthCare 2 Current Telehealth Applications 3 Assessing Needs & Next Steps 4 Essential Elements 5 Critical Success Factors 6 Other Important Issues 7 Q&A
3 Welcome to Telemedicine, Texas 2 Introductions & Overview of St. David s Healthcare
4 Mission, Goals, Values and Vision Organizational Overview Our Mission: To Provide Exceptional Care to Every Patient Every Day with a Spirit of Warmth, Friendliness and Personal Pride Established by SDH leadership upon creation of joint venture The organizational driver of everything we do The guiding principle for our day-to-day work Our Goals: Exceptional Care Customer Loyalty Financial Strength The driver of our strategic plan The key areas of strategic focus from which all measures of strategic and operational effectiveness flow Support the mission and vision 3
5 4 Mission, Goals, Values and Vision Organizational Overview Our Values: I ntegrity C ompassion A ccountability R espect E xcellence The foundation of our culture The individual and organizational characteristics that define us and our organization The commitments we make to the organization, one another and our stakeholders Our Vision: To be the Finest Care and Service Organization in the World Established after a record of organizational success The articulation of our forward-looking aspirations A high, admittedly difficult-to-measure bar, but an aspirational goal
6 5 History and Highlights Organizational Overview 1924 St. David's Episcopal Church works with 5 physicians to purchase original St. David s Hospital 1996 St. David s Hospital and HCA contribute local assets to a joint venture partnership St. David s Foundation is created, a joint owner of St. David s HealthCare with HCA 2006 St. David s HealthCare acquires St. David s Georgetown Hospital 2008 St. David s Medical Center establishes Texas Cardiac Arrhythmia Institute 2009 St. David s North Austin Medical Center opens St. David s Women s Center of Texas St. David s HealthCare acquires Austin Heart physician group 2010 St. David s HealthCare acquires Heart Hospital of Austin 2014 St. David s HealthCare provides inward facing Telepsych St. David s HealthCare begins Teleneuro program St. David s Children s Hospital opens in North Austin Medical Center 2015 St. David s Healthcare provides telemedicine to affiliates
7 Ownership Business Model: 5 0 : 5 0 G o v e r n a n c e Business Model (58% ownership) (41% ownership) (1% ownership) Mgmt. Services Mgmt. Fee St. David s HealthCare Partnership LP, LLP Surg. Center Mgmt. Services 7 Ambulatory Surgery Centers 7 Acute Care Hospitals 200 Aligned Providers 7
8 8 Flow of Funds Distribution of Earnings: SDH Board distributes earnings above and beyond current operating and capital requirements pro rata in accordance with sponsors ownership percentages Business Model Surplus Earnings from Operations 58% 41% 1% SHAREHOLDERS THE COMMUNITY Foundations have contributed $380+M since 1996
9 10 Community Grants Results St. David s Foundation and Georgetown Health Foundation Grants $58M $65M More than $380M in community grants 12.1% increase in 2016 $45M $50M $3M
10 11 Community Grant Partners The Foundations collaborate with 60+ nonprofit partners in these focus areas: HEALTHY PEOPLE Investing in Primary and Specialty Care AIDS Services of Austin Any Baby Can Austin Community Foundation Breast Cancer Resource Center CommuniCare Health Centers Community Health Centers of South Central Texas-Luling Easter Seals- Central Texas El Buen Samaritano Immunization Partnership Lone Star Circle of Care People s Community Clinic Planned Parenthood SafePlace Samaritan Health Ministries Tandem Project UT School of Nursing Volunteer Healthcare Clinic HEALTHY MINDS Supporting Behavioral Health Programs Any Baby Can Austin Child Guidance Center Austin Children s Services Austin Clubhouse ATC Integral Care Center for Child Protection CommuniCare Communities In Schools of Central Texas El Buen Samaritano Family Crisis Center Foundation Communities Hays-Caldwell Women's Center Hope Alliance Interagency Support Council of East Williamson County LifeWorks Lone Star Circle of Care People's Community Clinic Safe Alliance SafePlace Samaritan Counseling Center SIMS Foundation Spirit Reins Waterloo Counseling HEALTHY LIVING Promoting Health and Wellness A Legacy of Giving Austin Parks Foundation Boys & Girls Clubs of the Austin Area Foundation Communities Marathon Kids Sustainable Food Center YMCA (MEND program) HEALTHY SMILES HEALTHY AGING Results Mobilizing the St. David s Dental Program Austin ISD Del Valle ISD Hays Consolidated ISD Manor ISD Pflugerville ISD Round Rock ISD Capital Area Dental Foundation AIDS Services of Austin CommuniCare Health Center El Buen Samaritano People's Community Clinic Volunteer Health Clinic Health Alliance for Austin Musicians Lone Star Circle of Care Manos de Cristo Serving Aging Populations AGE of Central Texas Area Agency on Aging Austin Speech Labs Bastrop County Emergency Food Pantry Capital Area Food Bank of Texas The Care Communities Drive a Senior Network Family Eldercare Helping the Aging, Needy and Disabled Hospice Austin Meals on Wheels and More Texas Ramp Project UT School of Social Work Williamson-Burnet County Opportunities HEALTHY FUTURES Advancing Health Education and Research Capital IDEA Huston-Tillotson College Texas A&M Texas Higher Education Coordinating Board Texas State University UT School of Nursing UT School of Social Work
11 12 Honors and Accolades Honors and Accolades T O P P E R F O R M E R T O P P E R F O R M E R T O P P E R F O R M E R T O P P E R F O R M E R T O P P E R F O R M E R
12 Origin of Telemedicine? 13 From which war can one date the first successful application of telemedicine? A. Spanish American War B. Vietnam War C. Gulf War D. Civil War E. None of the above
13 Defining Telemedicine Telemedicine Includes the provision of medical information or services via telecommunication technology 14
14 Milestones-2017 Telemedicine Legislative Milestones CBO RELEASES MORE SCORES: Legislation that expands Medicare coverage of tele-stroke would cost the federal government $180 million over a decade. We would presumably see savings from few stroke victims or less serious cases. SHULKIN ASSURES DOCS ON TELEMEDICINE USE: Also during Tuesday s hearing, legislation (H.R. 2123) allowing VA doctors to treat patients through telemedicine regardless of where either are located. TEXAS LAW MARKS TURNING POINT ON TELEMEDICINE: With Abbott s signature on Senate Bill 1107, physicians can now utilize telemedicine services with patients they haven t met in person. This squashes an earlier requirement that physician-patient relationships had to be established with an in-person visit first. 15
15 Welcome to Telemedicine, Texas 16 Current Telehealth Applications & System Opportunities
16 Current Telehealth Applications 17 Outreach Telehealth Opportunities Neurology (TeleStroke, TeleNeuro) Behavioral Health Maternal Fetal Medicine Endocrinology Cardiology* Primary Care Dermatology Nephrology Intensivist
17 TeleNeurology 18 Jeffrey C. Wagner, MD Blue Sky Neurology
18 Tele Education Opportunities 19 St. David s Health Cast Monthly WebEx Clinical Education Series Featured CME B.L.A.S.T Sepsis Other CME Topics: Neurology Cardiology G.I. & Colon Pulmonology Emergency Medicine Ethics Pediatrics OBGYN Acute Stroke HIE/Cooling in the neonate Adult Sepsis Cardiac Emergencies in the adult Newborn Assessment Pediatric Drownings Hemodynamics Hyperbilirubinemia Cue-based feeding in the NICU Overdose in the ED Hyperbilirubinemia
19 Assessing Needs & Next Steps 20 Community Needs Assessment Care Collaboration Agreement (CCA) Telemedicine Service Agreement Medically Underserved Status Critical Access Distance to higher level of care Overarching "umbrella"-type agreement that sets the stage for an StD Hospital and Non-StD Hospital to consider what services may enhance clinical care in the Non- StD Hospital's community Type of Services Credentialing By Proxy Equipment Provider
20 Essential Elements 21 Connectivity Equipment Physicians Quality & Continuity
21 22
22 Critical Success Factors 23 CEO Buy-In CNO Engagement ED Director & MD Champion Education, Education & More Education Equipment Uptime Connectivity Integrity Equipment Provider Partner One Call Activation Multidisciplinary Team Active (Real-Time) Problem Solving Quality Metrics Reporting & Consistent Feedback Patient-Level Feedback re: Clinical Outcomes One Size Does Not Fit All
23 Other Important Issues Legislative/Regulatory Specialties Billing & Reimbursement 185 th Texas Legislative Session (SB 1107) Lessens requirements to establish physician/patient relationship for purposes of a telemedicine consult. Opens the door to use in the home (but not approved use just yet) (SB 1633) opens door for rural telepharmacy sites operated by a retail pharmacy. Requires experienced tech on the remote end. (also referred to as the Big Bill ) (HB 1697) Establishes a grant program for telenicu services for premature infants (SB-922) Ensures Medicaid coverage for telemedicine used in schools Equipment Configuration Clinical Work Flows Check Medicare Telehealth Payment Eligibility Analyzer by Address (HRSA) Submit billing with GT Modifier Consider the 4 determining factors for Medicare Reimbursement Patient Setting Technology Geography Provider Type Organization Tactics to Generate Revenue from Virtual Health Develop relationships with regional health systems and other nonaffiliated providers to offer virtual services for an additional revenue stream Source: Sg2 Navigating Virtual Health Reimbursement
24 Equipment Technology Implementation and Support 25 Business Intelligence Connectivity Testing Go-Live Training/Support Equipment Selection Radiology Access MDs credentialed EMR Access Real-Time Documentation/Ordering Workflow Tools Secure, Reliable & Scalable Preventative Maintenance 24/7 Support Equipment upgrades Reliable Downtime Solutions Ongoing Clinical Staff Training Program Analytics
25 Questions 26
26 THANK YOU Mark Clayton, LFACHE Affiliate Services Wendy Layton, Director Telehealth Program Jeffrey Wagner, MD Blue Sky Neurology
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