Connected Care Theory vs. Reality Joe Tracy Vice President Connected Care and Innovation 2016 Lehigh Valley Health Network
5 Campuses 1 Children s Hospital 160 Physician Practices 17 Community Clinics 14 Health Centers 11 ExpressCARE Locations 81 Testing and Imaging Locations 14,361 Employees 1,496 Physicians 642 Advanced Practice Clinicians 3,140 Registered Nurses 57,801 Admissions 208,882 ED visits 1,236 Acute Care Beds
LVHN Connected Care Programs Advanced ICU (AICU) BabyCam Infectious Diseases Interpreter Services LVHN TeleBurn SM Maternal Fetal Medicine U sound/genetic Counseling Neurosciences Stroke/Movement Disorders Psych Emergency/Eval Svc Radiology Remote Patient Monitoring Surgery Early Discharge (VICC) Toxicology Trauma Video Monitoring (reduce falls) MyLVHN Virtual Visits Post Surgical Follow-up Urgent Care Wound
LVHN Connected Care Programs Advanced ICU (AICU) BabyCam Infectious Diseases Interpreter Services LVHN TeleBurn SM Maternal Fetal Medicine U sound/genetic Counseling Neurosciences Stroke/Movement Disorders Psych Emergency/Eval Svc 19 Services Radiology Remote Patient Monitoring Surgery Early Discharge (VICC) Toxicology 31,000 + Trauma Encounters Video Monitoring (reduce falls) per year* MyLVHN Virtual Visits Post Surgical Follow-up Urgent Care Wound * Excludes TeleRadiology and BabyCam
Objectives Explore the realities of operating a connected care program. Identify some of the legal and regulatory barriers related to connected care. Answer your questions. Have some fun!
Back to School
CONNECTED CARE IS NEW AND INNOVATIVE Have I Got News for You
Connected Care is New!
GET TO YOUR TELEHEALTH DEMO QUICKLY Don t Jump the Gun
When You Have Guests Unfamiliar with Connected Care Start the conversation around an old fashion phone call!
Emergency Telephone Call Burn Remote Physician Description 83 year-old male Burned his lower leg yesterday while burning brush with gasoline. His burn looks to be about 0.5% TBSA. Wound is pink and moist with blistering. Patient has a history of diabetes and heart disease as well as mild dementia. I would like to treat him here and refer if there are any complications with healing.
Additional Conversation Burn Surgeon: Is his pain controlled and does there appear to be any signs or symptoms of cellulitis. Remote Dr.: His pain is controlled and he does not have any signs of cellulitis. His wound looks pink. Burn Surgeon: Does the wound blanch? Remote Dr.: It appears to blanch in the area of blister..
Case Summary TELEPHONE Same verbal communication No Visual.5% burn TBSA Pt. probably treated local and sent home. Big chance for infection If wound becomes infected two surgeries vs. one CONNECTED CARE Same verbal communication Couple Digital Pics 1.5% burn TBSA Pt. transferred to LVHN Burn Center No infection due to timely treatment One surgery next day discharged on day 5
Important Summary Points Connected Care provides a better assessment of the patient! Payor implications two surgeries vs. one and corresponding LOS differences. Think about the legal issues of mistreatment. MOST IMPORTANT think about the implications for the patient. Better health, better care, better cost.
SHOW ME THE MONEY SHOW ME A PRODUCTIVITY OFFSET HELP ME LOSE LESS MONEY The Battle of Connected Care
An Important Day in History
An Important Day in Telemedicine History
Medicare Reimbursement Medicare Telehealth Provisions S.2505 (Jeffords) and BIPA 2000 CBO estimated costs @ $150 million over 5 years
Medicare After 12+ Years
Medicare Reimbursement Reimbursement under a defined set of criteria Rural requirement may be the biggest issue at this time Applies equally across the continental U.S. Carve out for Store and Forward in Alaska and Hawaii Beginning to see other changes and additional carve out programs Total Joint Replacement Pilot 2 nd Generation ACOs
Medicaid Reimbursement If you have seen one Medicaid reimbursement program for connected care, you ve seen one program.
Commercial Insurance Reimbursement Competition Legislative Mandates Parity in Payment
Using Technology to Lose Less $$$
CROSS STATE LICENSURE Will it Ever be Easy for Connected Care?
An Interesting Observation on Interstate Licensure for Outpatient Telehealth
ONE OF THESE DAYS Someone will Eventually Challenge HIPAA
HIPAA vs. The Right Thing to Do
THE DONUT HOLE Understanding the Entire Picture
You Just Need to Zoom In on the Problem! Picture courtesy of Robert Schosser, MD, East Carolina University
NO! You Need to See the Entire Picture! Picture courtesy of Robert Schosser, MD, East Carolina University
CAREFUL WHAT YOU WISH FOR Know the Laws and Regulations
IT TAKES TWO TO TANGO Help Wanted
WHO YA GONNA CALL? Competing for Patients on the Same Platform
Deciding the Best Direct to Consumer Route
I M FROM THE GOVERNMENT AND I M HERE TO HELP Laws & Regulations that Result in Confusion
Four Examples The Balanced Budget Act of 1997 Emergency Medical Treatment and Labor Act (EMTALA) Credentialing and Privileging Internet Prescribing in Pennsylvania
Telemedicine isn t so much about practicing medicine differently, it s about using cars differently. Jack Moncrief, MD University of Missouri Telemedicine Grand Rounds 10/30/98
In Conclusion Connected Care is still treated differently than in-person care. Reimbursement is still the big challenge. Watch out there is competition everywhere and from some unusual suspects. Keep you ears open and an eye peeled for legislation and regulation that can negatively impact what you are doing. And remember ONE PERSON CAN MAKE A DIFFERENCE!
Contact Information: joseph.tracy@lvhn.org