The Role of Telehealth Resource Centers
and Telemedicine
Outcomes/Collaborations/Successes
March 24, 2014
Becky Sanders
Program Director
Upper Midwest Telehealth Resource Center
Agenda
• Telehealth Resource Centers
• Upper Midwest Telehealth Resource Center
• Overview of National Telehealth Landscape
– Outcomes/Collaborations/Successes
• Illinois Legislative Resources
• Upcoming UMTRC activities
telehealthresourcecenters.org
• Links to all TRCs
• National Webinar
Series
• Reimbursement,
Marketing, and
Training Tools
Definitions and Concepts
Telehealth and Telemedicine
• Sometimes used interchangeably
• Two types of distinctions •
Telemedicine = billable interactive clinical services
•
Telehealth =
•
•
Broader field of distance health activities (CME, etc.)
Clinical remote monitoring (usually at home)
Service vs. Delivery Mechanism
●
TH is not a service, but a delivery mechanism
for health care services
–
Most TH services duplicate in-person care
–
Some are made better or possible with TH
–
Reimbursement equal to “in-person” care
Three Basic “Types” or Domains
Hospitals & Specialties
•
Specialists see and manage patients remotely
Integrated Care
•
Mental health and other specialists work in primary
care settings (e.g., PCMHs, ACOs)
Transitions & Monitoring
•
Patients access care (or care accesses patients)
where and when needed to avoid complications
and higher levels of care
Federal Telemedicine Law & Policy
Professionals are regulated at the state level
(doctors, nurses, counselors, etc.)
Medicare: Pays for certain outpatient professional
services (CPT codes) for patients accessing care in
rural counties and HPSAs in rural census tracts.
*No regs; only conditions of payment.
Medicaid: Telemedicine is “a cost-effective
alternative to the more traditional face-to-face
way of providing medical care…that states can
choose to cover.”
Federal Updates
• Effective 1/1/2014 Medicare expanded
telehealth eligibility to include authorized
originating sites located in rural Health
Professional Shortage Areas (HPSAs)
• Refer to the Office of Rural Health Policy’s
(ORHP’s) rural definition.
• All non-MSA counties continue to be eligible. In
addition, sites in designated HPSAs located in
rural census tracts within urban (MSA) counties
are also eligible originating sites.
Federal Updates
• Eligibility will be determined annually based on
an authorized originating site’s status on
December 31 of the previous year.
• New web tool for authorized Medicare
telehealth originating sites to check their
geographic eligibility, as well as to update
rural areas using 2010 Census data.
• http://datawarehouse.hrsa.gov/telehealthAd
visor/telehealthEligibility.aspx
National Landscape
•
National Focus on Outcomes
•
•
Especially for HRSA Grantees
Triple Aim*
•
Improve Patient Experience
•
Improve Population Health
•
Reduce Costs
•
Diabetes, CHF, COPD
•
CMS National Health Expenditure Data projects
healthcare costs in the US at 19.9% of the GPD by 2022
* Developed by the Institute for Healthcare Improvement
Collaborations
• What are your current referral patterns?
•
Could they become your partners for providing
better patient care?
• Do you have standardized processes and
procedures?
• Do you have a physician champion?
Collaborate - Think LEAN
• LEAN
•
Maximize customer value while minimizing waste
•
Toyota Production System
•
Critical Access Hospital CEO Perspective
•
Telehealth Director Perspective
• In Healthcare Speak
•
Improve patient experience (and health) while
reducing costs
• Focus on workflow
•
How can technology (telehealth) be used further
improve workflow
Collaborate - Program Development
• Assess & Define
•
Step 1: Assess Service Needs & Environment
•
•
•
•
Step 2: Define Program Model
•
•
Asses service needs
Identify potential telehealth opportunities
Assess organizational readiness
Consider the type of program that will meet needs
Step 3: Develop Business Case
•
Determine that impact of the proposed telehealth
program
*CTEC Telehealth Program Developer Kit
Collaborate - Program Development
• Develop & Plan
•
Two steps support fully defining the activities
necessary for program implementation
•
Step 4: Develop and Plan Program & Technology
•
•
Create a detailed project plan
Step 5: Develop Performance Monitoring Plan
•
Define monitoring and evaluation mechanisms and
program improvement process
Collaborate - Program Development
• Implement & Monitor
•
The final two steps support implementation and
ongoing monitoring
•
Step 6: Implement Telemedicine Program
•
•
Perform all the work required to implement the
program
Step 7: Monitor and Improve Program (ongoing)
•
•
Collect data
Monitor performance
Successes
Hospitals & Specialties
•
Specialists see and manage patients remotely
•
•
•
•
•
•
•
•
Teleradiology – is often just called radiology
Telepharmacy – often evening and weekend care
Telestroke
Telecardiology
Tele-ICU
Maternal & Fetal Medicine
Sleep studies
Video Therapy in group homes
Successes
Integrated Care
•
Mental health and other specialists work in
primary care settings (e.g., PCMHs, ACOs)
•
Telepsychiatry
Successes
Transitions & Monitoring
•
Patients access care (or care accesses patients)
where and when needed to avoid complications
and higher levels of care
•
•
Population Health
Health Coaching
•
Iowa Chronic Care Consortium
•
200 rural Iowa Medicaid members with high risk diabetes
Successes
Patient Monitoring Methods
•
Patient enters data
•
•
•
•
Integrated Voice Response Systems
Web based systems
Smart Phone/Tablet Apps
Smart device collects data & sends it to central
database
•
Vital sign monitoring
•
Blood pressure, oxygen saturation, pulse, weight, glucose
levels, temperature, and electrocardiogram data
Outcomes
• From an urban hospital perspective
•
Specialist is more productive
• From a physician perspective
•
Especially one who has been doing rural rotations
•
•
Reduced windshield time
More productive
Outcomes
• From a rural hospital perspective
•
Retains ancillary labs, x-rays, etc.
• From a patient perspective
•
Remember the Triple Aim (better patient
experience)!
•
•
•
Less time off work
Less drive time
More convenient
In The News
• American Well
•
See a doctor anytime, anywhere from your phone or
tablet
• Healthspot
•
Private Pods with digital monitoring devices
• New Hampshire bill would offer patients
financial incentives for choosing telemedicine
•
$25 or 25%, whichever is higher
• Florida TaxWatch
•
Telemedicine Can Save Florida $1 Billion Annually
National Legislative Overview
•
Medicaid has some sort of telemedicine
reimbursement in 45 states
•
•
The 5 that do not are Iowa, Massachusetts, New Hampshire,
New Jersey, Rhode Island
15 states are reconsidering legislation that was
introduced in 2013
•
Telehealth Parity Bills
•
•
Florida, Illinois, Massachusetts, New York, Ohio, Pennsylvania,
South Carolina, Tennessee, Washington
National Telehealth Policy Resource Center
•
http://telehealthpolicy.us/state-laws-and-reimbursementpolicies
Illinois Legislation
House Bill 5315/Senate Bill 3319
Telehealth Act
The act provides that telehealth services consist
of (1) the provision of services and the mode of
delivering health care services, and (2) as it
relates to the delivery of health care, mental
health care, or substance use disorder
treatment. It also amends the Illinois
Insurance Code and sets forth requirements
concerning the coverage of telehealth services.
Illinois Licensure Law
Licensure Requirements: Temporary, visiting
professor, visiting physician, visiting resident, or full
medical license required.
Reciprocity: The Illinois Licensure Statute does
allow reciprocity with states where the licensure
requirements are substantially equivalent.
Exceptions allowed for emergencies and purely
consultative services.
“Internet Prescribing” – History of revoked licenses
due to prescribing via online form only.
Illinois Telemedicine Definition - I
Telemedicine means the performance of any of the
activities listed in Section 49, including but not
limited to rendering written or oral opinions
concerning diagnosis or treatment of a patient in
Illinois by a person located outside the state as a
result of transmission of individual patient data by
telephonic, electronic, or other means of
communication from within this State.
225 ILL. COMP. STAT. ANN. 60/49.5(c).
Illinois Telemedicine Definition - II
“Telemedicine” is the use of a telecommunication
system to provide medical services for the purpose
of evaluation and treatment when the patient is at
one medical provider location and the rendering
provider is at another location.
IL Admin. Code, Title 89 ,140.403 (2012).
Illinois Medicaid Policy
Telehealth is defined as the use of a telecommunication
system to provide medical services…for the purpose of
evaluation and treatment. Medical data exchanged can
take the form of…text, graphics, still images, audio and
video. The information or data exchanged can occur in
real time (synchronous) through interactive video…or in
near real time (asynchronous) through “store and
forward” applications.
HFS Informational Notice, Expansion of Telehealth Services,
January 12, 2010.
Illinois Medicaid Reimbursement
Medicaid Reimbursement (January 29, 2010)
• Hospitals, physicians, APNs, podiatrists, FQHCs, RHCs, and
Encounter Rate Clinics can participate.
• Telepsychiatry (after completed residency) with form HFS
3882 on file. Group treatment not covered.
• Originating site paid $25 (service code Q3014)
• Distant site paid per CPT or encounter rate (HCPCS Code
T1015) with “GT” modifier
• Encounter rate clinic is payee whenever it is involved in a
telemedicine encounter
http://www.hfs.illinois.gov/html/011210n2.html
Illinois Medicaid Reimbursement
Originating Site Requirements
For telemedicine services, a physician or other licensed
healthcare professional must be present at all times with
the patient at the Originating Site.
For telepsychiatry services, a physician, licensed healthcare
professional or other licensed clinician, mental health
professional (MHP), or qualified mental health
professional (QMHP), as defined in 59 IL Admin Code
132.25, must be present at all times with the patient at
the Originating Site.
Reimbursable sites: physician’s office, podiatrist’s office,
local health departments, community mental health
centers and outpatient hospitals.
Illinois Medicaid Reimbursement
Other Factors
Only enrolled providers can be reimbursed
Non-enrolled providers may be reimbursed by
originating sites (though not by HFS)
Originating sites that reimburse providers must
ensure and document that requirements are met
for Distant Site providers
No telemedicine reimbursement for non-medical
mental health providers
Home Health Care Certification
Section 140.471 Description of Home Health Care Services
d)
Effective July 1, 2012, to be eligible for reimbursement by
the Department, initial certification of intermittent skilled
nursing services or therapy services must have documentation
that a face-to-face encounter was conducted by the practitioner
requesting services.
1)
The physician responsible for performing the initial certification
must document that the face-to-face patient encounter…has occurred
no more than 90 days prior to the home health start of care date or
within 30 days after the start of the home health care…
2)
The face-to-face encounter must be performed by the certifying
physician, a nurse practitioner, etc.
C)
The face-to-face patient encounter may occur through telehealth, in
compliance with Section 140.403.
Telemedicine Privileging for Hospitals
IL Administrative Code 250.310
The medical staff shall be organized in
accordance with written bylaws, rules and
regulations approved by the governing board.
The bylaws, rules and regulations shall
specifically provide but not be limited to:
17) establishing a procedure for granting
telemedicine privileges, based upon the privileging
decisions of a distant-site hospital or telemedicine
entity that has a written agreement that meets
Medicare requirements;
Occupational Therapy Tele-practice
HB 2996 – Public Act 098-0264
“Occupational therapy may be provided via technology
or telecommunication methods, also known as
telehealth, however the standard of care shall be the
same whether a patient is seen in person, through
telehealth, or other method of electronically enabled
health care.”
http://www.ilga.gov/legislation/publicacts/98/PDF/098-0264.pdf
UMTRC Resources
IL Telemedicine Reimbursement Summary:
http://www.umtrc.org/resources/payersreimbursement/2013-illinois-telemedicinereimbursement-summary/?back=Resources
UMTRC Services
• Presentations & Trainings
• Consultation
• Technical Assistance
• Connections with other programs
• Program Design and Evaluation
• Information on current legislative and
policy developments
• www.umtrc.org/events
Certificate Training
• ATA Annual Conference
•
Full day pre-meeting course
•
Telemedicine 101
• National School of Applied Telehealth
•
Certified Telemedicine Clinical Presenter
•
Certified Telehealth Coordinator
•
Certified Telehealth Liaison
Contact Information
Becky Sanders
(812) 478-3919, ext. 232
bsanders@indianarha.org