u  Telemedicine – The Virtual Experience

u  April 2017

Telemedicine vs. Telehealth

u  Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status.

u  Telehealth The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.

Source: Health Resources Services Administration

Telemedicine vs. Telehealth

Telemedicine is real time two-way audio video communications and includes the application of video conferencing and store-and-forward.

Telemedicine vs. Telehealth

To facilitate the assessment, diagnosis, consultation, treatment, education, and self management of a patients healthcare

Disruptive Technology

New ways of doing things that disrupt or overturn the traditional business methods and practices

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Uber vs. Taxi

Amazon vs. Retailer

Netflix vs. Blockbuster

Telemedicine vs. Clinic

Competition

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Convenience

Access

Transparency

Cost

Telemedicine Price Transparency

Physician Office u  Medicare = $68.05 u  Average = $80.00

Telemedicine

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Telemedicine Corporations

Telemedicine Platforms

Subscription fee

Established patients

Global period

Supplement

Chronic Care Mgmt

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Telemedicine Trends

u  Expanding Reimbursement and Payment Opportunities

u  Continued Momentum at the state level

u  Retail clinics and employer onsite health clinics on the rise

u  Increased adoption in ACOs

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Telemedicine Growth u  Patients will increase from 350,000 in

2013 to 7 million in 2018 u  22% of employers with 1,000 or more

employees offer telemedicine services and another 37% planned to by the end of 2015

u  >50% of hospitals have a telemedicine Program

u  Projected to grow at a compound annual growth rate of 14.3% from 2014 to 2020

u  2016 legislative session, 44 states have introduced over 150 telehealth-related pieces of legislation

Sources: Public Health Institute Center for Connected Health Policy, Beckers Hospital Review

Telemedicine MGMA Poll

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Technology Adoption

•  American adults own a smartphone 64%

•  American adults own a tablet computer 42%

•  adults 65+ use the internet 59%

•  Adults 65+ say health information is the top reason for getting online 53%

13 Source: Pew Research Center

•  Users have a healthcare app on their phone 32%

•  patients willing to have video visits with Physician 64%

•  patients frustrated with wait times 97%

•  patients prefer easy access to healthcare services over in-person interactions with providers

74%

Telemedicine Advantages

Convenience/Access

Patient Engagement

Remote Patient Monitoring

Patient Compliance

Reduced Hospitalization /ER Visits

Time Management

Decreased cost to patient and healthcare system

Telemedicine – Triple Aim

Value = Improved Quality

Care

Better Patient

Experience

Lower Healthcare

Costs

Telemedicine Challenges

Privacy/Security

Face to Face visit

Technology Limitations

Documentation

Reimbursement

Equipment

Regulations

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Telemedicine Technology & Application

Synchronous

Remote Monitoring

Asynchronous

Mobile Health

Remote Monitoring & Mobile Health

Otoscope Stethoscope

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Definition of Interactive

u  Two-way, real-time (live) interactive communication between the patient and the distant site (consulting) practitioner via audio/video (Polycom or VTC) equipment.

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Definition of Store and Forward

Store and Forward is: asynchronous (not

live) transmission of medical information to be reviewed at a later time by a health care provider at the distant (consulting) site.

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Remote In-Person •  Diagnoses, treatments

follow reliable standard protocols based on evidence-based medicine

•  Suggested therapies are nearly always effective

•  Physical exam not required, visual exam adds nominal value

•  Diagnoses, treatments more complex, may vary within disease category

•  Therapies may need careful selection and monitoring

•  Physical exam or diagnostic test required to correctly identify issue and select treatment

•  Intervention required (i.e., immunization)

Emerging Areas for Virtual Care

Management, Maintenance •  Chronic disease checkups,

follow-ups •  Care plan updates •  Specialist consults Diagnosis, Treatment •  Remote diagnostics •  Self-guided interventions

Telemedicine Application

Telemedicine Reimbursement Considerations

u  Arkansas Telemedicine Act (Act 887) u  Arkansas Telemedicine Act (Act 203)

u  CMS Coverage Guidelines

u  Commercial Considerations

u  Self Pay

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Arkansas Telemedicine Act (Act 887)

u  Effective January 1, 2016 for commercial plans u  Effective July 1, 2016 for Arkansas Medicaid

u  Requires health plans to cover telemedicine the same as in person services

u  Must be licensed in Arkansas

u  Can be initial encounter with real time audio and visual telemedicine technology (amended August 26, 2016)

23 https://legiscan.com/AR/text/SB133/2015

Arkansas Telemedicine (Act 203)

u  Effective February 20,2017 u  Repealed code 17-80-118 u  Defines professional relationship

–  Can be initial telemedicine encounter

u  Minor Arkansas Medicaid must be PCP u  Held to the same standard as an in person encounter u  Originating site is location of the patient at TOS u  Provider must be licensed in Arkansas u  Informed Consent, Records, Privacy

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Source: http://www.arkleg.state.ar.us/assembly/2017/2017R/Acts/Act203.pdf

CMS Coverage Guidelines

u  HPSA Area

u  A county outside of a MSA.

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u  The offices of physicians or practitioners

u  Hospitals

u  Critical Access Hospitals (CAHs)

u  Rural Health Clinics

u  Federally Qualified Health Centers

u  Hospital-based or CAH-based Renal Dialysis Centers (including satellites)

u  Skilled Nursing Facilities (SNFs)

u  Community Mental Health Centers (CMHCs)

u  Physicians u  Nurse practitioners

(NPs) u  Physician assistants

(PAs) u  Nurse-midwives u  Clinical nurse

specialists (CNSs) u  Certified registered

nurse anesthetists u  Clinical psychologists

(CPs) and clinical social workers (CSWs).

u  Registered dietitians or nutrition professionals

Geographic Location Originating Sites Practitioners

CMS Coverage Guidelines

Requires interactive audio and video that permits real-time communication at the distant site, and the originating site.

Professional Service Billing •  CPT or HCPCS code for the professional

service along with the telehealth modifier GT

Originating Site Facility Fee •  HCPCS code Q3014

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Are Telemedicine visits reimbursable?

Yes • As long as you meet the payor

requirements • Some telemedicine companies are a self

pay only program

No • Texting, email, and fax are not reimbursable

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Telemedicine Self-Pay

May have patients sign a waiver or ABN

May be attractive to patients in

high deductible

health plans

May use healthcare

savings account

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Telemedicine Coding

u  Telemedicine is not a service provided, it is a mode of delivery

u  The originating site is the location of the patient at the time the service is being furnished.

u  The distant site is the site where the physician or other licensed practitioner delivering the service is located.

u  Originating site use HCPCS code Q3014

u  Distant site add modifier GT

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Telemedicine Privacy and Security

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u  Authorized users u  Secure communication

u  Monitor communication

u  Bandwidth

u  Storage

u  Business Associate Agreement (BAA)

Telemedicine Malpractice

u  Obtain written assurances from carrier

u  May create telemedicine policy

u  Consider state lines

u  Little history available

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Telemedicine Documentation

u  Documentation requirements same as that any face-to-face patient encounter, with the addition of the following:

u  A statement that the service was provided using telemedicine;

u  The location of the patient; u  The location of the provider; and u  The names of all persons participating in the

telemedicine service and their role in the encounter.

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Telemedicine Considerations

u  Telemedicine is still a complex area with individual state rules and regulations.

u  Consult with a healthcare attorney who is versed in telemedicine in your state.

u  There are different rules when telemedicine is provided across state line.

u  Federal Laws

u  Capital Investment

u  Speed, Clarity, and Security

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Questions