Perinatal TelemedicineDEXTER M. PAGE, MD, FACOGATLANTA PERINATAL ASSOCIATES PAGEMED, LLC
OBJECTIVES Why there is a need? Challenges Advantages Possibilities Perinatal assessment Scope of service
Why a NEED – Disparities APA experience Access Quality Geography Continuity Morbidity Prevention Awareness
Why Bother? Infant mortality rates 10% higher Rural child death rate (ages 1-14) 29% higher Poverty rate 58% higher Percent of population living in poverty is higher Percent of the population that is uninsured is higher
Why Bother? Receiving inadequate prenatal care (<or =4 physician visits) 47% higher Cancer death rate 33% higher Deaths from motor vehicle accidents 68% higher Educational levels < ninth grade are two times higher
“Cure” Growing Needs Inadequate Prenatal care late or infrequent Rural neglect minimizing the travel physician back-up/support Stopgap - Provider shortages Encourage partnerships Escalating costs Increasing demand for care
Quality Deficiencies Experts - 200 MFM graduates nationally 2/year in GA Marginalized care does not = managed care Outdated tools
Infant Mortality RateCritical measure of access to healthcare services Georgia ranks 48th in the nation Rate in rural counties is 11.4/1,000 Infant mortality rates are 10% higher Rate in 10.1/1,000 in urban counties Rural child death rate (ages 1-14) is 29% higher Without adequate medical infrastructure 33% higher infant mortality
GOALS Decrease the Disparity in Infant Mortality Objective 1: Decrease Baseline of 15.5 to 13.0 per African American infant thousand live births by mortality rate 5/31/14 Objective 2: Increase first Baseline of 85.2% in 2004- trimester initiation of 2006 to 87.0% by 5/31/14 prenatal care among African American women Objective 3: Decrease the Baseline to LBW = 10.3% percent of Low Birth and VLBW = 2.5 % of live Weight (LBW), Very Low births by 5/31/14. Birth Weight (VLBW) African American
Rural HealthcareCore problems facing rural health care providers Declining population High percentage of the elderly Poorer health status indicators Retaining medical and administrative staff
Rural Healthcare Core problems facing rural health care providers Maintaining sufficient inpatient occupancy and outpatient volume to cover costs Inability to achieve economies of scale Difficulty securing capital to renovate old physical structures and to replace outdated medical equipment High percentage of Medicare/Medicaid and indigent/CHARITY
Rural Healthcare Core problems facing rural health care providers Lack of planning Inability to adapt Problems can be traced to Medicare and other third party payment practices, including managed care Result Providers’ inability to shift costs Changes in reimbursement have decreased LOS Shift resulted in more outpatient treatment
Challenges Lead a horse to water…. Infrastructure Not a real “Trekkie” Cost of equipment Regulatory concerns Reimbursement issues Lack of standardization Reimbursement Credentialing of Providers High administrative cost Interactive video
Perinatologist Definition of a Subspecialist in MFM Is a subspecialist in obstetrics and gynecology By virtue of additional education cares for provides consultation women with complications of pregnancy Requires advanced knowledge of complications of pregnancy Obstetrical Medical Surgical The effects on both the mother and the fetus Requires expertise in the most current approaches to diagnosis and treatment of women with complicated pregnancies practice in a setting in which such modalities are available.
Perinatal Services H&P Counseling Genetic Imaging Lab interpretation Share info Manage the Risks, AND Transfer liability
Advantages Face to face Accurate Coordinate proper referrals Manage, Diagnose Image, Monitor Patient/Provider satisfaction Decreased LOS Reduced anxiety Increased compliance
Telemedicine Advantages Providing immediate access to specialty consultation Retaining the patient at the rural community hospital Reducing delays in providing acute care Maintaining continuity of care with the patient’s primary care physician Providing effective continuing medical education (distance learning) Expanding medical capability as well as the ability to supervise non-physician healthcare personnel Decreasing healthcare costs.
Telemedicine Advantages Providers want to reside in/near metropolitan areas Remove the feel of isolation from the medical community Most of the population in the rural areas are Medicare/Medicaid recipients and/or are uninsured There are fewer opportunities for on-call coverage and time off Rural docs work longer hours for same $$ urban MDs State-of-the-art equipment and technologies are often unavailable Patient referrals and transportation in emergency cases may be difficult
Requirements live or interactive; Service provided through the use of camera, video, or audio conference equipment on a real-time basis store-and-forward transferring information by sound, images, or images on videotape must be provided through the transference of digital images between locations allow quality consultation to referring provider obtain information analyze report back diagnosis and management
Challenges Perception Acceptance Compliance Lack of understanding Buy-in Reimbursement Documentation
Build relationships help local providers detect and manage maternal and fetal complications congenital anomalies, oligohydramnios or polyhydramnios, maternal medical disorders diabetes, hypertension autoimmune disorders
Build Relationships Hospitals Community centers OB/GYN Families Referrals
Telemedicine Services Ultrasound Level I, Complete: Interpretation (Store & Forward) CPT: 76801, 76802, 76805, 76810 Level II, Detailed Complete: Interpretation (Store & Forward) CPT: 76811, 76812 Transvaginal Ultrasound: Interpretation (Store & Forward) CPT: 76817 Follow-Up (Single item or AFI): Interpretation (Store & Forward) CPT: 76816 Limited Ultrasound: Interpretation (Store & Forward) CPT: 76815 Nuchal Translucency: Physician to co-sign with certified sonographer CPT: 76813 Real time/online participation of Perinatologist for all ultrasounds can be scheduled in advance. CPT 76811, 76812, 76817 For all ultrasounds, the remote site will bill for the technical/facility component, and the referral site will bill for the professional component.