mom, maternity, & monitoring
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mom, maternity, & monitoring mom, maternity, & monitoring Presentation Transcript

  • 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Quality Deficiencies Experts - 200 MFM graduates nationally 2/year in GA Marginalized care does not = managed care Outdated tools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
  • Balancing the Scales  Convenience  Patient-friendly Long appt wait times  Technology Limited resources  Real-time results Outdated  Cost-saving measures Patient anxiety  Provider efficiency Consolidation  Accuracy Regionalization  Timeliness  Patient compliance
  • 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
  • Active Assessments Fetal well-being PTL Cervical compromise Glucose monitoring Fetal development Fetal arrhythmia
  • 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
  • Pregnancy complications Prenatal diagnosis  Amniocentesis  CVS PTL concerns RPL Multiples Fetal anomalies
  • Pregnancy complications Maternal medical conditions Teratogenic concerns Counseling Procedures 2nd opinion
  • 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.
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