Telehealth
   The Future Is Here
  Virginia Telehealth Summit
        March 17, 2010
        Dena S. Puskin, Sc.D.
U.S. De...
Vision for America
 NO MATTER WHO YOU ARE
           OR
     WHERE YOU ARE
        YOU GET
THE HEALTH CARE YOU NEED
    WH...
Telehealth vs. Telemedicine

                  Telehealth
                                        Regional
    Health     ...
Patient




                                                       Urgent Care




                                       ...
A Different Kind of
          Toolbox
• Telehealth can be thought of
  as a tool box of technologies
  applied to diverse ...
History of U.S. Involvement in
               Telehealth
• Initiated telemedicine
  – Dates back to 1880s after invention ...
Does Telehealth “Work”
• Answer depends on clinical service,
  setting, and implementation
• What we think we know:
  Tel...
Summary of Key Challenges
•  Reimbursement/Start-up Costs
• Infrastructure
• Re-engineering Practice/Clinical Acceptance
•...
Reimbursement
• Contracts
• Medicaid
  – 23 states
• Private Plans
  – Recommend obtaining advance approval
  – State Laws...
Licensure/Privileging
• Licensure
  – Significant variability in definitions and
    details of regulation
  – Current lic...
Other Policy
       Considerations
• FDA Approval
• Telecommunications
  regulations: Broadband Report
• Anti-kickback law...
Addressing Telehealth Challenges:
     Demonstrating Value- Added
 Improve Clinical Acceptance:
    Demonstrate efficacy ...
Family Health Institute
                Reductions in HgbA1c with
               Treatment by Race /Language
        8.5

...
Telehealth Grants Projected
                   (FY 2010)
• Telehealth Resource Center Grant Program – 3 Yr
  Grants
    – ...
Telehealth Resource Centers
• ARIZONA TELEHEALTH RESOURCE CENTER*

• CALIFORNIA TELEHEALTH AND E-HEALTH
  CENTER*

• CENTE...
Telehealth Resource Center Map
HRSA Health IT Toolbox



 • A comprehensive online
   compilation of health IT
   planning, implementation
   and evaluat...
Telehealth Toolboxes/Modules
  • Current Toolbox Modules
    –Operations
    – Legislation and Regulation
    – Medicare R...
Technical
 Assistance/Information

 http://www.HRSA.gov/telehealth
     http://healthit.ahrq.gov/

http://telehealthresour...
Other Resources

•American Telemedicine
 Association
 http://www.atmeda.org
CONTACT US

Dena Puskin, Sc.D.
5600 Fishers Lane
Room 7C-22
Rockville, MD 20857
Phone: (301) 443-3682
Fax: (301) 443-1330 ...
Puskin
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Puskin

  1. 1. Telehealth The Future Is Here Virginia Telehealth Summit March 17, 2010 Dena S. Puskin, Sc.D. U.S. Department of Health and Human Services Health Resources and Services Administration
  2. 2. Vision for America NO MATTER WHO YOU ARE OR WHERE YOU ARE YOU GET THE HEALTH CARE YOU NEED WHEN YOU NEED IT
  3. 3. Telehealth vs. Telemedicine Telehealth Regional Health Health Inform. Professions Sharing Education Consumer Administration Telemedicine Education Public Evaluation Health Research Homeland Security
  4. 4. Patient Urgent Care Messaging Home Care Long Term Telehealth Office Visit Hospitals Live Pt-MD Care Health Public work Care Delivery Systems Electronic Health Records Telecommunications Informatics Infrastructure National Health Information Infrastructure And Telehealth
  5. 5. A Different Kind of Toolbox • Telehealth can be thought of as a tool box of technologies applied to diverse health care needs in a wide range of settings to connect people to improve access to health care services.
  6. 6. History of U.S. Involvement in Telehealth • Initiated telemedicine – Dates back to 1880s after invention of the telephone • Early U.S. Telehealth/Telemedicine – Nebraska Medical Center - 1955 – Massachusetts General Hospital/Logan International Airport Medical Station - 1967 – Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC) – 1972- 1975 – Alaska ATS-6 Satellite Biomedical Demonstration – 1971 – Texas Tech -1989 6
  7. 7. Does Telehealth “Work” • Answer depends on clinical service, setting, and implementation • What we think we know:  Telehealth services can improve access in rural communities  Telehealth can improve quality of care  Telehealth services do not necessarily improve productivity; depends on workflow design  Telehealth: Cost-effectiveness shown in closed systems, such as the VA, Kaiser, and limited small studies of non-closed systems - “free-world.”
  8. 8. Summary of Key Challenges • Reimbursement/Start-up Costs • Infrastructure • Re-engineering Practice/Clinical Acceptance • Evaluating cost/effectiveness, value-added • Financial Sustainability • Licensure/credentialing/scope of practice • HIPAA • Integration with EHRs/Health Information Exchange at “Point of Care” • Over-abundance of information about telehealth technologies -- few trusted resources
  9. 9. Reimbursement • Contracts • Medicaid – 23 states • Private Plans – Recommend obtaining advance approval – State Laws mandating coverage (e.g., Maine) • Medicare
  10. 10. Licensure/Privileging • Licensure – Significant variability in definitions and details of regulation – Current licensure language (where it exists) requires licensure in state where client receives service – Exception: Nurse Compact • Credentialing/Privileging – CMS/JCAHO Policies – FCC Broadband Report
  11. 11. Other Policy Considerations • FDA Approval • Telecommunications regulations: Broadband Report • Anti-kickback laws • Anti-trust laws • EHR/Meaningful Use
  12. 12. Addressing Telehealth Challenges: Demonstrating Value- Added Improve Clinical Acceptance:  Demonstrate efficacy in broader range of clinical services and settings • Reengineering Practice  Impact of Telehealth on work-flow and productivity • Financial Sustainability:  Cost-effectiveness/not simply reducing costs  Alignment of incentives • Workforce:  Address health professions shortages and maldistribution in light of increased demand due to demographics and expanded coverage
  13. 13. Family Health Institute Reductions in HgbA1c with Treatment by Race /Language 8.5 8 7.5 7 6.5 1st HgbA1C Most Recent White 7.23 6.95 Black 7.80 7.44 Latino-Eng 8.02 7.75 Latino- Span 8.12 7.81 Other 7.82 7.48
  14. 14. Telehealth Grants Projected (FY 2010) • Telehealth Resource Center Grant Program – 3 Yr Grants – 10 Regional Centers [6 new] – 2 Tele-home care Centers – 1 Legal and Regulatory Center • Telehealth Network Grant Program (including home health) – 24-25, 3-Yr Grants (7-8 new grants) – Collaborative Tele-home care evaluation • Licensure Portability Grant Program – Federation of State Medical Boards (2nd year of 3-Yr grant) • Licensure Portability ARRA Initiative – 2, 2-Yr Grants: $1 million to be awarded in February 2010
  15. 15. Telehealth Resource Centers • ARIZONA TELEHEALTH RESOURCE CENTER* • CALIFORNIA TELEHEALTH AND E-HEALTH CENTER* • CENTER FOR TELEHEALTH & E-HEALTH LAW • MIDWEST ALLIANCE FOR TELEHEALTH AND TECHNOLOGIES RESOURCES • NORTHEAST TELEHEALTH RESOURCE CENTER • GREAT PLAINS TELEHEALTH RESOURCE* CENTER • NORTHWEST TELEHEALTH RESOURCE CENTER*
  16. 16. Telehealth Resource Center Map
  17. 17. HRSA Health IT Toolbox • A comprehensive online compilation of health IT planning, implementation and evaluation resources to support the implementation of health IT for safety net providers. • The HRSA Health IT 17
  18. 18. Telehealth Toolboxes/Modules • Current Toolbox Modules –Operations – Legislation and Regulation – Medicare Reimbursement Policies – Marketing –Training • Toolbox Modules To Come – Evaluation – Business Planning – Technology Assessment
  19. 19. Technical Assistance/Information http://www.HRSA.gov/telehealth http://healthit.ahrq.gov/ http://telehealthresourcecenter.org Grants Information http://www.grants.gov
  20. 20. Other Resources •American Telemedicine Association http://www.atmeda.org
  21. 21. CONTACT US Dena Puskin, Sc.D. 5600 Fishers Lane Room 7C-22 Rockville, MD 20857 Phone: (301) 443-3682 Fax: (301) 443-1330 Fax E-Mail: dpuskin@hrsa.gov

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