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Demko ftp -wp 12.05.2014
- 1. Time for Telehealth: CriticalConnection & Foundational Cornerstone Tamara Y. Demko, JD, MPH, ABD Director, Florida TaxWatch Center for Health & Aging Florida TeleHealth Summit Winter Park, Florida December 5, 2014
- 2. The Promise ofTelehealth • Successfully used worldwide to deliver a full spectrum of health care services From pediatric endocrinology to emergency management “Anything ending in –ology” • Access to safe, appropriate health care when needed and before more costly interventions are needed Reduction in emergency department utilization Rural and non-ambulatory access Specialist consult as needed
- 3. The Progress ofTelehealth • World Health Organization – 25% responding countries have national telehealth policy/strategy Many more have telehealth programs (Mongolia, Norway) Or use for specific topics (28+ countries use for cardiology) • United States 21 states + Washington, D.C. legislatively mandate private coverage 12 states + Washington, D.C. legislatively mandate Medicaid coverage 43 states + Washington D.C. provide some level of Medicaid reimbursement
- 4. Case-by-Case Building ofROI Convincing, But Fragmented State System Telehealth Delivery Patient Condition(s) Metric 1 ROI Impact on Metric 1 Metric 2 ROI Impact on Metric 2 CO Centura Health at Home (CHAH) integrated home telehealth services with remote monitoring and a clinical call center Congestive heart failure, chronic obstructive pulmonary disease, and diabetes Cost savings $1000 and $1,500 per patient Thirty-day readmission rates Reduced by 62 % FL Baptist Health South Florida eICU LifeGuard remote 24/7 physician monitoring Varied Total Savings in 1 Year Snapshot $15 million ($1,800/day) Length-of-Stay (7 year period) Reduced 29% ICU stay; reduced 33% hospital stay FL University of Florida/UF Health Florida Initiative in Telehealth and Education (FITE), videoconferercing rural areas to UF specialists Diabetes (pediatric) Total program savings per year (excluding transportation savings) $27,860 Hospitalizations of children with diabetes per year Decreased from 13 to 3.5 MA Partners HealthCare along with the Center for Connected Health (CCH) Connected Cardiac Care Program (CCCP) telemonitoring Heart failure Net savings $8,155 per patient Heart failure hospital readmissions Reduced by 50 % TX CHRISTUS Health System Videoconferencing, home monitoring (Remote Patient Monitoring Solution (RPMS) Pilot) Heart failure Cost of care Decreased from $12,937 to $1,231 Average admissions Decreased from 1.43 to 0.20
- 5. Florida Needs Telehealth •Potential cost-savings = $1 billion with 1% reduction in charges across costly hospitalizations and emergency room visits (2012-13 AHCA data) – Critical Connections to Care • Rapid population growth • Geographic disparities across 67 counties • Aging & disabilities populations • Public health preparedness • Emergency management access
- 6. Florida’s Efforts toMove Telehealth Forward • Years of introduced legislation • 2014 Legislative Session • Board of Medicine • Industry conferences and discussions • Florida TeleHealth Workgroup
- 7. GAUGING FLORIDA’S STATEOF HEALTH Population, Economy, Physical Well-being
- 8. Florida Compared: Demographics, Health,Business FL CA GA NY TN TX VA Population (7/2013) 19,552,680 38,332,521 9,992,167 19,651,127 6,495,978 24,448,193 8,260,405 Population Rank 4 1 8 3 17 2 12 % State Population 65+ (7/2013) 3,647,617 4,791,731 1,195,955 2,832,481 952,376 2,966,167 1,105,381 # Medicaid Enrolled in Thousands (6/2013 KFF - pre open enrollment data) 3,290.00 7967.7 1,536.30 5,141.70 1,305.60 3,644.20 851.4 Geographic Disparity (2012 report) 48 42 37 14 17 39 40 Disparity in Health Status (2013 report) 41 48 18 24 11 46 37 Chief Executive Ranking Best States for Business 2 50 10 49 3 1 11 CNBC Ranking Best States for Business 20 32 1 40 14 2 8 ALEC Ranking Best State Economic Outlook 16 47 9 50 19 13 11 Tax Foundation Ranking Business Tax Environment 5 48 32 50 15 11 26
- 9. Florida Lags Behind American Telemedicine Association Grades Coverageand Reimbursement (C grade) COVERAGE & REIMBURSEMENT FL # States Higher Grade # States Lower Grade # States Equal Grade # States N/A *Overall Grade C 28 + D.C. 3 18 Parity Topics Private Insurance F 21+DC 0 28 Medicaid C 24+DC 8 17 Medicaid Service Coverage & Conditions of Payment Patient Setting F 38+DC 0 11 Eligible Technologies F 22 0 26+DC Eligible Providers F 26+DC 0 23 Informed Consent F 34+DC 0 12 3 Telepresenter C 36+DC 0 10 3
- 10. 42+ Policy DecisionPoints Spectrum of Options Coverage, Cost, & Parity • Medicaid • Medicaid-Medicare dual eligibles • Patient costs • Private insurance coverage mandate • Private insurance parity vs. different rates not comparable to face-to-face services • State employee health plan coverage Definitions, Locations, & Transmissions • Telehealth/telemedicine definition • Services defined • Distance/geography Restrictions • Originating site (e.g., clinician office, home) • Distant Site • Live videoconferencing • Remote monitoring • Store and forward • Other permitted transmissions • Excluded transmissions
- 11. Policy Decision Points- Continued Provider Related • Other health care practitioners • Out-of-state practitioners • Physicians/practitioners • Practice of medicine (what crosses into practice) • Practitioner registration/telehealth registry • Practitioner sanctioning • Practitioner training • Prescriptions – Controlled Substances/Legend Drugs • Prior relationship with patient • Professional Liability Coverage • Standard of care & quality of care • Supervision requirements • Telepresenter requirements Technology, Privacy, Recordkeeping, Other • Equipment/technology requirements • Fiscal impact monitoring • HIPAA compliance/privacy • Informed consent • Interstate compact • Medical/health records • National licensure • Population Uses/Rules (e.g., prison population) • Rulemaking Authority • Specialty Rules (e.g., eye care, mental health) • State reporting (e.g., legislative, state agency) • Statewide network • Venue/jurisdiction
- 12. Laying the Cornerstone •Telehealth as foundational in health care delivery that works • Long-term, sustainable health care system Ability of licensed practitioners to deliver care Ability of Floridians to get needed, timely care
- 13. TELEHEALTH CORNERSTONE CONFERENCE Whatdo policymakers need to know? On what policy decision points can we achieve consensus? What is needed to keep the discussion going while Florida refines decisions? What barriers currently exist and how can we overcome them?
- 15. STATE OF THENATION American Telemedicine Association Latoya Thomas Florida TeleHealth Workgroup Southeastern Telehealth Resource Center/ Florida State University Rena Brewer & Mike Smith STATE OF THE STATE
- 16. 3 Workshops –3 Lenses Different Angles for a Clearer Picture • Lens 1, Subject Matter: Child health, aging & disability, access to care, chronic disease management/ emergent issues • Lens 2 – Industry: Providers, practitioners, payers, business/innovation • Lens 3 – Consensus-Building: Out-of- state providers, scope, financials, technology & innovation
- 17. Lunch Panel –How to Build Telehealth Policy Discussion Highlights Speaker Pro Tempore Matt Hudson State Representative John Wood Mike Smith – Florida TeleHealth Workgroup Phillis Oeters – Baptist Health South Florida Justin Senior – Agency for Health Care Administration Dr. Mark Stavros – Florida State University Tom Feeney – Associated Industries of Florida
- 18. KEY POLICY MESSAGES •Not every issue requires legislation, • There will not be consensus on all issues • Top policy priorities going into the 2015 Legislative Session: – defining telehealth/telemedicine and what telehealth success entails – examining avenues for funding incentives and reimbursement – revisiting logical and safe licensure options – writing legislation to be technology neutral
- 19. KEY TAKE-HOME POLICYMESSAGES – making it easier for practitioners who engage in telehealth – leveraging existing technology (e.g., electronic health records) • Legislation should – seek to make telehealth more available – avoid language that imposes arbitrary restrictions – not detract from the current successful provision of telehealth occurring across the state (First do no harm) – consider the convening of an continuous advisory body while preliminary legislation goes forward – Lay the cornerstone by moving on policy issues for which there is clearer consensus
- 20. NEXT STEPS: MOVINGFROM CONFERENCES TO CORNERSTONE It’s Time for Telehealth
- 21. Building Tools Right ToolDepends on Job • Policymakers – ROI data – Information & decision tools – Real people/constituents (bringing the message home) • Patients – Social marketing push/market demand – Safety & awareness • Practitioners – Assurance of standards of practice within specialty – Clear guidelines, including reimbursement
- 22. Building Tools • Providers –Better understanding of costs (up front and long-term) & ROI – Negotiating contracts & options • Payers – ROI financial and outcome based – Patient demand; contract demand; alternative business models • Businesses & Innovators – Understanding of cost pass-through ESI, utilization, & employee productivity – Telecom successes, ROI potential – Grant partners & contracts
- 23. Building Tools • TelehealthChampions (Everyone in this room!) – Share your successes – Inventory & data collection – Find creative collaborations – Realistic policy expectations • Walking before running • Getting creative • Avoid polarized silos • All-or-nothing bets – Framing telehealth as win-win • Health care generally is zero sum • Telehealth can be uniquely different
- 24. Florida TaxWatch Tamara Y.Demko, JD, MPH, ABD tdemko@floridataxwatch.org Telehealth reports and conference materials are available at floridataxwatch.org
Editor's Notes
- #3 You heard about telehealth for ALS, tele-genetic programs, e-ICU, and tele-cardiac among other uses yesterday.
- #7 Senator Arthenia Joynes has introduced telemedicine legislation several years in a row. You heard from Representatives Mia Jones and Cary Pigman, who have both been great champions of telehealth in the Florida House.
- #15 Mike Smith mentioned some of our partners yesterday.