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Telemedicine SW Clinical Society

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Latest presentation on Telemedicine for the Southwest Clinical Society on October 30, 2015

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Telemedicine SW Clinical Society

  1. 1. + Telemedicine, Today and Tomorrow David Voran, MD Southwest Clinical Society Kansas City, 10/29-31/2015 http://www.slideshare.net/Dvoran/telemedicine-today-and-tomorrow-for-southwest-clinical-society
  2. 2. + Agenda and Objectives  Review the status of telemedicine globally and locally  Legislative, reimbursement initiatives, interstate licensing and ACA effect  Examine newer technologies and services available to clinicians  Make some projections http://www.slideshare.net/Dvoran/telemedicine-today-and-tomorrow-for-southwest-clinical-society
  3. 3. + Where is telemedicine today? … an update of sorts Objective 1 http://www.slideshare.net/Dvoran/telemedicine-today-and-tomorrow-for-southwest-clinical-society
  4. 4. + Growth Types in Telemedicine  Traditional hub and spoke telemedicine encounters increasing organically  Over 200 networks with 3,500 service sites in US  Over half of US hospitals using some form of telemedicine  Adding more spokes  Specialty driven telemedicine expanding primarily in ED’s  Provider-to-Provider consultation  Retail telemedicine pilots are expanding and gaining traction  Portal-based telehealth services are normal part of practice  Direct to consumer services popping up spurred by ACA Organic – Logarithmic Inorganic - Exponential
  5. 5. + Telehealth Growth Curve HIS Telehealth Report 2014
  6. 6. + Organic Growth continues in Hub and Spoke Networks Avera eCare
  7. 7. + Expanding Telemedine’s reach: In-House Telemedicine Nebraska Medical Center
  8. 8. + eVisits Booming “Almost one in six doctor visits will be virtual this year” Up 400% since 2012 eVisits have … saved UPMC an average of $86.80 per member visit compared with the cost of an office visit This year [2014] in the U.S. and Canada, 75 million of 600 million appointments with general practitioners will involve electronic visits, or eVisits
  9. 9. + Medical Centers Jumping In
  10. 10. + Mid-Level Telemed “Load Balancing”  CVS Minute Clinic Experience  California  Off loading volume to remote APRNs  Lower level LPN performs registration and hands on  Remote APRNs are MC providers in the same state who are in-between live patients  Over 4,000 visits in last year  Reimbursement same as face-to-face  Survey results (1,700 patients)  33% prefer video to face-to-face, 50% liked it about the same and 10% found it worse
  11. 11. + Retail Telemedicine Expansion  Collaborative Coverage  Physician shortages  Rate limiting steps  Chronic condition management  Cooperation with IDN  CCM reimbursement not dependent on face-to-face visits  Increasing range of services  Beyond APRN scope of practice  Clinic expansions
  12. 12. + Kicking it up a notch Looking at where telemedicine industry is really heading
  13. 13. + Telemedicine Studio in your Pocket Nearly every smart phone owner has more resolution, bandwidth and capability than all telemedicine facilities built in the 1990’s.
  14. 14. + Retail gets personal
  15. 15. + Daily “telemedicine”  Phone messages  Patient Portal  eVisits  Retail direct-to-consumer  Low cost answers to questions  Phone conversations  Peer based videoconferencing  Face Time  Skype  Retail direct-to-consumer  Most by phone  Maybe 10% video Asynchronous Synchronous
  16. 16. + My own experience with e-Visits using Vgo Robot  Inexpensive, ad-hoc use of mobile systems
  17. 17. + Dabbling in Retail Visits Signed up with HealthTap
  18. 18. + Other developments  75% of large employers would be offering telemedicine benefits for employees within the next year  57% of broadband households access at least one portal per month  ACA health plans are or will be offering telehealth coverage in most plans  Health insurers offering their own telehealth or video consults for enrollees  mHealth use expanding  Most new devices capable of measuring some health parameters
  19. 19. + Telemedicine Savings  Would require all employees and dependents to use technology-enabled interactions in lieu of face-to-face visits  37% employers will offer telemedicine consultations in 2015  > 80% of insurance providers to offer telemedicine reimbursement by 2019
  20. 20. + Legislative Updates and Initiatives … still struggling with “what IS is” Objective 2
  21. 21. + Medicaid.gov  Telemedicine seeks to improve a patient’s health by permitting two-way, real time interactive communication between the patient, and the physician or practitioner at the distant site.  Means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment.  Asynchronous or “store and forward” applications would NOT be considered telemedicine but may be utilized to deliver services.
  22. 22. + HIPAA Does NOT consider an interactive video consultation to be protected health information, so it does not govern telemedicine encounters. Not considered PHI unless it’s recorded. Device encryption and a private internet connection are recommended for patient security and privacy. Most videoconferencing tools are encrypted. Other types of telehealth, such as the transmission of patient data or images, ARE considered protected health information and must be managed according to HIPAA requirements. Fine line between real-time video transmission and the same interaction that is being stored.
  23. 23. + Medicare Reimbursement  Performed By  Physician  Nurse  Midwife  Clinical Psychologist  Registered Dietitian  Clinical Social Worker  Originating Site (Patient)  Office (Physician/NPA)  Hospital  Critical Access Hospital  Renal Dialysis  Federal qualified health center  Skilled Nursing Facility  Community Mental Health Center  Charges  E&M +  Facility ($24.24)  HCPCS Q3014  Type of Service “9, other items and services”
  24. 24. + Legislative Action  Fostering Independence Through Technology Act  Sens. Amy Klobuchar (D-Minn), John Thune (R-S.D.)  TELEhealth for MEDicare (TELE-MED) Act of 2013  Reps. Devin Nunes (R-Calif) and Frank Pallone (D-N.J)  HR 3077  H.R. 5380 creates a phased approach over four years to expand coverage of telemedicine-provided services and remove arbitrary barriers that limit access to services for Medicare beneficiaries. Included in these provisions are the gradual removal of geographic restrictions to patient care, and the addition of coverage for healthcare services that take place in other locations such as the home and walk-in retail health clinics
  25. 25. + Federation of State Medical Boards  Interstate Medical Licensure Compact  Expedited license  Recognized by all member states  Compliments, does not replace existing State licensure  Interstate Medical Licensure Compact Commission  Administrate physicians applying for this type of license  Spearheaded by Wyoming State Board of Medicine  Requires a minimum of 7 states to participate  Looking to form in 2016
  26. 26. + Available Guidelines  Formal Policies and Procedures  Guidelines and Consensus Documents  Operational Procedures  Foundation for formal deployment American Telemedicine Association
  27. 27. + Telehealth Grades for States
  28. 28. + States with Telemedicine Parity
  29. 29. + What’s Happening Around Here? …probably more than most of us realize Local Activity KU Center for Telemedicine & Telehealth
  30. 30. + Report Cards 2014
  31. 31. + 2015 Grades
  32. 32. + KU Med Telemedicine Overview Eve-Lynn Nelson, PhD Director, Center for Telemedicine & Telehealth Professor, Pediatrics (913) 588-2413 enelson2@kumc.edu
  33. 33. + Kansas  Medicaid covered some TM services since 2004  Physician, Psychotherapy, Pharmacological management – GT modifiers  Requires patient to be present at originating site  Requires State Licensure Kansas  Center for TeleMedicine & TeleHealth  Kansas Medical Center  60 nodes  4,500 (1,500 unique pts)  Become more research oriented  Dependent on grants  Exploring using system to provide urgent care for whole state
  34. 34. + KU Center for Telemedicine and Telehealth  Approximately 4,000 consults per year across 40 providers  Behavioral consults most common  Traditional model in supervised settings  Team-based services with trainee participation 42
  35. 35. + Kansas iCare
  36. 36. + Project Echo Mission To expand the capacity to provide the best practice care for common and complex diseases in rural and underserved areas and to monitor outcomes Extension for Community Health Outcomes
  37. 37. + Missouri  HB 986 – prohibits plans from denying telehealth coverage and reimbursement (7/2013)  Covers services that would have been delivered in-person  Mo-Healthnet requires 2-way interactive video  No restrictions on type of technology being used  No store and foreward reimbursement  Require prior face-to-face physical exam  Defined clinical locations  Hospital, CAH  Rural Health Clinic  Federally Qualified HC  Nursing Home  Dialysis Center  Mo State Rehab Center  Community Mental Health  Requires State Licensure  Missouri Telehealth Network  University of Missouri, Columbia  202 node MOREnet 2 gigabit backbone Missouri
  38. 38. + Missouri Telehealth Network Psychiatry 47% Dermatology 19% Autism 19% Ped Endocrinology 6% Neurology 4% Other 5% 2011-2012 Encounters
  39. 39. + Why Isn’t Telemedicine the Norm?  TM visits reimbursed at lower rates than face-to-face visits  RVU based productivity  Parochial nature of medicine  Site-specific credentialing  State licensing requirements  Store-and-forward prohibition  Scheduling issues  Culture of convenience  E-mail, texting favored over synchronous communication Regulatory and Reimbursement Logistics and Culture
  40. 40. + The Future of Telehealth …where it becomes personal Objective 3
  41. 41. +  Activity tracking devices + Apps  Fitbit, Fuel band, Vivofit, Gear  Biometric monitors  External  Implanted medical devices Quantified Self Movement
  42. 42. + Game Changers  Devices (moving out of the exam room)  AliveCor ECG  Cellscope  Proscope  Fitbit  Services  Cloud based storage and sharing  Multimedia Patient Portals  Embedded video conferencing  Communities (Fitbit) FDA approved mobile apps and devices. Selling to patients directly. Allowing them to record and share with physicians, family and friends …pushing cost and control to patients (Consumer Directed Care)
  43. 43. + iOS Health Kit Apple Watch Healthcare embedded into operating systems Enhancing real time research Openning door to real-time clinical population monitoring and intervention Will the exam room survive?
  44. 44. + +Convenience +Coverage +Consumerism Time Magazine, November 9, 2015
  45. 45. + +Convenience +Coverage +Consumerism Time Magazine, November 9, 2015
  46. 46. + Forecast: Telemedicine Potential  Operational costs of clinics and hospitals become unsustainable  Reimbursement paradigm reaches inflection point  Telemonitoring capabilities embedded in all devices  Adequate universal spectrum
  47. 47. +

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