Mario gutierrez georgia trc 2015 mario final
-
Upload
lloyd-sirmons -
Category
Healthcare
-
view
113 -
download
1
Transcript of Mario gutierrez georgia trc 2015 mario final
6th Annual Georgia Partnership for TeleHealth
Spring Conference MARCH 25-27
Savannah, GeorgiaMario Gutierrez
Executive Director
Center for Connected Health Policy • 877-707-7172
cchpca.org
TELEHEALTH POLICY & PRACTICE
We seek to advance state and national telehealth policies that:
• promote better health & health systems
• provide greater health equity
• Established in 2006, funded by the Office for the Advancement of Telehealth
• Twelve regional centers
• One national technology assessment center
• Collectively form a network of telehealth program expertise and experience
• Independently serve a designated region
TelehealthResourceCenter.org
One National Policy Resource Center - CCHP
What Is Telehealth?
Telehealth is a means for enhancing health care, public
health, and health education delivery and support using digital telecommunication technologies.
Telehealth?
A doctor's diagnosis "by radio" on the cover of theFebruary, 1925 issue of Science and Invention magazine
Why Telehealth is Essential to
the Future of Health Care
Advances in telecommunications technologies can help redistribute health care expertise to where and when it
is needed, and create greater value
Live VideoVariety of high-speed digital telecommunications
Outpatient or inpatient specialty consultation
Most commonly used
Store-and-Forward
Often low bandwidth, still images, can store video clips.
Best used in dermatology, ophthalmology, pathology, and radiology.
Exploring new avenues, such as psychiatry
TELEHEALTH MODALITIES
Remote Patient Monitoring
Hospital emergency departments, intensive care units, and skilled nursing facilities
At-home management of patients with chronic conditions
Keeping people healthy and at home
Mobile Health (mHealth)
Health care, public health, and health education
Supported by cell phones, tablet computers, PDAs, and other mobile communication devices
Can be targeted (promoting healthy behavior and disease management) to wide-scale (disease outbreak alerts)
TELEHEALTH MODALITIES
Remote Monitoring & M-
Health
Healthy Living
Chronic Conditions
AgingAcute Care,
ICU
End of Life
Cue provides molecular diagnostic capability in the home.
Apple Watch will display blood glucose levels from the Continuous Glucose Monitor
Handheld cellphone-based
Otoscope
12
Health Chair incorporates
a vast array of biosensors to measure basic vital signs:
Weight Blood Pressure Temperature ECG Auscultation of Heart and
Lung Sounds Blood Oxygen Saturation Motion Analysis Reflex Response Time
Incorporates communication unit with remotely controlled camera
Berkeley “Tricorder”Remote monitoring of multiple health functions in an
unobtrusive, wearable wireless device
• Combines accelerometer,
ECG, stethoscope, pulse-
oximeter, myography, and
other functions
• Bluetooth radio with
connectivity to PC and
smart phone
• 2 GB data storage
capacity: two days of
continuous monitoring
Monitoring Rx Adherence
FDA-Approved Digestible Microchip
FEDERAL & STATE POLICIES
Telehealth State-by-State Policies, Laws, &
Regulations
Interactive Policy Map
LawsRegsPendingBillsState & Federal
• Definition of telemedicine/telehealth
• Reimbursement for: live video
store-and-forwardremote patient monitoringemail/phone/faxtransmission/facility fees
• Consent issues• Location of service provided• Online prescribing• Private payer laws• Cross-state licensure
11 Telehealth Policy Areas
Current State Telehealth Policies:
Every State is Different!
Definition
• 43 states have a definition for “telemedicine”
• 28 states & DC have a definition for “telehealth”
• 2 states have no definition for either
Reimbursement
• 46 states & DC reimburse for live video
• 14 states reimburse for remote patient monitoring
• 9 states reimburse for store-and-forward
• 24 states and DC have telehealth private payer parity laws
Provider/Location Restrictions
• Most common reimbursements: consultations, mental
health, and radiology
• Most common providers reimbursed: physicians and
nursesAs of Feb. 2015
More State Telehealth Policy
DifferencesLooking Beyond the Medical Professions
• Some Medicaid programs reimburse for: home health, dental, speech-
speech-language pathology, physician assistants, physical therapists,
therapists, dieticians, genetic counselors, behavioral health
Additional Telehealth-Related Policy Practices
• 28 states require some form of informed consent
• Most states don’t consider an online questionnaire adequate to
establish a patient-provider relationship needed for prescribing.
Licensing
• 10 state medical boards issue special licenses related to telehealth.
• 11 additional states make allowances for contiguous states or make
exceptions for practicing on an infrequent basis.
As of Dec 2014
Florida and Georgia
Georgia: Medicaid
Reimbursement
• Live video reimbursement only!
• Eligible services include:
– Office visits; Pharmacologic management,
limited office psychiatric and radiological
services; A limited number of other physician
fee schedule services.
• Written informed consent required
Georgia: Other Policies
• Insurers required to cover telemedicine,
subject to terms and conditions.
(regulation, not law)
• GA Medical Board adopted practice
standards for the practice of medicine
through “electronic means”-strict and very
detailed!
Georgia: Medicaid
Reimbursement
Eligible Originating & Distant
• Provider offices;
• Hospitals;
• Critical Access Hospitals
• Rural Health Clinics (RHC);
• Federally Qualified Health Centers (FQHC);
• Skilled nursing facilities;
• Community mental health centers;
• GA public health clinics;
• School-based clinics
Eligible Sites
• Provider offices;
• Hositals;
• Critical Access Hospitals
• Rural Health Clinics (RHC);
• Federally Qualified Health Centers (FQHC);
• Skilled nursing facilities;
• Community mental health centers;
• GA public health clinics.
Florida: Medicaid
Reimbursement
• Live video reimbursement only!
• Eligible providers:
– Physicians
• Originating site must be:
– Hospital outpatient setting
– Inpatient setting
– Physician’s office
• Limited consultation codes reimbursed
• No facility or transmission fee
Florida: Medicaid
Reimbursement
• Other requirements
– Referring practitioner must be present during telemedicine consultation.
– Both distant and originating site must be located in FL.
– Documentation requirements:• Explanation of why services were not provided
face-to-face;
• Documentation of telemedicine service provided; and
• Patient consent
Florida: Other Policies
• No private payer parity law or
regulations
• Telemedicine Practice Standards
adopted by FL Board of Medicine &
Board of Osteopathic Medicine.
– Allows for the establishment of a physician-
patient relationship by telemedicine.
– Controlled substances cannot be
prescribed through telemedicine.
Florida TaxWatch
• “Time for Telehealth” 11/2014 Report: “Florida lawmakers need to act quickly to connect patients with higher quality, timely care by using telehealth to bring the state's health policies into the 21st century”
Study shows that hospital charges could be reduced by more than $1.2 billion annually based on hospitalization charges alone.
Evidenced-based Research coupled with Consumer Advocacy can be a powerful combination for change
Federal MediCare
Reimbursement for Telehealth
MEDICARE TEHEHEALTH POLICY:
OUTDATED!• Reimbursement is available for only a
limited number of Medicare Part B
services
• Reimbursement limited to live video
only substituting for in-person
encounter
• Can only occur when the originating
site is in:
• a Health Professional Shortage Area
(HPSA),
• a county outside of any Metropolitan
Statistical Area (MSA), or
• an AK/HI demonstration project
Federal Landscape 2015
FEDERAL LEGISLATION
• Proposed draft bill 21st Century CURE Bill in House Energy & Commerce
Committee includes provisions for Medicare to waive some telehealth
restrictions if certain conditions met-SEEMS TO HAVE BIPARTISAN SUPPORT!
• Previous Congressional Session bills :
HR 5380 (Thompson, Harper & Welch)
For Medicare, phased in increase of eligible geographic locations;
adding home as eligible site; reimbursing for RPM; reimbursing for
Store &Forward
HR 3306 (Harper, Nunes, Thompson & Welch) & S 2662
For Medicare, expand list of eligible originating sites including the
home; small expansion of S&F to CAHs & sole community hospitals;
for liability and licensing purposes services furnished at the
provider’s location; allows for the use of RPM in specialty medical
homes contracts
HHS/CMS
• Movement toward Accountable Care Organizations as part of the ACA
• President Obama sets goal of 90% of Medicare payments tied to VALUE---not fee for service
• CMS approves more Medicare tele-psych codes for reimbursement
• New code for “non-face to face” chroniccare management & coordination
Next Generation ACO
• Greater access to home visits, live telehealth services, and skilled nursing facilities;
• “benefit enhancements” allow circumvention of Medicare rules that go beyond benefits that Medicare Advantage (MA)
• Would allow ACOs to utilize the technology regardless of a patient’s geographic location.
Other Federal Activities
• Federal Communications Commission-Net
Neutrality & Protecting Connected Care
• Federation of State Medical Boards –
Licensing Compact/Interstate Licensure
FUTURE TRENDS IN TELEHEALTHPOLICY & PRACTICE
The Changing Healthcare
Landscape: 2015
Aging/sicker population
Primary care/specialist shortage
More newly insured with
Obamacare
Rising health care costs:
$3 trillion/year
Making Change Happen
Health Systems Policy Private Payers
Evidenced-based Research
Technology Changes
Consumer Demand
Federal And State Policy:
Volume-to-Value
Value‐based
• Pay for results
(quality/efficiency)
• Shared risk
• Partnerships and
collaborations
• Continuum of care
• Community health
improvement (HIT)
• Wellness care
Volume‐based
• Pay for service (volumes)
• Cost‐based reimbursement
• Hospital/physician
independence
• Inpatient focus
• Stand-alone care
systems
• Illness care
Team-based, Person-Centered Care
Everyone Working at the Top of Their License
Out of the “Box” of Health Care
Mercy Virtual Care Center-St. Louis
Opening Summer, 2015
Will accommodate nearly 300 physicians, nurses, specialists, researchers and support staff. Care will be delivered 24/7 via audio, video and data connections-3 million telehealth visits in first 5 years.
Virtual Care Anywhere
• 75 million Virtual Medical Visits in N. America-2014
-Deloitte
© 2014 Kaiser Permanente
Kaiser Permanente Leading the Way
Improved engagement, quality, and satisfactionMember retention My Health Manager users were 2.6 times
more likely to remain members 1
Quality of care improved 2.0 to 6.5% improvement - glycemic
(HbA1c), cholesterol, and blood pressure
screening and control2
Refill improves outcomes (LDL) 3
High patient satisfaction 85% rated encounters 8 or 9 on a 9 pt
scale4
1 Turley, Marianne; Garrido, Terhilda; Lowenthal, Alex; Zhou, Yi Yvonne, “Association Between Personal Health Record Enrollment and Patient Loyalty,” Am J Manag Care. 2012;18(7):e248-e253 (web exclusive)
2 Zhou, Yi Yvonne; Kanter, Michael H; Wang, Jian J; Garrido, Terhilda, “Improved Quality at Kaiser Permanente Through E-Mail Between Physicians and Patients,” Health Affairs, Vol 29, No 7 (2010); 1370-1375.
3 Sarkar, Urmimala, Lyles, Courtney; Parker, Melissa; Allen, Jill, et al., “Use of the Refill Function Through an Online Patient Portal is associated With Improved Adherence to Statins in an Integrated Health System,”
Medical Care, Vol 00, No 00 (2013)
4 Internal KP study, “Harvesting Value: Early Findings from Kaiser Permanente HealthConnect™” presented to Center for Information Therapy by T Garrido, C Serrato, J Oldenburg (1/15/2008)
45
US Healthcare Practitioners Who Currently Provide or Plan to Provide Telemedicine
Services*, Oct 2014*healthcare services via telephone, video or webcam visits Note: n=759; Source: Academy of Integrative Health & Medicine (AIHM) survey as cited
in press release, Nov 11, 2014
33%
Yes
29%
No-but planning to in the next few
years
38%
Noimmediate
plans
Even if
you’re on
the right
track…You’ll
get run over
if you stand
still!
Thank You!