Optimizing and Scaling TelehealthTelehealth During the Public Health Emergency Partner Webinar

Presenters:Alan Mitchell, HealthEfficientMagdalene Godena, HealthEfficient

July 28, 2020

HOUSEKEEPING

• Due to the size of the audience, all participants will be muted• Time has been allotted to answer questions at the end of the presentation;

feel free to submit questions via Chat during the presentation

Quality Improvement

Meaningful Use Value-Based Care

Integrated CareEHR Adoption

Practice Transformation

POPULATION HEALTH

ABOUT NYC REACH

Telehea lth Du rin g the Pu blic Hea lth Em ergen cy: Optim izin g a n d Sca lin g Te lehea lth

July 28, 2020

Abou t Hea lthEffic ien t

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• Non-profit, m is s ion-driven , m em bers hip organiza tion• HRSA-des igna ted Hea lth Center Controlled Network• 35+ m em bers in 7 s ta tes + Was hington , DC• Partner with PCAs in s om e s ta tes• Focus on im proving clin ica l and opera tiona l perform ance , often

us ing Hea lth Inform a tion Technology a s a tool• More info

• s upport@ hea ltheffic ien t.org• https :/ /hea ltheffic ien t.org

• Today’s pres enters :• Alan Mitchell, Executive Director• Magda lene Godena , Program Manager, Revenue Cycle

Agen da

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• Curren t s ta te of te lehea lth• Next s teps in te lehea lth: s tra tegies and s olutions• Telehea lth and revenue cycle , re im burs em ent s tra tegies• Q&A and dis cus s ion

The Sta te of Te lehea lth – “Then ”

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• Epocha l s hift in ca re de livery: m id-March 2020• Scram ble to adopt; fits and s ta rts ; then : cons iderable s ucces s• Daily re im burs em ent policy changes (Medica re , Medica id, priva te)• Technica l glitches and frus tra tions ; digital divide became apparent• Telehealth visits: 65% – 80% of total visit volume• New vendor entrants into the market: loss -leader pricing, “rapid

response” solutions• HIPAA ambiguities:

• providers using non -standard, non -healthcare -focused solutions• Enforcement questions

The Very Curren t Sta te of Te lehea lth (NY)

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• Efforts toward res tora tion of com prehens ive s ervices• In-pers on vis it volume going back up toward a “new norma l,” but with rea l

cha llenges like denta l, defin ing “s ick” vs . “well” in COVID-19 context• Figuring out long -term strategy: people, process, and

technology• Who gets seen for what, and how?

• Digital divide still an issue and it is not going away• Selecting a long -term vendor• Understanding long term costs and Return on Investment• Policy reversions still a question• Reckoning with long -term HIPAA implications• Exploring Remote Patient Monitoring (RPM)

Rem ote Pa tien t Mon itorin g - Defin ed

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Remote patient monitoring (RPM) uses digital technologies to collect medical and other forms of health data from individuals in one location and electronically transmit that information securely to health care providers in a different location for assessment and recommendations.

Source: Center for Connected Health Policy

Rem ote Pa tien t Mon itorin g in Pra c tice

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• Us e of devices to “continuous ly” m onitor pa tien t’s c lin ica l indica tors• Blood pres s ure (cuff)• Weight (s ca le )• SpO2 (puls e oxim eter) • Tem pera ture ( therm om eter)• Glucos e (glucom eter)• Apple Watch, Fitbit, e tc .

• Ques tions• In tegra tion in to pa tien t record• Pa tien t/provider tra in ing• Us ing da ta to in form clin ica l decis ion m aking• What’s your RPM “ecos ys tem ” – WiFi? Cellula r? Blue tooth? Hub?• How to ge t re im burs ed?

• Medica re , ok. Medica id? Va ries .

Telehea lth Stra tegy Ques tion s to An s wer

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• What technology platform should we use for the long term?• What does long -term pricing look like?• Whom should be seen for what, and how?

• Medical, behavioral health, dental• Audio/Visual, Audio Only, In -person

• What is your rev cycle strategy?• Still evolving reimbursement framework

• How do we address digital divide issues?• Long-term HIPAA and privacy considerations

• Please sign a Business Associates Agreement with all your vendors!

Techn ology Con s ide ra tion s

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• EHR in tegra tion• From the EHR vendor (e .g., eClin ica lWorks TeleVis its module)• Partia l in tegra tion with the EHR (uncommon)• Stand-a lone third-pa rty s olutions (crowded market)

• Clin ica l workflow in tegra tion• Can you mirror office workflows or care teams in the product?• What does your virtual waiting room look like?• RPM

• Integrated support for interpreters / third parties • Digital divide (user interface) solutions:

• Multiple language support• Works without an app• Works with a text message link• No email address required

Furthe r Digita l Divide Is s ues

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• Pa tien ts la ck equitable a cces s to :• Robus t s martphones /devices• Broadband• Minutes• Data plan• Cell towers• Privacy

• Educa ting pa tien ts and s ta ff on technology….• (next s lide)

Telehea lth Succes s Stra tegies

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• Rem em ber…• Provider and s ta ff tra in ing: inves t the res ources ( technology concie rge)• Pa tien t / provider experience:

• Pa tien t outrea ch / rea s s ura nce• tra in ing, rea s s ura nce• impa ct on provider workflow a nd pa tien t in tera c tions

• Cultura lly and Linguis tica lly Appropria te Services (CLAS)• Technical glitches are almost guaranteed; will slow you down, frustrate you• Everyone else is trying to do the same thing, at scale, right now

Telehea lth Billin g Gu ide lin es

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• At m inim um , the requirem ents to identify with payers and m a in ta ined a s polic ies change:• Technologies a llowed (a udio/vis ua l; a udio-only)• Provider type e ligibility (MD, DO, NP, PA, RN, e tc .)• Pa tien t e ligibility (New VS Es ta blis hed)• Originating Site limitations (where the patient is) • Distant Site limitations (where the provider is) limitations• Service type coverage• Cost-sharing rules• Consent and documentation requirements• Reimbursement rates• Claim form requirements:

• Claim form/type• Place of Service or Type of Bill• CPTs/HCPCS/Revenue Codes• Condition Codes/Modifiers• ICDs• Provider NPI

Medica re Codin g (Dis ta n t Site Billin g)

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Te lehea lth• Audio-video technology (s ynchronous )

• Audio-only ( te lephone/s ynchronous )

• Audio-only ( te lephone/s ynchronous )

• Secure ema il, text or porta l• CPTs 99421-99423• HCPCS G2061-G2063

• HCPCS G2010

• HCPCS G2012

• CPTs 99441-99443

• Over 200 CPT/HCPCS for CY 2020

Virtua l Check-in

E-Vis itsTelephonic E/M Services

Note: In form ation on this s lide is s pecific to Dis tan t Site billing

• Store-a nd-forwa rd (a s ynchronous )

NY Medica id Codin g

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Te lem edicine• Audio-video technology (s ynchronous )

• Audio-only ( te lephone/s ynchronous )

• CPT 99091

Rem ote Pa tien t Monitoring

Teleden tis try

Telephonic Encounters

Store-and-forward

• “Connected” digita l technologies

• As ynchronous video or ima ges• Audio-video technology (s ynchronous )

Note: In form ation on this s lide is s pecific to Dis tan t Site billing

• CDT D9995 + CDTs for s e rvices rendered• Store-a nd-forwa rd (a s ynchronous )

• CDT D9996 + CDTs for s e rvices rendered

• Coding va ries by provider and s ervice type

• 99201-99205, 99211, 99441-99443

• CPTs in Appendix P of the CPT book

• CPT repres enting s ervice provided

Reven ue Cycle Con s ide ra tion s

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• Unders tand each payer’s defin ition of Telehea lth/Telem edicine

• Ma inta in payer-is s ued docum enta tion and refer to it

• Identify your provider repres enta tives

• Utilize autom a tion within your EMR/PM whenever fea s ible

• Report frequently

Ques tion s a n d Dis cus s ion

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• Please submit questions through the chat box

• Questions that are not answered due to time constraints will be answered during the follow -up email

• Alan Mitchell, Executive Director (amitchell@healthefficient.org)• Magdalene Godena, Program Manager (mgodena@healthefficient.org)• support@healthefficient.org• https://healthefficient.org

Thank You!