Ronald S. Keen, FNP-BC€¦ · Ronald S. Keen, FNP-BC Chief, Virtual Health, Regional Health...

Putting TBI care into the white space of our patient’s lives to improve Readiness

Ronald S. Keen, FNP-BC

Chief, Virtual Health, Regional Health Command Europe

Mr. Steve Cain, PA; Kendra Jorgensen-Wagers, Ph.D.Senior Clinical Research Director and Deputy Site Director for the

Defense and Veterans Brain Injury Center (DVBIC)

GD Health Solutions contractor

[email protected]

“Medically Ready Force…Ready Medical Force” 1

mailto:[email protected]

Disclosure


The views expressed in this presentation are those of the presenter and do not constituteendorsement by the Federal Government, United States Army, Department of Defense, orThe Defense and Veterans Brain Injury Center.Dr. Wagers does not have any conflicts of Interest or financial endorsement to disclose.

The information presented today reflects the process improvement outcome from a Regional Health Command virtual health partnership with the TBI Clinic to pilot telemedicine as a multidisciplinary care model across the entire geographic region serviced by RegionalHealth Command Europe.

Presenter’s has no relevant financial or non-financial interests to disclose.

This continuing education activity is managed and accredited by AffinityCE in collaboration with AMSUS. AffinityCE and AMSUS staff as well as Planners and Reviewers, have no relevant financial or non-financial interests to disclose.Commercial Support was not received for this activity

Learning Objectives- Key Take aways

• At the conclusion of this presentation, the participants will be able to:o Describe how multidisciplinary TBI virtual health care

facilitates a more patient-centric and TBI readiness model of care.

o Illustrate how virtual health may increase patient compliance and personalization of care.

o Appreciate the facility of the TBI virtual health process flow.


Virtual Health Team Acknowledgments

Innovation takes a skilled and cooperative group of exceptional team members:

Mr. Ron Keen NP Ashley Jack PA

Mr. Steve Cain PA Claudia Roberts OT

Irma Black, MSA Hunter Hearn MD

James White PA Marianne Pilgrim OT

Rose Rademacher MSA Tina Aldana OD

Sam Mulliken LPN Juan Hill PhD

Juan Rivera MD Jessica Simmonds PhD


Virtual Health Background

• Landstuhl Regional Medical Center

is the largest OCONUS military treatment

facility, we service an expansive geographic

region spanning multiple countries.

• TBI is an issue to ensure force readiness.- Identifying patients and getting care quickly.

• Virtual health is a powerful platform for

facilitating that care.


Purpose of Virtual Telehealth Pilot

We had three main purposes and several different metrics to help answer these questions:

• Is virtual health a viable option to solve the issue of providing care in disparate locations?• Cost to provide care- medical TDY cost • Access to care- care closer to operational space

• Is virtual telehealth a feasible platform for use?• Connective issues?

• Is the quality of care comparable in virtual health environment?

• Provider and patient repeated use?

• Patient Satisfaction - Responsive to patient needs (group or individual care)


Pilot Study over four months.

15 unique TBI Patients throughout Europe

Across 4 different countries

67 encounters

Multiple locations to include virtual in-home

Group and Individual Encounters

7 disciplines of specialized TBI interdisciplinary care:

Sleep medicine, Occupational Therapy, medical management, case management, TBI Optometry/

Vision Therapy, Neuropsychology follow up & Behavioral Health.


Patient Population

Where and How to Conduct virtual health


Policy to Practice Structure:The Policy Framework

OP-ORD 16-50 virtual health to the Patient Location

-TBI Clinic SOP • Framed Safety, Scheduling and Clinical Care needs

▻Patients who can participate in virtual health and where

▹ Meet “same” standard of emergent response

▻Scheduling Coordination for use and function of virtual health

▻Providers who can provide care in virtual health

▻Consenting process

-


Policy to Practice StructureThe Practice Impact

- Clarified Use of the 95 modifier and approved virtual health procedure codes.

- Helped scope types of services and resources for care – no lost “value”.

- New Appendix P in the 2017 CPT manual lists 79 standard CPT codes for which the “95” modifier can be used to specify that the service was provided via a real-time, interactive audio and video telecommunications system, subject to payer approval. The codes listed in Appendix P pertain to:

psychiatric, psychotherapy, psychoanalysis, pharmacy management, ESRD.

Ophthalmological remote imaging for detection of retinal disease, cardiovascular monitoring and telemetry.

Genetic or neurobehavioral assessments, medical nutrition

Office, subsequent hospital, outpatient consult, inpatient consult, subsequent nursing facility, prolonged services

Behavioral change interventions and transitional care management codes

- Suggest virtual health option at booking


Virtual Health Outcome Metrics


1. Viable care option to disparate locations?Medical TDY Cost SavingsTime on Duty Re-investment

2. Feasibility:comparable care?connectivity issues?provider/patient recurrent use

3. Patient satisfaction:responsive to need?

-facilitation of new group care paradigm

Health Outcomes

Medical TDY Cost Savings Time on Duty Re-investment

Conservative estimate of $3,686.93 Over 322 hours recaptured on

for 15 people mileage/flight duty time re-invested

and lodging if greater than 100 mileshttps://www.defensetravel.dod.mil/site/otherratesMile.cfm

Patient Satisfaction Provider Recurrent Use


Providers participated in virtual health an average of 2.8 times

The 15 patients participated virtual health an average of 1.6 times

Considerations/ Lessons Learned


• Scheduling: Setting up clinicConsenting

• Conducting examswhat care/done how?

• Safety• IT infrastructure-

connectivity• Coding/RVU generation

What Makes the Difference?

• Emphasis on readiness. Castle coming to you…..

• Locates care where patient is at decreasing lost duty time and travel.

• All disciplines “stretch” to innovate care for patient.

• Allows for specialized treatment + individual needs + group synergy

• Clear SOP guidance and support infrastructure.


References

Martinez, R. N., Hogan, T. P., Lones, K., Balbale, S., Scholten, J., Bidelspach, D., ... & Smith, B. M. (2017). Evaluation and treatment of mild traumatic brain injury through the implementation of clinical videotelehealth: provider perspectives from the veterans health administration. PM&R, 9(3), 231-240.

Yurkiewicz, I. R., Lappan, C. M., Neely, E. T., Hesselbrock, R. R., Girard, P. D., Alphonso, A. L., & Tsao, J. W. (2012). Outcomes from a US military neurology and traumatic brain injury telemedicine program. Neurology, 79(12), 1237-1243.

Cain, S.M., Brown, J.N., Cornfeld, R.J., Hearn, H.A., Waibel, K.H., Jack, A.L., Jorgensen-Wagers, K.L., Black, I., Keen, R.S. and Ortiz-Rosado, E .( 2018). Military Medicine Implements In-home Virtual Health in Europe. US Army Medical Department journal.



QUESTIONS?

AND Don’t Forget: How to Earn CE? - If you would like to earn continuing education credit for this activity, please visit:http://amsus.cds.pesgce.com Hurry, CE Certificates will only be available for 30 Days after this event!

Ronald S. Keen, FNP-BC€¦ · Ronald S. Keen, FNP-BC Chief, Virtual Health, Regional Health...

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