Keys to Health Center Success June Conference · Keys to Health Center Success June Conference 1 ....
Transcript of Keys to Health Center Success June Conference · Keys to Health Center Success June Conference 1 ....
Stewart Levy –
President - Health Promotion
Solutions
Keys to Health Center Success
June Conference
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Agenda
• Introduction
• Definitions - Telehealth, Telemedicine, Telepresence
• Benefits to Healthcare System
• Telehealth funding and initiatives in Government
• FQHC Case Studies
• State Regulatory and Reimbursement
• Opportunities for FQHC
• Examples of various Telehealth Systems
• Questions and Answers
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Health Promotion Solutions - Introduction
Description - Consulting and service provider
focused on evidence – based health and disease
management solutions
Clients - Government agencies, non-profit
groups, employers, retailers, academic
organizations, Insurance companies, and clinics
Disclosure Statement
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Telehealth – Technology is Here Today
According to American Telemedicine Association :
Term “Telehealth” is used interchangeable with
“Telemedicine” however telehealth does not need
to involve clinical services :
- General Patient education
- Mobile health apps
- Non Clinical staff – Telephonic Health coaching
- Includes Phone , Fax, Email / Messaging,
PACS, EHR Video, Medical device telemetry,
Web conferencing, SMS Text
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“Telemedicine”– Delivery of Clinical
Healthcare Services with Practitioner
Telepresence
• Telepresence refers to various
technologies which allow a person to
feel as if they were present, or to have
an effect at a place other than their true
location.
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Telepresence
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Clinical Uses of Telehealth
Technologies 1) *Transmission of medical images for diagnosis (Store and forward )
2) *Individuals exchanging health services or education live via
videoconference (Teleservice or Video / Phone telehealth)
3) *Transmission of medical data for diagnosis or disease management
(Referred to as Telehome or home monitoring)
4) Prevention of disease and health promotion ( Health coaching )
5) Health advice by telephone (Referred to as teletriage)
* Telemedicine Services
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Benefits of Telehealth • Reduce Travel Time to clinic visits
• Staffing efficiencies
• Reduce delays in treatment
• Reduction in medical costs
• Direct - staff , clinic
• Indirect – unnecessary ER visits
• Access rural and urban locations
• Access to multiple specialties
• Consumer education
• Improvement in quality of care
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• 23% of ER visits for those under age 15 were:*
– Upper Respiratory
– Fever with no other complications
– Sore throat
– Ear ache
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Emergency room use nationally
• 65% of ER visits occur after business hours*
Total cost of unnecessary urgent care and ER visits is
$31 billion per year
• 45% of ER visits were not classified as immediate,
emergent or urgent at triage*
National Hospital Ambulatory Care Survey published by the CDC
Americans support the US of Telehealth
Online survey of 1,000 consumers was commissioned by the Health Research Institute unit of Price Waterhouse Coopers in Sep 2012
• 55% of consumers believe that universal health insurance coverage will not ensure equal access to care
• Nearly 75% of U.S. consumers say they would use telemedicine, defined as remote monitoring to track their condition and vital signs
• 50% of consumers would be willing to seek care through computer technology as a substitute for face-to-face, non-emergency visits
.
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Telehealth Technology
Acceptance in Rural Populations
Sample of 199 patients in a Federally Qualified Health Center (FQHC) in the rural South
• Purpose -investigate access to technologies, comfort with
technologies, and willingness to participate in clinical interventions among rural populations.
• Access to technologies among this underserved group was remarkably high (near or above 50%) for all technologies.
• Conclusion -access to and comfort with technologies is strong among highly underserved patients.
• lHealth and Technology Volume 1, Issue 2-4 , pp 99-105
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US Growth of Telemedicine
• According to Information Week research
– PPACA catalyst for accelerated growth
2012 – 14 billion → 2016 27 billion
“Telehome” market ( growing from 30% - 35%)
growing faster than “teleservice” market
(70%- 65% )
Government Use and Funding
• Grants - Available through 8 federal programs. 33% is from
research contracts with the U.S Department of Defense.
• Direct Services – VHA is largest provider of remote
medical services, projected to deliver over 350,000 patients
– Department of Defense, Indian Health Service and
Bureau of Prisons in the Department of Justice.
• Military Use – Triage and field mobile health clinics
• Medicare – Reimbursement for telehealth and remote care
• Center of Medicare and Medicaid Innovation - projects
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Government Projects Center for Medicare and Medicaid Innovation
1) Care for intensive care remotely from specialists
2) Patient based home telehealth monitoring
3) Indian Health Services – stroke and behavioral health
4) Use of non medical and non specialized providers
5) Gov’t promoting hospital initiatives – Accountable care
organizations
Medicare - Approved Originating Sites
( Where eligible patients are located)
• Offices of Practitioners
• Hospitals
• Critical Access Hospitals
• Rural Health Clinics
• Federally Qualified Health Centers
• Hospital based or CAH based Renal Dialysis
• Skilled Nursing Facilities
• Community Mental Health Centers
Medicare – Approved Distant Site locations
(Where practitioner is located)
• Physicians;
• Nurse practitioners (NP)
• Physician assistants (PA)
• Nurse midwives;
• Clinical nurse specialists (CNS)
• Clinical psychologists (CP) and clinical social
• Registered dietitians or nutrition professionals
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Results from VA
Northwest Health Network
• $742,000 cost savings by utilizing telemedicine
to provide 23,580 remote consultations
• Utilized store forward and videoconferencing
with trans-disciplinary network
• Reduction in travel costs in rural areas
• Improved the quality care due to issues
surrounding PTSD stigma
Military Study 2009 • 25% reduction in bed days and 19% reduction in
admissions for military telemedicine
Results from Rural FQHC Study - Practice based vs. telemedicine in collaborative
care model for depression in rural FQHC.
• 2007 – 2009 364 patients screened for depression
• Measure response, remission, change in depression
severity
1) Clinic – onsite primary care and nurse care manager
2) Telemedicine - Onsite primary care, and offsite team
of nurse, pharmacist, psychologist, and psychiatrist
FQHC Study Results
• Contracting with offsite telemedicine-
based collaborative care team showed
significant improvement . Potential to
yield better outcomes than traditional
practice based care with clinic staff
Georgia Partnership for Telehealth
FQHC - Case studies
• The Georgia Partnership for Health (GPT)
network includes 201 statewide access points
• Includes healthcare providers, health plans,
schools, rural health centers, nursing homes,
group practices, hospitals, community mental
health centers, and Prisons
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Georgia Partnership for Telehealth
• Year 1 – Payers provided reimbursement
for telemedicine the same as an office visit
• 160 physicians in 40 specialties participate
most utilized specialty being psychiatry.
• In 2010, the GPT facilitated 31,000
encounters - 11,000 were store-and-forward
consults, with the remainder comprising
real-time visits.
Challenges of Wide-scale
Telemedicine Adoption
• State Regulatory Laws
• Scalability
• Bandwidth Data Platforms
• Security
• Provider training and certification
• Interfacing with other multiple applications
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State Provisions
• State is responsible for assuring access and covering
face-to-face visits/examinations by these “recognized”
practitioners/providers in those parts of the state where
telemedicine is not available or limited.
• The general Medicaid requirements of
comparability, statewideness and freedom of choice
do not apply with regard to telemedicine services.
Telemedicine State Regulations
14 states allow for first patient visit physician examinations to take place electronically
• California New Mexico
• Hawaii North Carolina
• Kansas Pennsylvania
• Louisiana South Dakota
• Maryland Texas
• Ohio Vermont
• Nevada Virginia
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Current Medicaid Reimbursement for Telemedicine
Medicaid Reimbursement
• Originating Site – Facility Fee
• Practitioner – Distant Site
• 35 states offer some reimbursement
• States may select from a variety of
HCPCS codes (T1014 and Q3014),
CPT codes and modifiers (GT, U1-UD)
in order to identify, track and reimburse
for telemedicine services
Telemedicine State Coverage
• States have the option/flexibility to determine whether
(or not) to cover telemedicine
• Types of telemedicine to cover;
• Where in the state it can be covered;
• How it is provided/covered;
• Types of telemedicine practitioners/providers may be
covered/reimbursed, as long as such
practitioners/providers are “recognized” and qualified
• How much to reimburse for telemedicine services, as
long as payments do not exceed Federal Upper Limits.
New legislation Dec 2012
Mike Thompson introduced legislation
• To promote and expand the application
of telehealth under Medicare and other
Federal health care programs, and for
other purposes by eliminating in state
licensure requirements and support
reimbursement measures
Review of Various Telehealth
Products and Services
• Teladoc
• Health Spot
• Optimized Care Network
• Home Monitoring / Personal Body Devices
All
Teleadoc results – Employer and
Cash pay Telehealth provider
4 million users
*Based on Teladoc reporting and member surveys
97% Member Satisfaction
97% Physician Satisfaction
10min Avg. Consult Duration
0 Malpractice Claims
22min Avg. Response Time
91% Patient Issues Resolved
Health Spot -
The walk-in kiosk has
integrated medical
devices and is staffed
by an attendant.
Inside, patients receive
care from
practitioners over real-
time interactive
videoconferences.
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The Care4 Station Patient entry
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Medical Assistant - Attendant • Always present
• Facilitates:
– Check-in / ID validation
– Sanitization
– Patient assistance
Additional capabilities
based on attendant
certification
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HIPAA/Terms of Service
Acceptance
Name and contact info
Payment / Insurance
Symptoms
Current medications
Existing conditions
Allergies
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Patient Check in Process
The Care4 Station patient steps inside Floor View
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Vitals Check
Weight Temperature
Blood Pressure Summary
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Technology
Pulse Oximeter Otoscope
Stethoscope Dermascope
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Physician Portal
Displays patient
summary
Device controls in
kiosk
Image capture
Dictation
E-prescriptions and
EMR integration in
development
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• Printed patient
summary
• EMR record
• Access records
online
Post-appointment and follow-up
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Conditions Treated
– Colds & Flu
– Eye Conditions
– Skin Conditions
– Sinus Infections
– Earaches
– Sore Throats
– Depression/Anxiety
– Bronchitis
– URI
– Wellness check ups
– Blood pressure checks
– Diabetes Monitoring
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• Preference over urgent care or ER: 98%
• Would use Care4 Station again: 95.5%
• Patient age range: 24 – 89
Health Spot Utilization and Empowered Patient Care
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Public
Housing ?
Clinic ?
Health Spot Video
•
http://www.youtube.com/watch?v=J4BQ
cAKkVa4
Optimized Care Network
The OCN is a non profit, health care provider
network, consulting, and service organization to
support effective telehealth solutions including
- HealthSpot Station
- Home monitoring
- Telepresence Offices
- Other
.
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OCN Trans-disciplinary
Telehealth Providers
• Primary Care Doctors
• Pharmacists
• Behavioral Health Coaches
• Dieticians
• Nutritionists
• Specialists
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Optimized Care – Telepresence
Optimized Care Network
http://www.youtube.com/watch?v=YVz7
bKbeXVE&sns=em
Home telehealth monitoring
Home Monitoring
Telemedicine Devices • Blood Pressure
• EKG
• Pulse
• Weight
• Glucose
• Prothrombin time
• Blood Oxygen
• Spirometry
Summary
• Trends of exponential growth with health care reform
• Telehealth has been established with proven results
– Efficiencies , Cost reduction and improved care
• Already being used by Community Health Centers
• Flexible types of models
• Easy to implement
• Barriers becoming minimal or no longer exist
• Tie into CHC efforts with patients and community
• Consumers accept technology and find empowering
• Funding available
Questions