Insights2020 Telemedicine Comes Forward
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Telemedicine has moved to the forefront of healthcare, opening up opportunities for both practices and their patients. To help unpack some of the enormous amounts of new information, This presentation focuses on: - Relaxing of Regulatory Issues - How Telemedicine Can Help Your Practice - Challenges - The Future of Telemedicine
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Insights2020 Telemedicine Comes Forward
- 2. Telehealth Basics Relaxing Regulatory Issues How Telemedicine Can Help Your Practice Challenges The Future of Telemedicine 2
- 4. 4 E-visits Communication with patient and provider through an online portal Remote Patient Monitoring Collecting of vitals and physiologic information by the patient that is then sent to the health care professional for interpretation and monitoring of the data. Telehealth visit/virtual visit A real-time two-way audio and video communication visit between a clinician and patient using a smartphone, webcam, or online chat. Telephone visit Synchronous telephone conversation, telephone evaluation, and management of services. Virtual Check-ins/Digital Visits A brief (5–10 minute) check-in with a health care professional via telephone or other telecommunication device, or a remote evaluation of recorded video or images submitted by an established patient. Types of Telemedicine www.cms.gov
- 5. 5 “There’s the assumption in primary care that you always had to have in-person contact, and that telemedicine would be unsatisfactory, or wouldn’t fill the void. That’s been exposed — actually, it’s safer, it’s quicker, and it’s easier. If I just have a quick question, I want to see someone and engage them and see their focus is on me. But do I have to be in that office? And for a physician, can I get more things done, be more efficient, and protect myself, as well as my patients? People are now seeing this model, which we thought would take years and years to develop. And it’s probably been accelerated by a decade.” Chris Jennings, policy consultant and former health care adviser to the Obama and Clinton administrations: Telemedicine Accelerated
- 6. 6 Telemedicine Fun Facts Telehealth programs used to take almost two years to implement. With COVID-19, that time has been shortened to less than a month. Medical group in Oregon went from 700 telemedicine visits per month to 70,000 per week. Updox survey found that, out of 2000 respondents, 42% have used telehealth services during the pandemic. 91% of seniors had a favorable experience & 78% are likely to use it again for a medical appointment in the future. Better Medicare Alliance Modern Healthcare Opthalmology Times
- 8. • $200 million in funding • Funding is in the eighth round - $50 million has been distributed in rounds 1-7 • Part of the CARES Act • Limited to nonprofit and public eligible health care providers (More information on Eligibility in FCC Form 460) • Must apply through online application portal: https://www.fcc.gov/covid-19-telehealth-program Funding: COVID19 Telehealth Program o Telecommunications o Information services o Connected patient monitoring devices (e.g., pulse-ox, BP monitoring devices) • Covers:
- 9. • CMS is waiving limitations on the types of care providers eligible for Medicare reimbursement, thus allowing physical and occupational therapists and speech language pathologists. • Hospitals can now bill for outpatient services furnished remotely by hospital-based practitioners, including telehealth to patients at home – considered a “temporary provider-based department of the hospital.” They can now bill Medicare as the originating site for telehealth services furnished to those patients. • CMS is expanding the list of audio-only phone services reimbursable through Medicare to include many behavioral health and patient education services, and the agency is increasing reimbursements for those services to match similar office or outpatient services, retroactive to March 1. • The agency has added numerous new services to the list of telehealth services reimbursable under Medicare. • Federally qualified health clinics and rural health clinics will now be reimbursed for providing telehealth services. • CMS is waiving the video requirement for certain evaluation and management services, enabling providers to bill Medicare for services delivered by audio-only phones. • HIPAA currently allows non-traditional platforms - Facetime and Skype are currently allowed even though they are not HIPAA compliant - This will likely change as things progress and penalties could occur. • Patients’ written consents are currently not required in all states, but it is best practice 9 Relaxed Guidelines and Expanded Waivers
- 10. 10 Challenges
- 11. 11 Patients do not have access to cell phones, computers, or webcams. Elderly and chronically ill population may have difficulty accessing appointments Wifi or cell phone service may not be reliable Challenge: Technology
- 12. 12 Obtaining patient consent may prove difficult HIPAA compliance has been [relaxed] by The Office for Civil Rights (OCR) at the Department of Health and Human Services (HHS). Vendors with HIPAA-compliant communications include: Skype for Business / Microsoft Teams Updox VSee Zoom for Healthcare Doxy.me Google G Suite Hangouts Meet Cisco Webex Meetings / Webex Teams Amazon Chime GoToMeeting Spruce Health Care Messenger Challenge: Patient Privacy and HIPAA
- 13. 13 Make sure the schedule has Telehealth as a Visit type, especially if you are still seeing some patients in the clinic. This will help avoid confusion. Decide how you will collect copays or check the patient’s insurance. Monitor patient Follow Up items such as referrals and labs and how these get to other medical staff members to complete. Determine who schedules the follow up visit. Challenge: Workflow
- 14. 14 Making sure patients are educated and know what they need to bring the appointment. Vital Signs and Physical Exams are limited. Deciding when and where to have the telemedicine visits. Quiet and private rooms are needed for the medical staff and the patient. Other Challenges
- 16. 16 • Can Calm Fears • Limits exposure of sick patients to your Medical Office Staff • High risk patients can receive care without leaving their home • Removes barriers to care, including transportation to the clinic and limited appointment slots • Seeking care from the comfort of your home is time saving and convenient to the patient • Patients with chronic conditions can use remote monitoring devices (blood pressure, glucometers, etc.) connected to the EHR platform to be closely and regularly monitored by medical staff, which can improve results • Improve provider productivity • Increase revenue/reimbursement/reduce costs • Allows for Integrated scheduling Patients can schedule their own appointments on a website such as doxy.me or through a patient portal which is integrated with your practice management system and EHR.
- 18. 18 Medicare lifting the originating site requirements for the pandemic was a big leap forward. That always seemed to be the issue and roadblock for most groups, as it blocked the use of codes for many urban/ suburban areas. There may be some more reform around requirements. Telemedicine is here to stay • Enables providers to conduct additional visits without requiring additional staff • Reduces hospital admissions, unnecessary ER/office visits • Provides access to care to patients without reliable transportation • Better patient outcomes