Telemedicine: If You’re not at the
Table You May be on the Menu
Jacques Orces, DO, FAAP
Medical Director Telemedicine
Chief Medical Information Officer
Miami Children’s Health System

Nicklaus Children’s Hospital
• Traditional MD to MD International Consult
• Hospital to Hospital
• Direct to Patient
• Telerehab
• Home Monitoring
• Employee Health
• School Health
• Cruise Ships/Yachts
• Robots in Hospital

Telehealth Cart and Devices

Inside the Command Center

Consultation Pod

Mobile Apps

Telemedicine
• Should be seen as Platform for the delivery of
health care and not a project, pilot, or
program.
• Must be seen as a Both/And and not an
Either/Or
• Should be aligned with the organizational
strategy to address needs and gaps

50 Shades of Telemedicine
• Each State Determines Reimbursement
• Each State Licenses Providers
• Each State Determines Who Can Provide
Telemedicine
• Each State Defines a Telemedicine Visit
• Each State Defines e-Prescribing and what can
be e-Prescribed

State of Telemedicine
• 2017 KPMG/HIMSS Analytics Study
• 147 Healthcare Executives
– Maintaining a sustainable business and/or
financial model was biggest challenge
– Followed
• Clinical Adoption Concerns
• Lacking a Defined Strategy
• Regulatory/Compliance Issues

Reimbursement
• Primary Obstacle to the Complete Adoption of
Telemedicine as a Platform for the Delivery of
Care
• Insurance Parity Alone Not Sufficient
• Move Towards Value-Based/At-Risk Payments
Will Drive Telemedicine Forward

Business Model

Assumptions
• >90% Value Based/At-Risk Reimbursement
• 24/7 Telemedicine Access Given to Families
• Zero Cost to Families for Telemedicine
Consultation
• Operational Costs for Telemedicine are
Expected Expenses

Nicklaus Children’s Hospital
• 90,000 Emergency Department Visits
• Average cost for an ED visit $1,0000
• If you reduce ED visits by 5% Using
Telemedicine
• Savings of $4,500,000.00

Results
• Lower Costs
• Improved Health of Populations
• Improved Patient Satisfaction
• Minimize Lost Time at Work/School
• Happier Clinicians
• Patients in ED Cared for Sooner
• Potentially Better Outcomes

Health Affairs
• 6 % of All Children Account for 34% of all
Medicaid Dollars Spent
• $1.6 Billion USD

Journal of Telemedicine and Telecare

Chronic Health Savings
– Telemedicine
• Home Monitoring
• Targeted Medical and Nursing Visits
• Telerehab
• Minimize Transportation Needs/Risks
• Ongoing Needs Assessments/Interventions
• Reduce ED Visits, Admissions, and Readmissions

Conclusion
• Telemedicine will be a key solution in value
based/at-risk reimbursement models
• Improve patient satisfaction/experience
• Improve the care of populations
• Reduce the cost of care

Thank You