Call for Presentations: gpTRAC Regional Telehealth Forum 2014

Telehealth & HIT:  Partners in Patient Care
gpTRAC Regional Telehealth Forum
April 3-4, 2014

The Great Plains Telehealth Resource & Assistance Center (gpTRAC) has opened the Call for Presentations for this year’s Telehealth Forum.

We are looking for presentations that support this year’s theme and can:
1) expand the understanding that telehealth is indeed a technology that creates and uses various kinds of health information in the care of a patient;
2) share how an organization intertwined their  telehealth services with their HIT services;
3) encourage others to look to their own organizations and say “We should do that too!”.

Anyone with expertise is invited to submit an abstract.  Click here for more guidance and directions surrounding your submission and to access the abstract form.

Forum Registration: Watch for the official registration information…coming soon!!
Hotel Registration: Click here to make your room reservations at the Embassy Suites, Minneapolis, Airport/Mall of America. There is a limited number of rooms reserved for this event.

If you have any questions, please email gptrac@umn.edu or call 888-239-7092.
We are looking forward to a great event!

 

Telehealth News Flash, July 29

Telehealth news and events we have been talking about around our office this week:

Telehealth coverage broadens through state legislature
State legislatures are hearing a lot about telehealth these days.  Missouri became the 19th state to mandate reimbursement by private insurers to healthcare providers for telehealth services.  Kentucky has expanded telehealth reimbursement to Medicaid beneficiaries.  Mississippi passed a private insurer reimbursement mandate.  In the last 7 months, 12 states have introduced or enacted telehealth reimbursement legislation.  Around the gpTRAC office, we are discussing ways to get Minnesota involved in doing the same!

South Central Telehealth Resource Center Quarterly Thought Conference Webinar:  Telehealth Reimbursement in Mississippi
A great webinar presented last week by UMMC’s Dr. Kristi Henderson on the process of passing state-wide telehealth legislation.  Archived and available at learntelehealth.org

Nurses use Google Hangout to collaborate on technology
Google hangout isn’t just for teenagers and chatting with friends who are abroad anymore.  These providers discuss the usefulness of media for healthcare collaboration in a 25 minute youtube video between nurses in Toronto and Australia. 

Minnesota DHS: Telemedicine and Chemical Health

The Minnesota Department of Human Services is exploring how telemedicine can improve the efficiency and effectiveness of interventions, treatment, and recovery related to Alcohol and Drug Abuse.  Why?  According to DHS research, of all the people who seek treatment for chemical health issues in the US, only 10% actually receive it.  Additionally, rural populations experience the most barriers to substance abuse treatment programs and recovery options.  Telemedicine technology could help ameliorate these problems by extending the reach of chemical health counselors employed in areas like the Twin Cities, to underserved and geographically isolated populations in rural Minnesota, where counselors are harder to find.  However, currently insurers do not resimburse for chemical health services delivered at a distance.  DHS has a task force (the Sustance Use Disorder Model of Care Workgroup on Telemedicine) compiling information on the subject.  The group recently released their first collective report:  Telemedicine/Telehealth Workgroup Issue Analysis.  For more information, visit the DHS website.

Telehealth News Flash

The telehealth news articles we have been talking about around our office this week:

New York Times Well:  My Stroke of Luck
How one man learned about telestroke technology through a stroke of his own.  His response to reimbursement resistance:  “Well, there was no living, breathing stroke specialist at my bedside to bill in those first vital hours. Give me a virtual doctor any day.”

Washington Post:  Telemedicine makes new advances, all the way to Antarctica
Videoconferencing enables a partnership between the University of Texas Medical Branch and National Science Foundation workers living at a scientific research station in Antarctica.

Healthcare IT News:  Why not MU for telemedicine?
Noteworthy reflection on Ryan Spaulding’s presentation at this year’s American Telemedicine Association meeting.  The topic:  Meaningful use of telemedicine and how Telehealth Resource Centers can help create a national strategic plan.

Argument: It is not necessary to include mid-level providers in telemedicine policy

Advocates for telemedicine policy that includes mid-level providers will likely face opposition.  Three likely arguments will be: (1) patients aren’t interested in telemedicine, (2) telemedicine should not replace in-person visits and (3) if telemedicine policy does change, there is no need to include mid-level providers.  Below is a sample evidence-based response to the third argument.

Argument:  It is not necessary to include mid-level providers in telemedicine policy.

Response: Unless mid-level providers are reimbursed for services provided via telemedicine, they will remain underutilized.  In the proposed policy we include nurse practitioners (NP), physician assistants (PA), nurse midwifes, and clinical nurse specialists (CNS). There are three main reasons they should be included as reimbursable for telemedicine services.

1.  According to the Association of American College work force projections “nationwide physician shortages are expected to balloon to 62,900 doctors [by 2015] and 91,500 by 2020 (Krupa, 2010).”  Mid-level providers can help fill this gap.

2.  It has been suggested that “in telemediated heath care nurses or physicians’ assistants are the key actors who have to perform many tasks in the absence of physicians (Oudshoorn, 2009).”  Mid-level providers are an ideal workforce to train as technology experts for delivering telemedicine services.

3.  Under the Interstate Nurse Liscensure Compact, a nurse that is liscenced to practice in one state of the compact, may practice in any state of the compact (Bailey, 2011).  This means that nurses are not subject to the same laws governing licensing of physicians which prohibit them from practicing medicine (or telemedicine) outside of their state.  There are currently 24 states that have adopted the compact (Bailey, 2011).  Nurses, therefore, are able to offer telemedicine to a wider range of patients nationwide than primary care physicians.

The utilization of mid-level providers is integral to maximizing the potential benefits of telemedicine.

Bailey, R.A. (2011). The Legal, Financial, and Ethical Implications of Online Consultations, HEINONLINE, 16, J. Tech. L. & Policy, 53

Krupa, C. (2010) Physician Shortage Projected to Soar to More than 91000 in a Decade, American Medical Association. Retrieved from http://www.ama-assn.org/amednews/2010/10/11/prsb1011.htm

Oudshoorn, N.(2011) Telecare Technologies and the Transformation of Healthcare. United Kingdom, Palgrave MacMillan.

Argument: Telemedicine should not replace in-person doctor visits

This is part 2 in our 3 part series on responding to arguments against telemedicine. 

Background:  Advocates for telemedicine policy that includes mid-level providers will likely face opposition.  Three likely arguments will be: (1) patients aren’t interested in telemedicine (covered here), (2) telemedicine should not be allowed replace in-person visits and (3) if telemedicine policy does change, there is no need to include mid-level providers.  Below is a sample evidence-based response to the second argument.

Argument:  We should not let telemedicine replace in-person doctor visits

Response:  It is true that a patient-doctor interaction is different through telemedicine.  Without the physical ability to touch the patient, the doctor is limited in the care they can provide.  However, telemedicine is a tool meant to complement existing healthcare methods, not replace them.  As specified in the American Medical Association guidelines about online medical consultations, “E-visits are not intended for new patients or for established patients with an urgent medical issue, a condition with a significant visual component, such as a rash, or one requiring a physical exam.  Those patients would be asked to visit the patient’s practice for an on-site evaluation (Bailey, 2011).”  Telemedicine will not replace traditional in-person visits; only expand the range of care providers are able to offer.

Bailey, R.A. (2011). The Legal, Financial, and Ethical Implications of Online Consultations, HEINONLINE, 16, J. Tech. L. & Policy, 53

Argument: Patients don’t want to use telemedicine services

Advocates for telemedicine policy that includes mid-level providers will likely face opposition.  Three likely arguments will be: (1) patients aren’t interested in telemedicine, (2) telemedicine should not be allowed replace in-person visits and (3) if telemedicine policy does change, there is no need to include mid-level providers.  Below is a sample evidence-based response to the first argument.

Argument:  Patients don’t want to use telemedicine services

Response: Telemedicine patients have reported good acceptance rates and satisfaction with the technologies and treatment via telemedicine has been proven to be efficacious (Whitten, 2007).  Additionally, a recent Price Waterhouse Cooper Study found that 50% of people surveyed stated that they “would seek healthcare through online consultations” and that “email consultations were the most preferred method”, followed by “Webcam/video consultations (Thompson et al, 2011).”

Thompson, M., Isgur, B., & Foong, S. (2011) Focusing on Healthcare Value, Price WaterHouse Cooper, Retrieved from http://www.pwc.com/us/en/view/issue-12/focusing-on-healthcare-value.jhtml

Whitten, P. & Buis, L. (2007) Private Payer Reimbursement for Telemedicine Services in the United States, Telemedicine and e-Health, Vol. 13, DOI: 10.1089/tmj.2006.0028

Telehealth Resource Center Upcoming Webinar

The National Telehealth Webinar Series presents: If I Knew Then What I Know Now… Building A Telehealth Network From The Ground Up – October 18, 2012

Image of The National Telehealth Webinar Series
October 18, 2012
10:00 AM HST, 12:00 PM AKDT, 1:00 PM PDT, 2:00 PM MDT, 3:00 PM CDT, 4:00 PM EDT

Presented by:

Brian Coltharpe, MA – Director of Innovation, Health Resources of Arkansas

“We built our network without any grant money or any outside advice; not because we were arrogant and self-sufficient, but because we weren’t aware of the multitude of resources available to help us do it cheaper and easier. If I knew then what I know now. . .”

Telemedicine is a rapidly expanding service field: an invaluable resource for those in remote areas and cost effective from all points of view.  But, the process for setting up a network and making it all work together can be a challenge.  In this educational webinar, Brian Coltharpe, Director of Innovation for Health Resources of Arkansas will be sharing valuable lessons based on what he’s discovered over the last 8 years.

Simultaneous streaming with the Quarterly Thought Conference from SCTRC at LearnTelehealth.org.

Registration for this event is FREE, at:  Click HERE

For GoToMeeting system requirements: Click HERE

The National Telehealth Webinar Series provides timely information to support and guide the development of your telehealth program by experienced telehealth professionals from the HRSA-designated Telehealth Resource Centers.  These webinars are FREE to the public on the 3rd Thursday of each month.

Live Interactive versus Store-and-Forward Telemedicine Consultations

A telemedicine consult can happen multiple ways. Two of the most common are a Live Interactive Telemedicine Consult and a Store-and-Forward Telemedicine Consult.

In a Live Interactive Telemedicine Consult the telemedicine provider and the patient are connected via live interactive telecommunication technologies, meaning they can see and hear each other in real time.
In a Store and Forward Telemedicine Consult the telemedicine provider and patient are not connected via live interactive telecommunication technologies. Rather, store-and-forward is the asynchronous transmission of medical information which is reviewed at a later time by a medical provider at a distant site. The medical provider receives this information and reviews it, without the patient being present.

For a more detailed explanation of the difference between Live Interactive and Store-and-Forward, as well as information on reimbursement for both types of service, watch this short video with gpTRAC expert Zoi Hils:

Like this video? Find more informational videos on the gpTRAC youtube channel here.

Learn How to Create Revenue for your Telehealth Initiative

By Mike Grove
Based on the ATA 2012 Informational Session “Learn How to Get Paid and Create Revenue for your Telehealth Initiative” hosted by
Nina M. Antoniotti, RN, MBA, PhD, Director of TeleHealth Business. Marshfield Clinic, Marshfield, WI, USA. 

For someone like me who is relatively new to telehealth and not as familiar with reimbursement issues, this was a highly informative session as my three pages of single-spaced notes attest!  I certainly wasn’t alone as this was the most well-attended concurrent session I visited at ATA 20 12.  No surprise as everyone from vendors to clinicians to policy experts is interested in understanding how the money flows vis a vis telehealth applications.   Dr. Antoniotti is clearly one of the foremost telehealth reimbursement experts in the country which was evidenced by her ability to address state-specific questions thrown her way by the audience.

Dr. Antoniotti defined the payment buckets as coming from one of three sources:  Medicare, Medicaid, and everyone else (including private payers and out-of-pocket).  As simple as that may sound, she emphasized the profoundly different rules each has for payment which explains much of the misunderstanding around payment for telehealth services.   She presented a helpful and decidedly simple payment algorithm used by CMS when considering reimbursement and noted that the variation in state-administered Medicaid payments which require localized understanding of payment issues. 

Several general reimbursement strategies were highlighted which suggested a sort of philosophical reconsideration of institutional revenue.  Most broadly, vertical alignment of patient ancillary services was mentioned as a strategy to keep a patient within one’s system for as much of the care process as possible.  She also suggested that cost avoidance and expense reduction should really be thought of as a revenue source, meaning that readmissions and length of stay (LOS) are areas to be reexamined when considering telehealth services.  Specifically, targeting clinical services that historically have high no-show rates as prime candidates for telehealth efforts is a good way to begin to build the internal business case.  

The take-away point from Dr. Antoniotti  was “if you get reimbursed for an in-person service, assume you will for a telehealth service as well.”  To me, this sounded like an interesting problem as it appears that there is room for creative thinking when it comes to use of telehealth services.  It solidified the point I heard over and over during ATA…that telehealth should be embedded within processes and essentially synonymous with healthcare delivery.