2015 conference power point

1. 6th Annual Georgia Partnership for
TeleHealth
Spring Conference MARCH 25-27
Savannah, Georgia
Mario Gutierrez
Executive Director
Center for Connected Health Policy • 877-707-7172
cchpca.org
TELEHEALTH POLICY & PRACTICE

2. We seek to advance state
and national telehealth
policies that:
• promote better health
& health systems
• provide greater health
equity

3. • Established in 2006, funded
by the Office for the
Advancement ofTelehealth
• Twelve regional centers
• One national technology
assessment center
• Collectively form a network
of telehealth program
expertise and experience
• Independently serve a
designated region
TelehealthResourceCenter.org
 One National Policy
Resource Center - CCHP

5. What Is Telehealth?
Telehealth is a means for enhancing health care, public
health, and health education delivery and support using
digital telecommunication technologies.

6. Telehealth?
A doctor's diagnosis "by radio" on the cover of the
February, 1925 issue of Science and Invention magazine

7. Why Telehealth is Essential to
the Future of Health Care
Advances in telecommunications technologies can help
redistribute health care expertise to where and when it
is needed, and create greater value

8. Live Video
Variety of high-speed
digital
telecommunications
Outpatient or inpatient
specialty consultation
Most commonly used
Store-and-
Forward
Often low bandwidth, still
images, can store video
clips.
Best used in dermatology,
ophthalmology, pathology,
and radiology.
Exploring new avenues,
such as psychiatry
TELEHEALTH MODALITIES

9. Remote Patient Monitoring
Hospital emergency departments,
intensive care units, and skilled
nursing facilities
At-home management of patients with
chronic conditions
Keeping people healthy and at home
Mobile Health (mHealth)
Health care, public health, and health
education
Supported by cell phones, tablet
computers, PDAs, and other mobile
communication devices
Can be targeted (promoting healthy
behavior and disease management) to
wide-scale (disease outbreak alerts)
TELEHEALTH MODALITIES

10. Remote Monitoring & M-
Health
Healthy
Living
Chronic
Conditions
Aging
Acute Care,
ICU
End of Life

11. Cue provides molecular diagnostic capability in the home.
Apple Watch will display blood glucose levels from
the Continuous Glucose Monitor

12. Handheld cellphone-based
Otoscope
12

13. Health Chair incorporates
a vast array of biosensors to
measure basic vital signs:
 Weight
 Blood Pressure
 Temperature
 ECG
 Auscultation of Heart and
Lung Sounds
 Blood Oxygen Saturation
 Motion Analysis
 Reflex Response Time
Incorporates communication
unit with remotely
controlled camera

14. Berkeley “Tricorder”
Remote monitoring of multiple health functions in an
unobtrusive, wearable wireless device
• Combines accelerometer,
ECG, stethoscope, pulse-
oximeter, myography, and
other functions
• Bluetooth radio with
connectivity to PC and
smart phone
• 2 GB data storage
capacity: two days of
continuous monitoring

15. Monitoring Rx Adherence

16. FDA-Approved Digestible
Microchip

17. FEDERAL & STATE POLICIES

18. Telehealth State-by-State Policies, Laws, &
Regulations
Interactive
Policy Map
Laws
Regs
Pending
Bills
State &
Federal

19. • Definition of telemedicine/telehealth
• Reimbursement for: live video
store-and-forward
remote patient monitoring
email/phone/fax
transmission/facility fees
• Consent issues
• Location of service provided
• Online prescribing
• Private payer laws
• Cross-state licensure
11 Telehealth Policy Areas

20. Current State Telehealth Policies:
Every State is Different!
Definition
• 43 states have a definition for “telemedicine”
• 28 states & DC have a definition for “telehealth”
• 2 states have no definition for either
Reimbursement
• 46 states & DC reimburse for live video
• 14 states reimburse for remote patient monitoring
• 9 states reimburse for store-and-forward
• 24 states and DC have telehealth private payer parity laws
Provider/Location Restrictions
• Most common reimbursements: consultations, mental
health, and radiology
• Most common providers reimbursed: physicians and
nurses
As of Feb. 2015

21. More State Telehealth Policy
Differences
Looking Beyond the Medical Professions
• Some Medicaid programs reimburse for: home health, dental, speech-
speech-language pathology, physician assistants, physical therapists,
therapists, dieticians, genetic counselors, behavioral health
Additional Telehealth-Related Policy Practices
• 28 states require some form of informed consent
• Most states don’t consider an online questionnaire adequate to
establish a patient-provider relationship needed for prescribing.
Licensing
• 10 state medical boards issue special licenses related to telehealth.
• 11 additional states make allowances for contiguous states or make
exceptions for practicing on an infrequent basis.
As of Dec 2014

22. Florida and Georgia

23. Georgia: Medicaid
Reimbursement
• Live video reimbursement only!
• Eligible services include:
– Office visits; Pharmacologic management,
limited office psychiatric and radiological
services; A limited number of other physician
fee schedule services.
• Written informed consent required

24. Georgia: Other Policies
• Insurers required to cover telemedicine,
subject to terms and conditions.
(regulation, not law)
• GA Medical Board adopted practice
standards for the practice of medicine
through “electronic means”-strict and very
detailed!

25. Georgia: Medicaid
Reimbursement
Eligible Originating & Distant
• Provider offices;
• Hospitals;
• Critical Access Hospitals
• Rural Health Clinics (RHC);
• Federally Qualified Health
Centers (FQHC);
• Skilled nursing facilities;
• Community mental health
centers;
• GA public health clinics;
• School-based clinics
Eligible Sites
• Provider offices;
• Hositals;
• Critical Access Hospitals
• Rural Health Clinics (RHC);
• Federally Qualified Health
Centers (FQHC);
• Skilled nursing facilities;
• Community mental health
centers;
• GA public health clinics.

26. Florida: Medicaid
Reimbursement
• Live video reimbursement only!
• Eligible providers:
– Physicians
• Originating site must be:
– Hospital outpatient setting
– Inpatient setting
– Physician’s office
• Limited consultation codes reimbursed
• No facility or transmission fee

27. Florida: Medicaid
Reimbursement
• Other requirements
– Referring practitioner must be present during
telemedicine consultation.
– Both distant and originating site must be
located in FL.
– Documentation requirements:
• Explanation of why services were not provided
face-to-face;
• Documentation of telemedicine service provided;
and
• Patient consent

28. Florida: Other Policies
• No private payer parity law or
regulations
• Telemedicine Practice Standards
adopted by FL Board of Medicine &
Board of Osteopathic Medicine.
– Allows for the establishment of a physician-
patient relationship by telemedicine.
– Controlled substances cannot be
prescribed through telemedicine.

29. Florida TaxWatch
• “Time for Telehealth” 11/2014
Report:
“Florida lawmakers need to act quickly to
connect patients with higher quality, timely care
by using telehealth to bring the state's health
policies into the 21st century”
 Study shows that hospital charges could be
reduced by more than $1.2 billion annually
based on hospitalization charges alone.
 Evidenced-based Research coupled with
Consumer Advocacy can be a powerful
combination for change

30. Federal MediCare
Reimbursement for Telehealth

31. MEDICARE TEHEHEALTH POLICY:
OUTDATED!
• Reimbursement is available for only a
limited number of Medicare Part B
services
• Reimbursement limited to live video
only substituting for in-person
encounter
• Can only occur when the originating
site is in:
• a Health Professional Shortage Area
(HPSA),
• a county outside of any Metropolitan
Statistical Area (MSA), or
• an AK/HI demonstration project

32. Federal Landscape 2015
FEDERAL LEGISLATION
• Proposed draft bill 21st Century CURE Bill in House Energy & Commerce
Committee includes provisions for Medicare to waive some telehealth
restrictions if certain conditions met-SEEMS TO HAVE BIPARTISAN SUPPORT!
• Previous Congressional Session bills :
HR 5380 (Thompson, Harper & Welch)
For Medicare, phased in increase of eligible geographic locations;
adding home as eligible site; reimbursing for RPM; reimbursing for
Store &Forward
HR 3306 (Harper, Nunes, Thompson & Welch) & S 2662
For Medicare, expand list of eligible originating sites including the
home; small expansion of S&F to CAHs & sole community hospitals;
for liability and licensing purposes services furnished at the
provider’s location; allows for the use of RPM in specialty medical
homes contracts

33. HHS/CMS
• Movement toward Accountable Care
Organizations as part of the ACA
• President Obama sets goal of 90% of Medicare
payments tied to VALUE---not fee for service
• CMS approves more Medicare tele-psych
codes for reimbursement
• New code for “non-face to face” chronic
care management & coordination

34. Next Generation ACO
• Greater access to home visits, live
telehealth services, and skilled nursing
facilities;
• “benefit enhancements” allow
circumvention of Medicare rules that
go beyond benefits that Medicare
Advantage (MA)
• Would allow ACOs to utilize the
technology regardless of a patient’s
geographic location.

35. Other Federal Activities
• Federal Communications Commission-Net
Neutrality & Protecting Connected Care
• Federation of State Medical Boards –
Licensing Compact/Interstate Licensure

36. FUTURE TRENDS IN TELEHEALTH
POLICY & PRACTICE

37. The Changing Healthcare
Landscape: 2015
Aging/sicker population
Primary care/specialist shortage
More newly insured with
Obamacare
Rising health care costs:
$3 trillion/year

39. Making Change Happen
Health Systems Policy Private Payers
Evidenced-based
Research
Technology
Changes
Consumer
Demand

40. Federal And State Policy:
Volume-to-Value
Value‐based
• Pay for results
(quality/efficiency)
• Shared risk
• Partnerships and
collaborations
• Continuum of care
• Community health
improvement (HIT)
• Wellness care
Volume‐based
• Pay for service (volumes)
• Cost‐based
reimbursement
• Hospital/physician
independence
• Inpatient focus
• Stand-alone care
systems
• Illness care

41. Team-based, Person-Centered
Care
Everyone Working at the Top of Their License

42. Out of the “Box” of Health
Care

43. Mercy Virtual Care Center-St.
Louis
Opening Summer, 2015
Will accommodate nearly 300 physicians,
nurses, specialists, researchers and
support staff. Care will be delivered 24/7
via audio, video and data connections-3
million telehealth visits in first 5 years.

44. Virtual Care Anywhere
• 75 million Virtual Medical Visits in N.
America-2014
-Deloitte

45. © 2014 Kaiser Permanente
Kaiser Permanente Leading the Way
Improved engagement, quality, and satisfaction
Member retention
 My Health Manager users were 2.6 times
more likely to remain members 1
Quality of care improved
 2.0 to 6.5% improvement - glycemic
(HbA1c), cholesterol, and blood pressure
screening and control2
 Refill improves outcomes (LDL) 3
High patient satisfaction
 85% rated encounters 8 or 9 on a 9 pt
scale4
1 Turley, Marianne; Garrido, Terhilda; Lowenthal, Alex; Zhou, Yi Yvonne, “Association Between Personal Health Record Enrollment and Patient Loyalty,” Am J Manag Care. 2012;18(7):e248-e253 (web exclusive)
2 Zhou, Yi Yvonne; Kanter, Michael H; Wang, Jian J; Garrido, Terhilda, “Improved Quality at Kaiser Permanente Through E-Mail Between Physicians and Patients,” Health Affairs, Vol 29, No 7 (2010); 1370-1375.
3 Sarkar, Urmimala, Lyles, Courtney; Parker, Melissa; Allen, Jill, et al., “Use of the Refill Function Through an Online Patient Portal is associated With Improved Adherence to Statins in an Integrated Health System,”
Medical Care, Vol 00, No 00 (2013)
4 Internal KP study, “Harvesting Value: Early Findings from Kaiser Permanente HealthConnect™” presented to Center for Information Therapy by T Garrido, C Serrato, J Oldenburg (1/15/2008)
45

46. US Healthcare Practitioners Who Currently
Provide or Plan to Provide Telemedicine
Services*, Oct 2014
*healthcare services via telephone, video or webcam visits Note: n=759;
Source: Academy of Integrative Health & Medicine (AIHM) survey as cited
in press release,
Nov 11, 2014
33%
Yes
29%
No-but planning
to in the next few
years
38%
No
immediate
plans

47. Even if
you’re on
the right
track…You’ll
get run over
if you stand
still!

48. Thank You!