how covid-19 is changing healthcare
TRANSCRIPT
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Introduction: Bonnie Young
April 24, 2019
Accessing GaHIN Through GAMMIS
Annika JonesDCH OIT – Health Information Technology
April 22, 2020
How COVID-19 Is Changing Healthcare:
Three Things Providers Should Know
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Mission: The mission of the Department of Community Health
is to provide access to affordable, quality health
care to Georgians through effective planning,
purchasing, and oversight.
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Partnering for SuccessThe Department of Community Health and the
Georgia Health Information Network (GaHIN) work
closely to ensure that providers and caregivers can
access patient health information at the point of
care to optimize outcomes and reduce costs.
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Presentation to:
Presented by:
Date:
Insert Presentation NameWe have developed training on the simple steps needed to sign up to access GaHIN as well as how to navigate within the electronic record
• Part 1 – accepting the Terms and Conditions required prior to access
• Part 2 – primary functions and navigation within the GAMMIS Clinical Viewer
https://ibmwh.adobeconnect.com/gammis-training
You must have an active, authorized GAMMIS login and accept the terms and conditions (one time) prior to gaining access to GaHIN data
Note: Your facility may block streaming content on the internet, including content streaming from the truvenhealth.com domain. In this case, you will need to contact your IT Team for information on how to access streaming content.
GAMMIS Online User Training
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GaHIN – Georgia’s Statewide Health Information Exchange
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Georgia Health Information Network (GaHIN)
GaHIN is Georgia’s state-designated Health Information Exchange (HIE)
Dedicated to creating a healthier Georgia through
the use and exchange of electronic health information
• Advance patient-centered healthcare
• Increase efficiency
• Improve the health of the
state’s entire population
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Creating a Statewide Electronic Network
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GaHIN Products and Services
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Connecting Georgia
Basic Data Exchange Free email messaging service to securely send patient health information to other authorized healthcare professionals
2019 Totals• 1,108,303 send & receive transactions
• 2018 – 747,960 Direct transactions
• 6,445 registered providers
• 356 member organizations
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Connecting Georgia
Robust Integrated Patient Search (Query)Providers can use their EHR to quickly access patient health data from hospitals, physician practices, state health systems and much more
2019 Totals• ~14,641 connected providers
• 3,885,730 queries
• 2018 – 2,388,290 queries
• 36,513,390 MPI records
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Connected Organizations
State Agencies• GA Medicaid/Department of Community Health (DCH)
• GA Department of Public Health (DPH)
• GA Division of Families and Children Services (DFCS)
• GA Department of Juvenile Justice (DJJ)
• GA Department of Behavioral Health and Developmental Disabilities (DBHDD)
Health Systems/Hospitals• Children’s Healthcare of Atlanta (Epic)
• Emory Healthcare (Cerner)
• Grady Health System (Epic)
• Gwinnett Health System (RelayHealth)
• WellStar Health System (Epic)
Regional HIEs• GRAChIE/Chatham HealthLink (Cerner)
• HealtheConnection (Cerner)
• HealtHIE Georgia (Azalea)
• HI-BRIDGE HIE (formerly Georgia Health Connect)
Care Management Organizations• Amerigroup (with IHE)
• CareSource
• Peach State
• WellCare
Specialty Connections• Atlanta Gastroenterology Associates (Greenway)
• Georgia Partnership for Telehealth (Azalea)
National Exchange• Veterans Health Administration
• Department of Defense
• DaVita Healthcare Partners
• Alabama (AOHR)
• East Tennessee HIE (etHIN)
• South Carolina HIE (SCHIEx)
• North Carolina HIE (NCHIEA)
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Emergency Waivers During COVID-19 Crisis: Telehealth Issues
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Emergency Waivers During COVID-19 Crisis: Telehealth Issues
Georgia Health Information NetworkApril 22, 2020
Tracy M. Field, PartnerParker, Hudson, Rainer & Dobbs LLP303 Peachtree Street, NE, Suite 3600
Atlanta, GA [email protected] (404) 420-1146
Jennifer M. Vaughan, PartnerParker, Hudson, Rainer & Dobbs LLP303 Peachtree Street, NE, Suite 3600
Atlanta, GA [email protected] (404) 420-5531
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Agenda
Telehealth Services
Previous Telehealth Restrictions
COVID-19 Section 1135 Waiver and March 31 Interim Final Rule (IFR)
Update: Other Virtual Services
HIPAA Waivers
Other Important Issues, During and After PHE
4/22/2020 14
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Before the Public Health Emergency (PHE)
Legal Standard
• Patient must reside in rural area
• Patient must be physically present at healthcare facility when service is provided (facility fee)
• Federal reimbursement for few telehealth services
• Cannot use for first-time visits
• Must use technology with audio and video capabilities that permits real-time interactive communication
– Note: Some exceptions for stroke, ESRD and substance use
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Before the PHE
Telehealth Services
• State legal standards for Medicaid coverage vary
• Concern / enforcement activities focus on whether services actually delivered
– Significant increase in telemedicine Medicaid reimbursement over years:
• Rendering provider reimbursed
• Facility fee paid
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Before the PHE
HHS OIG Report issued April 1, 2020: SC Medicaid overpaid for telemedicine services rendered between 2014 and 2017
Only allowed reimbursement for 3 of 100 sampled claims
Services not properly documented
Document start/stop time
Document location of consulting site
17© 2020 Parker Hudson Rainer & Dobbs LLP. All Rights Reserved.
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CARES Act (March 6, 2020)
• Coronavirus Aid, Relief and Economic Security (CARES) Act
• Includes financial grants, stimulus, loans
• Includes Waiver Authority to HHS
– The Waiver ONLY applies during PHE
… however, now that telemedicine services are more widely allowed…
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CMS Waiver
March 17, 2020 – CMS Issue Press Release, Fact Sheets
• Expands “Eligible Providers”
– Physicians, including extenders
– Clinical Psychologists
– Licensed Clinical Social Workers
– Registered Dieticians
– NOTE: This list could be expanded; SNFs are pushing for therapy services to be delivered remotely
• Initially, if can bill CMS for service if conducted in person, can bill for Telehealth
19© 2020 Parker Hudson Rainer & Dobbs LLP. All Rights Reserved.
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CMS Waivers
During the Public Health Emergency
• Patient AND Providers can be ANYWHERE in USA – including if patient is at home!
• Provider bills “as if” in person
• Append POS code to claim (as if not remote)
• Can be a new patient – “Enforcement discretion” in audits
20© 2020 Parker Hudson Rainer & Dobbs LLP. All Rights Reserved.
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CMS Waivers and New Regulation
Regulation published April 6, 2020
CMS added coverage for inpatient hospital care for ED visits, observation, inpatient care
Coverage even if not for patient with COVID-19
Regulation details coding guidelines
• CHECK REGULARLY – CMS and State updates/ changes OFTEN
21© 2020 Parker Hudson Rainer & Dobbs LLP. All Rights Reserved.
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CMS Waivers, Regulation and Dear Clinician LetterIn “Dear Clinician” letter, CMS directs that be paid for telemedicine services for new and established patients
Tip: Maintain screen shots of guidance, web pages, CMS and State guidance todocument compliance
• CHECK REGULARLY – CMS and State updates/ changes OFTEN
22© 2020 Parker Hudson Rainer & Dobbs LLP. All Rights Reserved.
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CMS Waivers
Equipment
• Telephones with audio/ video capabilities
• Audio only?
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CMS Waivers
Coding Guidance and Coverage Confusion
• Expanding list of services – but every service is NOT covered
• CMS issued conflicting directions on how to code where the services were performed
• Keep documentation!
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CMS Waivers
Cost Sharing Obligations
• Generally, the government does not permit providers to waive cost sharing for Medicare covered services
– Concern is that could be undue influence on patients
• During PHE, cost-sharing is waived by Medicare….and increasingly private payers
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Federal Issues: Rx
• Drug Enforcement Agency (DEA)
– Prescribers must have DEA federal registration and there must be corresponding state registration
– State registration under DEA is waived for each state, as long as prescribing provider has one valid state registration
26© 2020 Parker Hudson Rainer & Dobbs LLP. All Rights Reserved.
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Georgia Medicaid Waivers
State laws still in effect – and must be considered!
Georgia Medicaid issued guidance on March 18th
- No originating site limitations, can be conducted at patient’s home
- For home and community-based waiver programs, can initial, annual care determinations via telehealth
27© 2020 Parker Hudson Rainer & Dobbs LLP. All Rights Reserved.
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Georgia Medicaid Waivers
Georgia Medicaid issued additional guidance on March 26th
- Qualified rendering providers include physicians, PA, NP and certified nurse midwifes
- Any provider enrolled in Medicaid can use telehealth services
- Specific directions regarding coding, differs from CMS
- Document patient verbal consent to render care, waive written consent requirement
28© 2020 Parker Hudson Rainer & Dobbs LLP. All Rights Reserved.
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HIPAA Waivers
March 17, 2020 the Office of Civil Rights Issued Waivers for HIPAA enforcement
- Waive enforcement against providers operating in “good faith” using telehealth services
- Can be for telehealth services for any medical issue, not merely COVID-19 related issues
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HIPAA Waivers
March 17, 2020 the Office of Civil Rights issued Waivers for HIPAA enforcement
- Should notify patients if use these applications they may not be private
- FaceTime
- FaceBook Messenger
- Skype
- Use private locations when conducting visits (!)
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HIPAA Waivers
March 17, 2020 the Office of Civil Rights issued Waivers for HIPAA enforcement
- Encourage but not require execution of Business Associate Agreements with vendors in telehealth
- Question – could this waiver apply more broadly than telehealth?
31© 2020 Parker Hudson Rainer & Dobbs LLP. All Rights Reserved.
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HIPAA
• Office of Civil Rights Enforcement Discretion
– Business Associate Waiver for PHE reporting
– Stay tuned!
32© 2020 Parker Hudson Rainer & Dobbs LLP. All Rights Reserved.
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Telehealth
• Are the flood gates open?
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Medicare Telehealth and Visual Services
• For first time, can bill for phone calls!
• New and established patients
• Consent issues
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CMS Waivers
• Hospice, Home Health, IRFs
– Coverage for services depends on face-to-face visits
• Nursing Home Use
– Scope still being debated
– Note: Hospital visits for inpatients can be virtual (and billed) but not yet a broader waiver
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Other Considerations
• Federal Communications Commission April 2nd Report and Order
– Establishes COVID-19 Telehealth Program
– Funding to support “connected care”
– Grantee limitations: nonprofits and public entities eligible
• Includes schools, community health centers, hospitals, etc.
36© 2020 Parker Hudson Rainer & Dobbs LLP. All Rights Reserved.
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Questions?
37
Tracy M. Field, PartnerParker, Hudson, Rainer & Dobbs LLP303 Peachtree Street, NE, Suite 3600
Atlanta, GA [email protected] (404) 420-1146
Jennifer M. Vaughan, PartnerParker, Hudson, Rainer & Dobbs LLP303 Peachtree Street, NE, Suite 3600
Atlanta, GA [email protected] (404) 420-5531
© 2020 Parker Hudson Rainer & Dobbs LLP. All Rights Reserved.
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QUESTIONS??
Georgia Health Informat ion Network
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Please participate in the brief survey following this webinar.
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Thank you!