integrating telemedicine into your practice
TRANSCRIPT
John Steinmann, DOCalifornia Orthopedic Association
Friday May 17, 2019
Integrating Telemedicine Into Your Practice
• Introduction• Telemedicine Today• New Patient• Established Patient
Post-OperativeRoutine Follow-up
• Reimbursement• Practice ROI• Questions/Answers
• Disclosure• Telemedicine Today• Laws Re: Telemedicine• Available Technologies• Indications
Established PatientPost-OperativeRoutine Follow-up
New Patients• Reimbursement• Practice ROI• Questions/Answers
2
Faculty Financial/Conflict of Interest Disclosure
Founder, CEOAxS Health
Digital Health and Telemedicine Platform
AGENDA
3
Our patients will increasingly demand convenience, access and affordability.
All of these are fulfilled by telemedicine.
q Telemedicine in an orthopedic surgery practice?q What are the available telemedicine technologies?q Can telemedicine really make me more efficient?q Will Medicare and private insurers pay for telemedicine?q How well is this technology accepted by patients?q What laws support, restrict or govern telemedicine?q Indications for telemedicine in an orthopedic practice?q What are the economics regarding this technology?
• Introduction• Telemedicine Today• Laws Re: Telemedicine• Reimbursement• Available Technologies• Indications
Established PatientPost-OperativeRoutine Follow-up
New Patients• Practice ROI• Questions/Answers
AGENDA
Integrating Telemedicine Into Your Practice
4
• Introduction• Telemedicine Today• Laws Re: Telemedicine• Reimbursement• Available Technologies• Indications
Established PatientPost-OperativeRoutine Follow-up
New Patients• Practice ROI• Questions/Answers
AGENDA
• As of 2016 Kaiser conducted more than half their visits virtually
• Telemedicine’s expected annual growth rate is 27.5%• Telemedicine visits have increased from 350,000 in 2013
to 7,000,000 in 2018• 86% of physicians and as high as 98% of patients
reported high satisfaction with telemedicine services • 76% of patients care more about access to healthcare
and convenience than the human interaction• 44% of private practices are making telehealth their #1
priority
Integrating Telemedicine Into Your Practice
5
• Introduction• Telemedicine Today• Laws Re: Telemedicine• Reimbursement• Available Technologies• Indications
Established PatientPost-OperativeRoutine Follow-up
New Patients• Practice ROI• Questions/Answers
AGENDA
Benefits of a Telemedicine Platform• Patient Convenience• Time Efficiency/Automation• Enhanced Revenue• Stability and Growth of your Practice
Risks of not employing Telemedicine• Intrusion into your market or loss of market share• Failed Revenue Opportunity• Failed Efficiency Opportunity • Patient Inconvenience
Integrating Telemedicine Into Your Practice
6
• Introduction• Telemedicine Today• Laws Re: Telemedicine• Reimbursement• Available Technologies• Indications
Established PatientPost-OperativeRoutine Follow-up
New Patients• Practice ROI• Questions/Answers
AGENDA
q Laws governing in-office visits pertain to telemedicineq Securely protect the exchange of PHIq Obtain written or verbal patient consentq Obligated to the same standards of careq Adhere to State licensing standardsq Adhere to laws governing location of service
Integrating Telemedicine Into Your Practice
7
• Introduction• Telemedicine Today• Laws Re: Telemedicine• Reimbursement• Available Technologies• Indications
Established PatientPost-OperativeRoutine Follow-up
New Patients• Practice ROI• Questions/Answers
AGENDA
Telemedicine parity laws “mandate [that] commercial payers provide coverage and reimbursement for telemedicine services comparable to in-person services.” As of May 2017, 40 states approved or proposed legislation allowing for telemedicine parity.
8
• Introduction• Telemedicine Today• Laws Re: Telemedicine• Reimbursement• Available Technologies• Indications
Established PatientPost-OperativeRoutine Follow-up
New Patients• Practice ROI• Questions/Answers
AGENDA
q Must negotiate individual contracts with payers q Define modifiers and codes availableq Define indications and address frequencyq Find areas where payers bear the cost of seeing patientsq Medicaid HMO who pays for transportationq Work Comp who pay for time and transportationq Employers who pay for time and transport q Post-op Telemedicine with-in the post-op global period
does not require a contract
Integrating Telemedicine Into Your Practice
Reimbursement almost does not matter
9
• Introduction• Telemedicine Today• Laws Re: Telemedicine• Reimbursement• Available Technologies• Indications
Established PatientPost-OperativeRoutine Follow-up
New Patients• Practice ROI• Questions/Answers
AGENDA
(Reimbursement-Cost)/Time In-office
($91-$72)/10min = $114/hr
(Reimbursement-Cost)/Time Telemedicine
($49-$24)/2min = $750/hr
Integrating Telemedicine Into Your Practice
For every 5 telemedicine appointments I free up 4 slots for new patients
10
• Introduction• Telemedicine Today• Laws Re: Telemedicine• Reimbursement• Available Technologies• Indications
Established PatientPost-OperativeRoutine Follow-up
New Patients• Practice ROI• Questions/Answers
AGENDA
Synchronous(video)
Asynchronous(text)
Combined(text with optional video)
Integrating Telemedicine Into Your Practice
In the majority of use cases, Asynchronous or a Combined Platform Telemedicine will be preferred by both patient and provider
TelemedicineSynchronous Telemedicine (Video)• Advantages
• More personal and formal• Allows for Limited Exam• Improved Reimbursement?
• Disadvantages• Technical Resource Intensive• Lacks Time efficiency• Lower ROI
Asynchronous Telemedicine (Text)• Advantages
• Time Efficiency• Patient and Provider Convenience• Less Technical Requirements• Greater ROI
• Disadvantages• Reimbursement • Less Formal or Personal
Asynchronous Telemedicine platforms use logical algorithms to ask patients a series of questions, and gather relevant pictures for the provider to review within an appointment window.
Asynchronous Telemedicine
Combined platforms use similar logical algorithms to ask patients a series of questions, but include an optional audio-video communication between the patient and provider.
Combined Platform
14
• Introduction• Telemedicine Today• Laws Re: Telemedicine• Reimbursement• Available Technologies• Indications
Established PatientPost-OperativeRoutine Follow-up
New Patients• Practice ROI• Questions/Answers
AGENDA
30%
Integrating Telemedicine Into Your Practice
What percentage of in-office orthopedic visits better performed via telemedicine?
If a patient does not need a hands on exam they do not need to be in your office
15
• Introduction• Telemedicine Today• Laws Re: Telemedicine• Reimbursement• Available Technologies• Indications
Established PatientPost-OperativeRoutine Follow-up
New Patients• Practice ROI• Questions/Answers
AGENDA
Integrating Telemedicine Into Your Practice
Post-op TelemedicineCandidates• 1st and 3rd, or 2nd visits• Relative Contraindications
• Lack of a smart phone• Necessary X-rays• Necessary suture removal
Post-op Telemedicine
Post-op Telemedicine
18
• Introduction• Telemedicine Today• Laws Re: Telemedicine• Reimbursement• Available Technologies• Indications
Established PatientPost-OperativeRoutine Follow-up
New Patients• Practice ROI• Questions/Answers
AGENDA
Integrating Telemedicine Into Your Practice
Follow-up TelemedicineCandidates• 1/2 of all follow-up patients• Assessing treatment result• Review MRI• Medication refills• Work Comp awaiting authorization• Relative Contraindications
• Lack of smart phone• Re-examination necessary• Contract preclusion
Scheduling and Onboarding
Other Uses
“Walk-in” Specialty Care
Other Uses
21
• Introduction• Telemedicine Today• Laws Re: Telemedicine• Reimbursement• Available Technologies• Indications
Established PatientPost-OperativeRoutine Follow-up
New Patients• Practice ROI• Questions/Answers
AGENDA
Integrating Telemedicine Into Your Practice
Eligible Post Operative Appts% Post-Operative Visits Eligible for Telemedicine 33%Percent Patients Opt-In to Telemedicine 70%Number of Post-Ops converted to telemedicine/year/provider 254
Eligible Routine Follow-Up ApptsPercent of follow-up visits eligible for telemedicine 33%Percent patients opt in to telemedicine 70%Visits converted to telemedicine 427
Additional In-Office Visits (Time freed by Telemed)Telemedicine Appointments/Day 6.2Mins saved/day - MD/DO 49.5Mins required, New Patient Visit - MD/DO 13.0Additional New Visits/Day 3.8
22
23
q Telemedicine has been a very positive addition to my practiceq Patient acceptance and appreciation has been outstandingq The benefits are immense but adoption will be slow q Telemedicine is inevitable – do not wait too long
• Introduction• Telemedicine Today• Laws Re: Telemedicine• Reimbursement• Available Technologies• Indications
Established PatientPost-OperativeRoutine Follow-up
New Patients• Practice ROI• Questions/Answers
AGENDA
Integrating Telemedicine Into Your Practice
Summary
Questions?
Thank you