telemedicine conference - april 2014
DESCRIPTION
Overview of Telemedicine in Kansas, from the Regional Telemedicine Conference held in Salina, KS, April 16, 2014.TRANSCRIPT
SalinaTelehealth
Regional Telemedicine Conference Heartland TRC
1-877-643-HTRC (4872)
http://www.HeartlandTRC.org
Gordon AllowayProject Director, HTRC
HTRC PARTNERSSince 2010
University of Oklahoma Health Sciences Center
Started 1993
Store-and-Forward expertise
University of Kansas Medical Center
Started 1991
2,000+ clinical consults/yr
University of Missouri Health System
Started 1994
Public/Private Network
Telehealth / Telemedicine:
The
Delivery of CareTechnology-Assisted
What Telemedicine is:
1. A method of delivering care that is available for use when appropriate.
2. A care delivery method with proven efficacy and insurance reimbursement, in general, equal to in-person care.
What Telemedicine is: Not:
1. Significantly different way of providing care
2. An additional level of care
3. A replacement for face-to-face care
4. A departure from clinical protocols
5. Tele-surgery or Robotic surgery
6. Virtual care / Checklist medicine
Telemedicine Benefits:
1. Increased community satisfaction– Meeting a community need– Keeping patients in community
» Additional revenue (Rx, food, gas)
2. Increased patient satisfaction– Access to specialists– Keeps patients in community
– Time is key for stroke– Family access– Reduced transp.
Telemedicine Benefits:
3. Increased Board satisfaction– Efficient addition of services at your facility
– Technology available for admin. needs
4. Increased staff satisfaction– Fill available capacity
– Available for CME & CE training
5. Enhanced Continuity of Care– Increases practitioner avail.
Terms
Relationshipof
TechnologyTerms
WhatAbout
mHealth?
Two Common Forms of Telemedicine
1. Asynchronous or “Store-and-forward”
Example: RadiologyX-ray image/CAT scan/MRI
Sent to different location
Radiologist reads image and responds to PCP/patient
Two Common Forms of Telemedicine2. Interactive or “Real Time”
Example: Clinical ConsultationScheduled appointment
Patient at clinic, hosp, CAH
“Normal” exam room
Presenter/provider remains with patient in exam roomOperates equipment, assists provider
Specialist/Provider/Practitioner on video monitor
Reimbursement
Good News! There Is Reimbursement
• Medicare (2001)• Medicaid varies by state, but generally follows
Medicare guidelines– Kansas (2004)
• Reimbursement available from all health insurance providers (no need for KS legislative mandate)
• Also, Federal grants & loans available
2014Medicare
CPT / HCPCS Codes –
Telehealth Services
Telehealth Service CPT / HCPCS Codes
Emergency department or initial inpatient consultations HCPCS codes G0425 – G0427
Follow-up inpatient consultations (hospitals or SNFs) HCPCS codes G0406 – G0408
Subsequent hospital care services, limitation 1 telehealth visit every 3 days CPT codes 99231 - 99233
Subsequent nursing facility care services, limitation 1 telehealth visit every 30 days CPT codes 99307 - 99310
Office or other outpatient visits CPT codes 99201 -- 99215
Individual and group diabetes outpatient self-management training (DSMT) services, with a minimum of 1-hr. of in-person instruction to be furnished in the initial year training period to ensure effective injection training
HCPCS codes G0108 and G0109
Individual and group Kidney Disease Education (KDE) services HCPCS codes G0420 and G0421
End Stage Renal Disease (ESRD) related services CPT codes 90951, 90952, 90954, 90955, 90957, 90958, 90960, and 90961
Individual and group Medical Nutrition Therapy HCPCS code G0270 and CPT codes 97802 -- 97804Individual and group health and behavior assessment and intervention (HBAI) services CPT codes 96150 - 96154
Psychiatric diagnostic interview examination CPT code 90791 and 90792Individual psychotherapy CPT codes 90832 -- 90834 and 90836 -- 90838Pharmacologic management CPT code 90862Neurobehavioral Status Exam CPT codes 96116
Smoking cessation services HCPCS codes G0436 and G0437, andCPT codes 99406 and 99407
Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention services HCPCS codes G0396 and G0397
Annual alcohol misuse screening, 15 minutes HCPCS code G0442Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes HCPCS code G0443
Annual depression screening, 15 minutes HCPCS code G0444
High-intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes
HCPCS code G0445
Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes HCPCS code G0446
Face-to-face behavioral counseling for obesity, 15 minutes HCPCS code G0447
Transitional care management services CPT code 994951 and 994962
Telehealth originating site facility fee (short description: “telehealth facility fee”) Q03014
Medicare Benefit Policy – Telehealth ServicesNEW for 2014
(Effective 01/01/14)
Transitional care management services CPT code 994951 and 994962
1. Communication with patient and/or caregiver within 2 business days of discharge; face-to-face visit within 14 calendar days of discharge and moderate complexity of medical decision-making during service period
2. Communication with patient and/or caregiver within 2 business days of discharge; face-to-face visit within 7 calendar days of discharge and high complexity of medical decision-making during service period
Telehealth Guidelines
• Patient location:–Physician/Practitioner’s office–Hospital (inpatient or outpatient)–Critical Access Hospital (CAH)–Rural Health Clinic (RHC)–Federally Qualified Health Center (FQHC)–Skilled Nursing Facility (SNF)–Hospital-based or CAH-based Renal Dialysis Centers–Community mental health center (CMHC)–HPSA county outside metro area
Telehealth Guidelines• Physician/Provider location (“Distant Site”)
– No limitation on location– Must be licensed in state where patient is located
• Who may receive payment– Physician, PA, – Nurse practitioner, Nurse midwife,– Clinical nurse specialist, Clinical Psychologist,
Clinical social worker– Registered dietitian/nutrition professional
Telehealth Guidelines
• Interactive audio and video telecommunication must be used in real-time communication
– Patient must be present and participating
• Payment is equal to the current Physician Fee Schedule amount
• Telehealth Facility Fee (for Originating Site)– Billable separately under Part B
Kansas-Specific Reimbursement
• Included in Kansas Medical Assistance Program (KMAP) policy
• Three KanCare MCOs• Amerigroup • Sunflower• UnitedHealthCare
• Private Insurance – most major carriers
State Telehealth Mandate
• Mental/Behavioral Health – Kansas - SB 175, HB 2395 and HB 2317– Mass– Nebraska
Technology
Telemedicine in the 1990’s
Telemedicine in Kansas: 1991
Hays AHEC Kansas City
Telemedicine in KansasClinical Consults: 1993-2001
1993 1994 1995
19961997
19981999
2000
2001
0
500
1000
1500
2000
2500
3000
Telemedicine Technology KUMC 1993 - 2010
1993
2010
Telemedicine Today
TelemedicineToday
• Smaller, less expensive equipment• High quality, high definition (HD) technology• Less expensive internet connectivity• Mobile, wireless capability
Applications
Specialty Consultation via ITV
Group Sessions and Educational Events
Telestroke / Physician-to-Physician
Intra-Oral Scope (Tele-Sleep Study)
What Tele-Sleep Presenter Sees
Electronic Otoscope for Pediatrics
Oncology Care (Hospital Exam Room)
Telemedicine on Smaller Scale
Interactive Tele-Video (ITV)Putting technology concerns into the past.
PROVIDER’S OFFICEw/ Desk Top Computer
TABLET
SMARTPHONE
Telehealth Peripherals
http://www.telehealthtac.org/toolkits/patient-exam-cameras-technology-overview#Patient_Exam_Cameras
Digital Stethoscopes
Telehealth Peripherals
http://www.telehealthtac.org/toolkits/patient-exam-cameras-technology-overview#Patient_Exam_Cameras
Total Exam Camera
AdvantagesSame FeaturesLess expensiveEasily Available
Digital Camera/Camcorders
FeaturesDigital
Records imageHas own lighting
HD
VS
Technical Advances
• Smaller, less expensive equipment
• From analog to digital
• From telephone lines to internet lines
• Wireless
• Encryption
• Integration
Technical Advances
• Next generation:
Robotics
Security
• Two Sections1. Privacy Rule2. Security Rule
Health Insurance Portability Accountability Act (HIPAA)
Privacy/Security Issues• Generally, all
videoconferencing systems are secure
• All include encryption• Log-in at both sites
• Privacy• Telemedicine room should be private just like any
other clinic room• Telemedicine patients same rights
HIPAA Security Rule• “The standards and specifications of the Security Rule are
specific to electronic protected health information (e-PHI). . . E-PHI does not include paper-to-paper faxes or video teleconferencing or messages left on voice mail, because the information being exchanged did not exist in electronic form before the transmission. In contrast, the requirements of the Privacy Rule apply to all forms of PHI, including written and oral.”US Dept. of Health & Human Serviceshttp://www.hhs.gov/ocr/privacy/hipaa/faq/securityrule/2010.html
Insurance & Licensure
Insurance & Licensure
• Standard malpractice insurance covers telehealth
• Very low risk service to date– 3-4 known cases (2 were online
prescribing)
– 2 New Mexico cases bring up telehealth use – If available and not used, there may be liability
• No national physician license– A few states require telemedicine license
• Supplemental licensing
Insurance & Licensing
• State Licensing Boards regulate practitioners– Physician/Practitioner must be licensed in state where
patient is located.
– No limits on practitioner location
Credentialing & Privileging
CREDENTIALING & PRIVILEGING
• Where patient is located is place of service
• Providers need to be credentialed / privileged/ licensed at each place of service
• Effective July 2011 – hospital’s governing body still responsible for all privileging decisions, but can accept credentials from distant-site Medicare hospital
CMS
TELEMEDICINE WORKS BOTH WAYS
1. Bring additional services into your site. Refer to specialists not currently available Patient remains onsite
2. Extend your services to other sites. Expand outreach activities Distant sites have access to your staff’s expertise Additional outpatient activity without additional traffic
Kansas Best Practices – Telehealth / Telemedicine
Telemedicine Services at Goodland Regional Medical Center
Kansas Best Practice - Telehealth / Telemedicine
Kansas Best Practice - Telehealth / Telemedicine
Hays Daily NewsBy KALEY CONNER
10/25/2013
KUCTT • Over 60 sites interacted with KUCTT• 16 specialties provided
Total KS activity unknown
Stormont-Vail& Mayo Clinic Care Network
Funding
Telemedicine in U.S.Multiple Federal Funding Resources
– HRSA – Network Planning and Network Development
• Grant assistance for upfront planning and initial development
– http://www.grants.gov/web/grants/search-grants.html
– USAC – Rural Health Care Support
• Will pay for % of Internet access cost
– http://wireless.fcc.gov/outreach/index.htm?job=funding
– Dept. of Commerce – National Telecomm. and Information Admin.
• Expanding broadband Internet access
• State Broadband Initiative & Tech Opp. Pgm.
• http://www.ntia.doc.gov/grants-combined
Telemedicine in U.S.Multiple Federal Funding Resources
– USDA – Rural Development (RD) – Grants & Loans
• Community Facilities (CF) Program - $70 million Direct Loans / $10 million Grants
– Areas/towns up to 20,000 pop.
– Construction or renovation of hosp., NF, Clinic (inc. necessary equipment)
– Purchase of specific equipment (new CT scanner), technology, software
• Application is once a year (end of May/early June)
• Announced 60 days in advance of due date
• RD staff assistance available for application process
• http://www.rurdev.usda.gov
Telemedicine in U.S.Multiple Federal Funding Resources
– USDA – Rural Development (RD) – Grants & Loans
• Distance Learning and Telemedicine (DLT) Program - $15 million
– Areas/towns up to 20,000 pop.
– 15% matching requirement
– Minimum grant award: $50,000; maximum: $500,000
– Purchase of computer hardware/software, computer network components, terminal equip., inside wiring, and inside equip. warranties
• Application is once a year (end of May/early June)
• Announced 60 days in advance of due date
• RD staff assistance available for application process
• http://www.rurdev.usda.gov
Telemedicine in U.S.Federal Funding Support - Kansas
USDA – Rural Development (RD) – CF Program
Onaga, KSArea: 410 acresPop: 707 (2012)
$5 million CF Direct Loan
Bundled variety of needs:
• EMR hardware/software in hosp. & clinics
• Renovations/enhancements to existing hospital
• Purchased diagnostic equipment
• Refinanced existing debt
USDA Rural Dev HIT Telehealth Program Funding Overview Webinar, April 2013, http://youtu.be/sPXfhyF6lgc
Telemedicine in U.S.Federal Funding Support - Kansas
USDA – Rural Development (RD) – CF Program
WHO: Great Plains Health Alliance, Inc.
WHAT: 24-Hospital NetworkWHERE: Phillipsburg, KS
$2.2 million bank loan guarantee
$3 million CF Direct Loan
Acted as borrower for hospital network:
• EHR hardware/software for 22 CAHs
• Enabled them to provide telemedicine services, virtual consults, diagnostic exams and imaging, and remote monitoring of patients.
USDA Rural Dev HIT Telehealth Program Funding Overview Webinar, April 2013, http://youtu.be/sPXfhyF6lgc
Telemedicine in U.S.Multiple Federal Funding Resources
– FCC – Broadband funding (Formerly Univ. Serv. RHC Program)
• Healthcare Connect Fund – Supports broadband connectivity and networks
– Provides 65% discount on broadband services, equipment, connectivity, construction, if shown to be most cost-effective
– Requires 35% contribution
• Started January 1, 2014
• Encourages use of consortiums
• KHA is leading initiative in Kansas
• FCC website: http://www.fcc.gov/health
Telemedicine in U.S.Multiple Federal Funding Resources
Eligible to participate in Healthcare Connect Fund– Public or not-for-profit hospitals, rural health clinics, community
health centers, health centers serving migrants, community mental health centers, local health departments or agencies, post-secondary educational institutions/teaching hospitals/medical schools, or a consortia of the above
– Non-rural HCPs may participate in Healthcare Connect Fund if they belong to a consortium that has a majority rural HCPs
– The largest HCPs (400 + patient beds) are eligible, but support is capped if non-rural.
Connectivity in Kansas Hospitals*
• 66% - Have videoconferencing equipment• 31% - Using telemedicine (2010)
– Daily 55%– Weekly 20%
• 23% - Receiving reimbursement for telemedicine (25% - Not sure)
• 50% used same equipment for education and training
* Kan-ed Telemedicine Capacity and Readiness Survey, KS Office of Edu. Innovation & Evaluation / Kan-ed , 2010
Connectivity in Kansas
• Internet access via Internet Service Provider (ISP) is available throughout Kansas
• ISP Internet connectivity is adequate for high-quality videoconferencing
• Multiple Internet-based videoconferencing services now available via ISP connectivity
Source: Kansas Board of Regents: Evaluating the Effects of Eliminating the Kan-ed Program, Legislative Post Audit Committee, Legislative Division of Post Audit, State of Kansas, January 2012.
http://[email protected]
1-877-643-HTRC (4872)