Stewart Levy –

President - Health Promotion

Solutions

Keys to Health Center Success

June Conference

1

Agenda

• Introduction

• Definitions - Telehealth, Telemedicine, Telepresence

• Benefits to Healthcare System

• Telehealth funding and initiatives in Government

• FQHC Case Studies

• State Regulatory and Reimbursement

• Opportunities for FQHC

• Examples of various Telehealth Systems

• Questions and Answers

2

Health Promotion Solutions - Introduction

Description - Consulting and service provider

focused on evidence – based health and disease

management solutions

Clients - Government agencies, non-profit

groups, employers, retailers, academic

organizations, Insurance companies, and clinics

Disclosure Statement

3

Telehealth – Technology is Here Today

According to American Telemedicine Association :

Term “Telehealth” is used interchangeable with

“Telemedicine” however telehealth does not need

to involve clinical services :

- General Patient education

- Mobile health apps

- Non Clinical staff – Telephonic Health coaching

- Includes Phone , Fax, Email / Messaging,

PACS, EHR Video, Medical device telemetry,

Web conferencing, SMS Text

5

“Telemedicine”– Delivery of Clinical

Healthcare Services with Practitioner

Telepresence

• Telepresence refers to various

technologies which allow a person to

feel as if they were present, or to have

an effect at a place other than their true

location.

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Telepresence

8

Clinical Uses of Telehealth

Technologies 1) *Transmission of medical images for diagnosis (Store and forward )

2) *Individuals exchanging health services or education live via

videoconference (Teleservice or Video / Phone telehealth)

3) *Transmission of medical data for diagnosis or disease management

(Referred to as Telehome or home monitoring)

4) Prevention of disease and health promotion ( Health coaching )

5) Health advice by telephone (Referred to as teletriage)

* Telemedicine Services

9

Benefits of Telehealth • Reduce Travel Time to clinic visits

• Staffing efficiencies

• Reduce delays in treatment

• Reduction in medical costs

• Direct - staff , clinic

• Indirect – unnecessary ER visits

• Access rural and urban locations

• Access to multiple specialties

• Consumer education

• Improvement in quality of care

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• 23% of ER visits for those under age 15 were:*

– Upper Respiratory

– Fever with no other complications

– Sore throat

– Ear ache

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Emergency room use nationally

• 65% of ER visits occur after business hours*

Total cost of unnecessary urgent care and ER visits is

$31 billion per year

• 45% of ER visits were not classified as immediate,

emergent or urgent at triage*

National Hospital Ambulatory Care Survey published by the CDC

Americans support the US of Telehealth

Online survey of 1,000 consumers was commissioned by the Health Research Institute unit of Price Waterhouse Coopers in Sep 2012

• 55% of consumers believe that universal health insurance coverage will not ensure equal access to care

• Nearly 75% of U.S. consumers say they would use telemedicine, defined as remote monitoring to track their condition and vital signs

• 50% of consumers would be willing to seek care through computer technology as a substitute for face-to-face, non-emergency visits

.

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Telehealth Technology

Acceptance in Rural Populations

Sample of 199 patients in a Federally Qualified Health Center (FQHC) in the rural South

• Purpose -investigate access to technologies, comfort with

technologies, and willingness to participate in clinical interventions among rural populations.

• Access to technologies among this underserved group was remarkably high (near or above 50%) for all technologies.

• Conclusion -access to and comfort with technologies is strong among highly underserved patients.

• lHealth and Technology Volume 1, Issue 2-4 , pp 99-105

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US Growth of Telemedicine

• According to Information Week research

– PPACA catalyst for accelerated growth

2012 – 14 billion → 2016 27 billion

“Telehome” market ( growing from 30% - 35%)

growing faster than “teleservice” market

(70%- 65% )

Government Use and Funding

• Grants - Available through 8 federal programs. 33% is from

research contracts with the U.S Department of Defense.

• Direct Services – VHA is largest provider of remote

medical services, projected to deliver over 350,000 patients

– Department of Defense, Indian Health Service and

Bureau of Prisons in the Department of Justice.

• Military Use – Triage and field mobile health clinics

• Medicare – Reimbursement for telehealth and remote care

• Center of Medicare and Medicaid Innovation - projects

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Government Projects Center for Medicare and Medicaid Innovation

1) Care for intensive care remotely from specialists

2) Patient based home telehealth monitoring

3) Indian Health Services – stroke and behavioral health

4) Use of non medical and non specialized providers

5) Gov’t promoting hospital initiatives – Accountable care

organizations

Medicare - Approved Originating Sites

( Where eligible patients are located)

• Offices of Practitioners

• Hospitals

• Critical Access Hospitals

• Rural Health Clinics

• Federally Qualified Health Centers

• Hospital based or CAH based Renal Dialysis

• Skilled Nursing Facilities

• Community Mental Health Centers

Medicare – Approved Distant Site locations

(Where practitioner is located)

• Physicians;

• Nurse practitioners (NP)

• Physician assistants (PA)

• Nurse midwives;

• Clinical nurse specialists (CNS)

• Clinical psychologists (CP) and clinical social

• Registered dietitians or nutrition professionals

18

Results from VA

Northwest Health Network

• $742,000 cost savings by utilizing telemedicine

to provide 23,580 remote consultations

• Utilized store forward and videoconferencing

with trans-disciplinary network

• Reduction in travel costs in rural areas

• Improved the quality care due to issues

surrounding PTSD stigma

Military Study 2009 • 25% reduction in bed days and 19% reduction in

admissions for military telemedicine

Results from Rural FQHC Study - Practice based vs. telemedicine in collaborative

care model for depression in rural FQHC.

• 2007 – 2009 364 patients screened for depression

• Measure response, remission, change in depression

severity

1) Clinic – onsite primary care and nurse care manager

2) Telemedicine - Onsite primary care, and offsite team

of nurse, pharmacist, psychologist, and psychiatrist

FQHC Study Results

• Contracting with offsite telemedicine-

based collaborative care team showed

significant improvement . Potential to

yield better outcomes than traditional

practice based care with clinic staff

Georgia Partnership for Telehealth

FQHC - Case studies

• The Georgia Partnership for Health (GPT)

network includes 201 statewide access points

• Includes healthcare providers, health plans,

schools, rural health centers, nursing homes,

group practices, hospitals, community mental

health centers, and Prisons

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Georgia Partnership for Telehealth

• Year 1 – Payers provided reimbursement

for telemedicine the same as an office visit

• 160 physicians in 40 specialties participate

most utilized specialty being psychiatry.

• In 2010, the GPT facilitated 31,000

encounters - 11,000 were store-and-forward

consults, with the remainder comprising

real-time visits.

Challenges of Wide-scale

Telemedicine Adoption

• State Regulatory Laws

• Scalability

• Bandwidth Data Platforms

• Security

• Provider training and certification

• Interfacing with other multiple applications

25

State Provisions

• State is responsible for assuring access and covering

face-to-face visits/examinations by these “recognized”

practitioners/providers in those parts of the state where

telemedicine is not available or limited.

• The general Medicaid requirements of

comparability, statewideness and freedom of choice

do not apply with regard to telemedicine services.

Telemedicine State Regulations

14 states allow for first patient visit physician examinations to take place electronically

• California New Mexico

• Hawaii North Carolina

• Kansas Pennsylvania

• Louisiana South Dakota

• Maryland Texas

• Ohio Vermont

• Nevada Virginia

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Current Medicaid Reimbursement for Telemedicine

Medicaid Reimbursement

• Originating Site – Facility Fee

• Practitioner – Distant Site

• 35 states offer some reimbursement

• States may select from a variety of

HCPCS codes (T1014 and Q3014),

CPT codes and modifiers (GT, U1-UD)

in order to identify, track and reimburse

for telemedicine services

Telemedicine State Coverage

• States have the option/flexibility to determine whether

(or not) to cover telemedicine

• Types of telemedicine to cover;

• Where in the state it can be covered;

• How it is provided/covered;

• Types of telemedicine practitioners/providers may be

covered/reimbursed, as long as such

practitioners/providers are “recognized” and qualified

• How much to reimburse for telemedicine services, as

long as payments do not exceed Federal Upper Limits.

New legislation Dec 2012

Mike Thompson introduced legislation

• To promote and expand the application

of telehealth under Medicare and other

Federal health care programs, and for

other purposes by eliminating in state

licensure requirements and support

reimbursement measures

Review of Various Telehealth

Products and Services

• Teladoc

• Health Spot

• Optimized Care Network

• Home Monitoring / Personal Body Devices

All

Teleadoc results – Employer and

Cash pay Telehealth provider

4 million users

*Based on Teladoc reporting and member surveys

97% Member Satisfaction

97% Physician Satisfaction

10min Avg. Consult Duration

0 Malpractice Claims

22min Avg. Response Time

91% Patient Issues Resolved

Health Spot -

The walk-in kiosk has

integrated medical

devices and is staffed

by an attendant.

Inside, patients receive

care from

practitioners over real-

time interactive

videoconferences.

34

The Care4 Station Patient entry

35

Medical Assistant - Attendant • Always present

• Facilitates:

– Check-in / ID validation

– Sanitization

– Patient assistance

Additional capabilities

based on attendant

certification

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HIPAA/Terms of Service

Acceptance

Name and contact info

Payment / Insurance

Symptoms

Current medications

Existing conditions

Allergies

37

Patient Check in Process

The Care4 Station patient steps inside Floor View

38

Vitals Check

Weight Temperature

Blood Pressure Summary

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Technology

Pulse Oximeter Otoscope

Stethoscope Dermascope

40

Physician Portal

Displays patient

summary

Device controls in

kiosk

Image capture

Dictation

E-prescriptions and

EMR integration in

development

41

• Printed patient

summary

• EMR record

• Access records

online

Post-appointment and follow-up

42

Conditions Treated

– Colds & Flu

– Eye Conditions

– Skin Conditions

– Sinus Infections

– Earaches

– Sore Throats

– Depression/Anxiety

– Bronchitis

– URI

– Wellness check ups

– Blood pressure checks

– Diabetes Monitoring

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• Preference over urgent care or ER: 98%

• Would use Care4 Station again: 95.5%

• Patient age range: 24 – 89

Health Spot Utilization and Empowered Patient Care

45

Public

Housing ?

Clinic ?

Health Spot Video

•

http://www.youtube.com/watch?v=J4BQ

cAKkVa4

Optimized Care Network

The OCN is a non profit, health care provider

network, consulting, and service organization to

support effective telehealth solutions including

- HealthSpot Station

- Home monitoring

- Telepresence Offices

- Other

.

47

OCN Trans-disciplinary

Telehealth Providers

• Primary Care Doctors

• Pharmacists

• Behavioral Health Coaches

• Dieticians

• Nutritionists

• Specialists

48

Optimized Care – Telepresence

Optimized Care Network

http://www.youtube.com/watch?v=YVz7

bKbeXVE&sns=em

Home telehealth monitoring

Home Monitoring

Telemedicine Devices • Blood Pressure

• EKG

• Pulse

• Weight

• Glucose

• Prothrombin time

• Blood Oxygen

• Spirometry

Summary

• Trends of exponential growth with health care reform

• Telehealth has been established with proven results

– Efficiencies , Cost reduction and improved care

• Already being used by Community Health Centers

• Flexible types of models

• Easy to implement

• Barriers becoming minimal or no longer exist

• Tie into CHC efforts with patients and community

• Consumers accept technology and find empowering

• Funding available

Questions