HHS Telemedicine Hack

Week 8: Office Hours #4— Clinical Best Practices

September 9, 2020

7Saving Lives. Protecting Americans.

• 10-week learning community to accelerate telemedicine implementation for ambulatory care providers

• Peer-to-peer learning

Case studies and discussion boards

Modeled after CMS-led learning collaboratives (e.g., Transforming Clinical Practice Initiative)

• Inclusive and diverse

All ambulatory care providers invited to participate

• Designed as 10-week sprint

Urgency due to public health need

Optimize telemedicine readiness in anticipation of fall COVID-19 surge

GOAL: At least 90% of participants will have conducted and billed 1 or more video-based

telemedicine visits by September 30, 2020

Welcome to Telemedicine (TM) Hack!

8Saving Lives. Protecting Americans.

“HHS Telemedicine Hack” Curriculum

Session #1: Telemedicine– Where Do I Start?

July 22nd, 12-1PM ET

Session #2: Workflows & Documentation

August 5th, 12-1PM ET

Session #3: Overview of Telehealth Billing & Reimbursement Policies

August 19th, 12-1PM ET

Session #4: Clinical Best Practices & the Art of the Tele-Physical Exam

September 2nd, 12-1PM ET

Session #5: The New Normal– Making Telemedicine Part of Your Permanent Practice

September 16th, 12-1PM ET

You are here

Office Hours # 1July 29th, 12-1PM ET

Office Hours # 2August 12th, 12-1PM ET

Office Hours # 3August 26th, 12-1PM ET

Office Hours # 4September 9th, 12-1PM ET

Office Hours # 5September 23rd, 12-1PM ET

GOALAt least 90% of participants will have conducted and billed 1 or more video-based telemedicine visits by

September 30, 2020

9Saving Lives. Protecting Americans.

“HHS Telemedicine Hack” Data Use

• Project ECHO® collects registration, participation, questions/answers, chat comments, and poll responses for this program

and shares this data with HHS/ASPR. Your individual data will be kept confidential. These data may be used for reports,

maps, communications, surveys, quality assurance, evaluation, research, and to inform new initiatives

10Saving Lives. Protecting Americans.

Logistics

• Use Q&A function on Zoom for questions and comments for speakers

• Use Chat function on Zoom for technical/logistical issues

• This session is being recorded. Your attendance is consent to be recorded.

• CME/Continuing Professional Development (CPD) credits—Link is in today’s Project ECHO email announcement and will also

be placed in the Chat at end of session.

11Saving Lives. Protecting Americans.

Today’s Agenda• Case #1: Innovative Telehealth Services at a Rural FQHC – Darrick Nelson, MD—Chief Medical Officer, Hidalgo Medical Services, Silver City,

NM (10 min)

Q&A Follow-up (5 min)

• Ask Our Panelists Your Clinical Best Practices Questions (35 min) – Moderated by Dr. Christian Ramers. Panelists are:

Darrick Nelson, MD—Chief Medical Officer, Hidalgo Medical Services, Silver City, NM

Dale Alverson, MD— Past ATA President, Professor Emeritus, University of New Mexico, Albuquerque, NM

Susan Kressly, MD, FAAP—American Academy of Pediatrics, Warrington, PA

Andrew Watson, MD, MLitt, FACS— Past ATA President, Assistant Professor of Surgery, UPMC, Pittsburgh, PA

Aileen Deogracias, OTR/L—Owner and Occupational Therapist, Therapy Works, PC, Lawrenceville, GA

Tina Gustin, DNP, CNS, RN—Assistant Professor, Director of the Center for Telehealth Innovation, Education, and Research, Old Dominion University, Norfolk, VA

Patrick Hawkins, DNP, ANP, NP-C— Adult Nephrology Nurse Practitioner, Kidney Disease and Hypertension Consultants, Flint, MI

Carolyn Rutledge, PhD, FNP-BC—Professor, Associate Chair of Nursing, Old Dominion University, Norfolk, VA

John Scott, MD, MSc – Professor of Medicine, Medical Director of Digital Health, UW Medicine, Seattle, WA

Kathy Wibberly, PhD—Director, Mid-Atlantic Telehealth Resource Center, Charlottesville, VA

Two TRC staff—Janine Gracy (Heartland TRC) and Elizabeth Krupinski (SWTRC)— will answer questions in Q&A box that are not posed to the panel.

12Saving Lives. Protecting Americans.

Case #1: Innovative Telehealth Services at a Rural

FQHC

Darrick Nelson, MD

Chief Medical Officer and Program Director

Hidalgo Medical Services

Silver City, NM

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CASE STUDY: Background

Population: Rural and Frontier, ~ 35k

population spread over 7,414 mi² (19,202

km²)

Services: FQHC, Primary Medical, Mental

Health, Dental and Family Support Services

and Family Medicine Residency Program

Telemedicine Before COVID: <5% of

Mental Health visits and 0% Medical visits

Telemedicine Now: 76% of Mental Health

visits and ~30% Medical visits

H i d a l g o M e d i c a l S e r v i c e s

My telemedicine lifehacks are…

1. Communicate often with patients about availability of telehealth visits

2. Find innovative ways to take advantage of telehealth technology

[MAPS OR PHOTOS of practice area]

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Impact of Billable Encounters

0

50

100

150

200

250

300

350

400

450

20-Jan 10-Mar 29-Apr 18-Jun 7-Aug 26-Sep

Billable

24% Decrease

Beginning 3/13/2020

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Weekly Telehealth Visits

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Safety in COVID-19

• Patients arriving at our clinics are screened for

influenza-like symptoms

If positive screen, patients are offered

telehealth visit from their car

If test is needed, patients tested from car

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Telehealth and + COVID-19

• If an HMS patient is positive for COVID-19

Patient is offered Telehealth visit within 24 hours

of positive test notification

A second Telehealth follow-up visit is offered for

4-7 days after first visit

Additional visits as necessary

Feedback from + patients early in the pandemic

indicated that after they were notified of + test, they felt

isolated and forgotten about

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Mental Health and Telehealth

0

50

100

150

200

250

300

350

400

450

500

3/25 3/30 4/6 4/13 4/20 4/27 5/4 5/11 5/18 5/25 6/1 6/8 6/15 6/22 6/29 7/6 7/13 7/20 7/27 8/3 8/10 8/17 8/24

Total

Face to Face

Televideo

Telephonic

Telephonic and Televideo visits account for 76% of Mental Health visits

19Saving Lives. Protecting Americans.

Innovative Telehealth Services (Pediatrics)

• Pediatrician working from home due to high risk of

morbidity or mortality

Children come in to clinic as usual

Medical Assistant rooms patient and connects

with Pediatrician via televideo

MA uses EKO digital stethoscope and

Pediatrician listens to heart and lungs remotely

MA uses Firefly Otoscope while pediatrician

conducts video exam

20Saving Lives. Protecting Americans.

Innovative Telehealth Services (Medication Assisted Treatment for Opioid Use

Disorder)

• Some stable patients receiving medication

assisted treatment (MAT), commonly called

“Suboxone” therapy, may benefit from telehealth

Decrease distant travel

Decrease undue risk of exposure

May increase compliance

Relapse and overdose rates are increasing!

https://www.ama-assn.org/system/files/2020-

08/issue-brief-increases-in-opioid-related-

overdose.pdf

21Saving Lives. Protecting Americans.

HMS Future and Telehealth

• We intend to expand patient access with telehealth

Offer after hour and weekend telehealth visits to our patients

Decrease unnecessary ER visits

Decrease costs to the healthcare system

Decrease unnecessary travel

Increase patient satisfaction

Improve quality of care

Commercial insurers already offer telehealth visits for their members in order to

satisfy the above points

Why not accomplish the same with the PCP?

22Saving Lives. Protecting Americans.

Your Telemedicine Questions,

Answered

Please submit your questions through the Q&A box

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TRAIN is Your One-Stop Shop for TM Hack Resources

• Visit www.train.org

Login if you have an account, or create an account if you don’t have one

• To access discussion boards, slides, and recordings

Click on “Your Profile” (under Your Name on the top right) to access the “Manage Groups” screen

Enter “TMHACK” under “Join by Group Code”

Save your profile and then click the Discussions tab

Click here for a TRAIN User Guide with step-by-step instructions

• Other TRAIN benefits

HHS training certificate, if you complete 8/10 TM Hack sessions

Access to other trainings, including COVID-19 resources

24Saving Lives. Protecting Americans.

TRAIN Discussion Boards

• Discussion Boards (n=11)

Slides, Recordings, and Session Materials

8 topical boards

Getting Started in Telemedicine (Week 1)

Workflows & Integration (Week 3)

Regulations, Compliance, and Documentation (Weeks 3 & 5)

Billing Policy, Coding, and Reimbursements (Week 5)

Scaling Up & Sustainability (Week 9)

Equitable Access

Miscellaneous

Technology

Specialty Connect

Telehealth Resource Centers (TRCs)

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TM Hack Updates

• Next week’s session (Week 9): “The New Normal: Tips to Make Telemedicine Part of Your Permanent Practice”

Didactic presented by a telehealth expert subject matter expert/internist from UW Medicine

Case presenters include: 1) Pediatric provider from a tribal healthcare facility in Anchorage, AK, and 2) Family medicine physician

assistant from an independent Rural Health Clinic in Shoshone, ID

• Week 10—Office Hours #5 (final TM Hack session)

26Saving Lives. Protecting Americans.

“HHS Telemedicine Hack” Curriculum

Session #1: Telemedicine– Where Do I Start?

July 22nd, 12-1PM ET

Session #2: Workflows & Documentation

August 5th, 12-1PM ET

Session #3: Overview of Telehealth Billing & Reimbursement Policies

August 19th, 12-1PM ET

Session #4: Clinical Best Practices & the Art of the Tele-Physical Exam

September 2nd, 12-1PM ET

Session #5: The New Normal– Making Telemedicine Part of Your Permanent Practice

September 16th, 12-1PM ET

You are here

Office Hours # 1July 29th, 12-1PM ET

Office Hours # 2August 12th, 12-1PM ET

Office Hours # 3August 26th, 12-1PM ET

Office Hours # 4September 9th, 12-1PM ET

Office Hours # 5September 23rd, 12-1PM ET

GOALAt least 90% of participants will have conducted and billed 1 or more video-based telemedicine visits by

September 30, 2020

27Saving Lives. Protecting Americans.

Pay It Forward

tmhack@hhs.gov

(Use this email to

reach TM Hack

organizers directly)

28Saving Lives. Protecting Americans.

TRC Picks—Frequently Used Telehealth Resources

• Telehealth COVID-19 Policies—Federal and State

• State Medicaid Telehealth Policies

• How to Select Technology–TTAC Tool Kits

• What to Expect in a Telehealth Visit (for patients)

• Telehealth Implementation Checklist

• FDA Medical Devices Fact Sheet