Rural Telemental Health in the Great Lakes Region€¦ · Rural Telemental Health in the Great...
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Rural Telemental Health in the Great Lakes Region Jonathan Neufeld, PhD Upper Midwest Telehealth Resource Center
Transcript of Rural Telemental Health in the Great Lakes Region€¦ · Rural Telemental Health in the Great...
Rural Telemental Health in the Great Lakes Region
Jonathan Neufeld, PhDUpper Midwest Telehealth Resource Center
Challenges Faced by Rural Mental Health Providers
Financing Changes
Regulatory Changes
Meaningful Use, EMRs, HIEs
ACOs, PCMHs
New Technologies
Health Care Land Grab
Indiana Rural Health Association
These are our core members– Critical Access Hospitals
– Rural Disproportionate Share Hospitals
– Rural Health Clinics
– Other rural health providers
Strong affiliations with– Community Mental Health Centers
– Community Health Clinics
– Indiana Hospital Association
Telemental Health Outreach Program
Thesis: Given the right equipment and good training, some rural providers could use telehealth to meet some of their goals
– Increase access to MH services
– Improve service quality
– Control costs
Outreach Program
3 years (May '09 – Apr '12), $375,000 total Salaries:
− ~1.0 FTE (2 half-time positions) Telemedicine Equipment Travel & Training No Clinical Services
How it Worked
Grant assembled, equipped, and trained a network of rural telehealth providers
− Equipment – purchased and installed− Support – training in TM best practices− Recruiting – facilitated contracts between sites
“Peer” sites used the network to better meet the mental health needs of their rural clients
Peer sites were financially self-sustaining; IRHA provided equipment on “perpetual loan” basis
Right Things in the Right Order
● Leadership is Critical● Business Model First● Committed & Talented
People Second● Relationships Third● Procedures and
Technology to fill
Equipment
Supplied by Site:
- Internet (>1 Mbps)
- Room
- Staff
Traditional Telemedicine
Hub and Spoke Model
Providers at the hub
Patients at the spoke
Spoke receives services
Hub receives payment
Examples: Specialty Consults, Emergency Evaluations in ED
Med Ctr
Site
Site
SiteSite
Site
Site
Peer-to-Peer Telemedicine
Peer-to-Peer Model
Clinicians anywhere
Patients anywhere
Patient site bills, receives payment
Clinician gets paid by patient site (as an employee or contractor)
CLINIC
CMHC
OFFICE
Possible Business Models
Direct billing for specialty care, outreach– Payers reimburse for most services
– Increased referrals into core business lines
Contracting for remote services– Recruit needed skills from outside local region
Cost avoidance, efficiency improvement– Reduce travel or costly events
– Leverage greater efficiency
Example 1: Direct Billing & Outreach
Bloomington Meadows Psychiatric Hospital (Private Mental Hospital, Bloomington)
Offered psychiatric evaluations at rural hospital emergency departments
Once providers were credentialed at local site, they could bill for evaluation services on site
Increased referrals for inpatient and outpatient services (core business)
Example 2: Remote Services
Recruited and contracted for psychiatric providers outside their local area
– Carey Services (RHC in Marion)• MD and NP in Indianapolis
– Oaklawn Psychiatric Center (CMHC in Elkhart and South Bend)
• MDs in Chicago (2) and California (1)
• Self-funded expansion to 2 additional sites
• Continuing to expand
Example 3: Optimization
Otis R. Bowen Center (CMHC in Warsaw)
Problem: No-shows in high-expense services in remote areas
Solution: Telemedicine visits and Open Scheduling
Results: Significant improvement in service efficiency
Unexpected Development: Patients voluntarily drive further for Open TM Clinics
Bowen Center Efficiency
NP 1 NP 20%
20%
40%
60%
80%
100%
120%
61%
84%83%
112%
Non-TMTM
Tim
e c
on
ve
rte
d t
o b
illa
ble
se
rvic
es
Psychiatric NPs were able to increase their billable hours in TM clinics compared to traditional in-person clinics by about 30%.
Telemental Health Services
Nov '09 Feb '10 May '10 Aug '10 Nov '10 Feb '11 May '11 Aug '11 Nov '11 Feb '120
50
100
150
200
250
300
Oaklawn
WindRose
Reid
Four County
Carey Services
Centerstone
Bloomington Meadows
Osman & Associates
Bowen Center
Networks Built
Organizations: 9
Sites:– Hospitals: 4
– Clinics: 4
– CMHCs: 14
– Offices: 7
– LTC: 8
– TOTAL: 37
Upper Midwest Telehealth Resource Center
● Expand across region● Connect/Empower rural providers to support
each other● Provide Training and Research to support TM● Same enthusiasm and ideas
– no equipment money
Medicaid TM Service Costs
2007 2008 2009 2010 2011 2012$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
Indiana Medicaid Telemedicine Paid Claims
MCOHIPFFS
Regional Variation
Out-of-state Consulting Telemedicine Medicaid Pay Commercial Pay Other Factors
Ohio Allowed on a “non-frequent” basis
Board may issue TM certificate
No coverage (see exception in Other Factors)
No law Telepsychiatry allowed and paid under certain conditions
Indiana Allowed; outside docs can provide second opinions
Restricts “regular, routine, non-episodic” telemedicine (?)
Paid as FFS only; 20-mile separation
No law; varies
Illinois Emergency practice and out-of-state consults allowed
IL license required
FFS or Encounter Rate
No law; varies
Michigan Allowed in exceptional circumstances, when requested by MI doc, when traveling in MI
No specific TM provisions
50-mile separation
Mandated Equivalent Coverage (effective 1/1/2013)
In-state providers used whenever possible for Medicaid enrollees
Contact Info - Questions
Jonathan Neufeld, PhD
Clinical Director
Becky Sanders
Project Director
Telehealthresourcecenters.org
