National Conference of State Legislators Transforming Health Care Through Technology

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1 National Conference of State Legislators Transforming Health Care Through Technology Nina M. Antoniotti,, RN, MBA, PhD Marshfield Clinic TeleHealth Thursday, April 13, 2011 Washington, D.C.

2 MARSHFIELD CLINIC SERVICE AREA

3 Mission of Provider TeleHealth To improve access to specialty and primary services for populations with unmet needs by reducing the burden of time and distance for the patient; To improve organizational efficiency and effectiveness through reductions in costs of providing care; and To improve provider access and communications with patients at a distance

4 TELEHEALTH Extends high quality, advanced health care electronically to situations in which the physical presence of a provider or consumer is not feasible, practical or is unnecessary.

5 Mission of Consumer TeleHealth To be patient-centric To reduce the burden of access To reduce out of pocket costs To assist with changing health behaviors To collaborate with primary care

6 TeleHealth is a tool for improving access and attaining quality metrics that influence and change population health care beliefs and behaviors.

7 Base TeleHealth On.. Health Care Provider Employer Payers Health Care Patient and Family Relationships

8 Marshfield Clinic TH Services Allergy Audiology Burn Care Cardiology Cardiovascular Surgery Child Psychiatry Concussion Clinics Dentistry Dermatology Diabetes Management Disease Management Endocrinology ENT Geriatrics Infectious Diseases Jail Primary Care Medical Genetics Nephrology Mobile Retinal Screening Neurology Seizure, Parkinson, General Nurse Triage Nutrition Services Obstetrics Oncology Orthopedics Ophthalmology Pain Management Pathology Pediatric Nutrition Pediatric Endocrinology Pediatric Nephrology Pediatric Neurology Pharmacy Plastic Surgery Primary Care Psychiatry Pulmonary Medicine Research Studies Skilled Care Sleep Studies Speech Pathology Social Worker Therapy Support Groups Urology Wound Therapy

9 Where is TeleHealth? Physician Offices/Rural Centers Indian Health Centers Hospitals Skilled Nursing Facilities Head Start Centers

10 Clinician Offices Hospitals, SNFs, Outpatient Centers Clinics

11 Clinical Exam Technologies Patient Exam Camera Digital Electronic Stethoscope Fiber-optic Otoscope Fiber-optic Ophthalmoscope Digital Camera Document Camera Intra-oral Camera Laser Caries Detector Computer or No-Computer??

12 TelePathology Form-based patient symptom and medical history data capture Video and still digital cameras Remote controlled microscope with remote slide viewing Digital Microscope Microscope slide scanner Internet connections

13 Mobile Retinal Screening Non-Mydriatic Fundus Camera Digital Image Capture Network Archived Similar to PACS Read by Centrally Located Retinal Surgeon

14 TeleStroke Systems

15 Sterile Products Pharmacy 15

16 Retail Pharmacy MERCER MINOCQUA 16

17 ICAA Head Start Oral Health Needs of Children and TeleHealth

18 Marshfield Clinic Research Foundation National Farm Medicine Center Biomedical Informatics Research Center National Children s s Center North American Guidelines for Childrens Agricultural Tasks (NAGCA) Epidemiology Research Center Center for Human Genetics Personalized Medicine Marshfield Clinic Education Foundation

19 Barriers to Telemedicine Physicians Lack of reimbursement Lack of organizational readiness good business plan Broadband costs for private practices Technology costs internal infrastructure Lack of standards Lack of Venture Capital and reasonable transmission costs Patients Lack of access through TeleHealth Lack of awareness 19

20 Medicare and Medicaid: What Needs to be Done? 1. Make all services currently covered by Medicare eligible for payment if delivered by TeleHealth. 2. Make all Medicare certified practitioners eligible for payment. 3. Make all Medicare certified facilities eligible for the Medicare facility fee payment. 4. Delink the facility fee from the practitioner s payment. 5. Put TeleHealth technology costs on the cost reports as allowable costs. 6. Allow TeleHealth visits in the PPS calculations for home health. 7. Pay for episodes of remote monitoring when used as a part of a comprehensive health team approach to chronic conditions.

21 How can the Federal Government be used to spur broadband investment in telemedicine? Continue to fund service grants broadband is infrastructure, not service Continue to fund USAC and increase funding levels Develop incentives for carriers to build out the last mile perhaps under USAC Change the NTIA, RUS, BTOP, and TOPS programs to be more service oriented Include Urban populations in funding programs Fix the rural definition problem!!!!!!!!!!!!!!!!! Health care reform must include TeleHealth provisions No reimbursement or other barriers to access to care through TeleHealth

22 Rural Health Care Division USAC What Can the State Legislators Do for TeleHealth?

23 Federal Communications Commission Proposed Changes to the Rural Health Care Division, USAC WC Docket Proceeding No Proposed Changes often Put the Clinicians and the Carriers on Opposite Sides

24 1) Health Care Broadband Infrastructure Program Marshfield Clinic TeleHealth believes that diverting funds from the current health care program which supports the deployment of telecommunications equipment for the purposes of direct patient care, improvement of access to health care services, and the reduction in the burden of illness and disease of remote and disparate populations SHOULD NOT be part of the new guidelines for use of funds under the Rural Health Care Program. Example: FCC Pilot Program Question: What happens to excess capacity?

25 2. Rural Health Care Primary Program (RHCD Support Program) Valuable, critical program for most organizations lifeline for many Works well, streamlined application, helpline support staff Expansion of the Primary RHCD program is the most valuable use of funds Increase # of applicants through pro-spective assistance from carriers Expand Eligible Health Care Entities SNF, Dialysis Centers, School-based Clinics, Community-based Residential Facilities, CBRFs,, Head Start Clinics, rural dental centers, county jails, public health offices, free standing emergency departments, emergency transportation services offices, data warehouses that are a part of a larger health care delivery system (not HIEs) Ensure that all Medicare, Medicaid, and underserved populations have access to health care through broadband support

26 (con t) Definition of Rural and Grandfathering Conditions Adopt a consistent and legitimate definition of rural that does not significantly impede rural health care providers from receiving support under RHCD for broadband access. Go back to USDA grandfathering provisions due to expire this year and use definitions of rural that are based on population of actual community and not proximity to urban areas.

27 (con t) Changes in Support Calculation Marshfield Clinic DOES NOT SUPPORT any new calculation strategies that reduce support. The 50% calculation would significantly reduce Marshfield Clinic s s support.

28 3) Health Broadband Services Program Agree to rename Internet Access Fund to the Health Care Broadband Access Fund Increase support to 50% for an eligible rural health care provider s s monthly recurring internet costs Include any advanced telecommunications platforms that provide point-to to-point access to broadband (cellular, mobile, satellite) Analyze low utilization before making any changes that reduce or divert funding NO MINIMUM BANDWIDTH REQUIREMENTS NO MINIMUM SPEED REQUIREMENTS

29 (con ) Do not support requirement for lowest bidder No requirement for evergreen status of contracts

30 4) Data Gathering and Performance Measures Support requirements for formal performance measures for participants in all of the proposed programs in the proposed changes with the exception of the Infrastructure Program (Marshfield Clinic does not support this program)

31 Thank you! Nina M. Antoniotti, RN, MBA, Ph.D. Director, Marshfield TeleHealth g

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