Building Sustainable Telemedicine Programs: a How-to Guide

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Patrick Chester Rose
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1 Building Sustainable Telemedicine Programs: a How-to Guide

2 First, some results Missouri Case Study 9000 Total Patient Visits on 1DocWay 180 Weekly Appointments Created /8/2011 8/8/2012 8/8/ /5/ /5/ /5/2013 2

3 Model design lies at the core of sustainability Hub and spoke setup allows for maximum benefit Rural Health Clinic Critical Access Hospital Community Mental Health Center Military Base PCP s Office Skilled Nursing Facility FQHC 3

4 Missouri Case Study: Sustainability metrics all around Hub Hospitals: 256% ROI $300k new revenue Physicians: Stable hourly income 1DocWay Spoke Sites: Avg $21/hr profit 80% reduction in ED hold times Patients: 6 wk wait to 2 wks 130 fewer miles driven per appt 3 4

5 The right program creates positive incentives for all stakeholders Hospitals: Build brand and referral base Expand reach of services Strengthen relationships with nearby communities Increase revenue Reduce readmissions 35,000+ Underserved care facilities: Increase access to specialist docs Improve community health and wellness Receive enhanced reimbursement through telemed bonuses ,000+ Physicians: Improve lifestyle working at home Expand scheduling flexibility Increase patient pool and revenue Deliver better care to underserved patients, more consistently 1DocWay 80 Million+ Patients: Access higher quality care Control chronic illnesses better by seeing physicians more easily Prevent escalation of illnesses by seeing physicians sooner 3 5

6 1 Hub providers can expand reach, revenue, and manage patients better The delivery of reimbursable telepsychiatry services means Rural Health Clinic Critical Access Hospital Community Mental Health Center Military Base PCP s Office Skilled Nursing Facility FQHC 6

7 2 Spokes increase usage 47% Year-to-Year Monthly hours booked per spoke site Sampling of spoke clinic hours booked per month First Month Present Volume Growth (Monthly) H Group % HSC % Hannibal % % YoY H Group Carbondale % MO Highlands % UCC % Lafayette % 5.00 PFH % Comp Connections % SEMOBH % 7

8 3 85% of all visits are follow ups Patients average 4 visits during treatment Patient accounts by # of appointments made on 1DocWay Total appointments by sequence of visit 4% 1% 0% 7% 3% 15% 9% 15% 44% 42% 20% 40% Number of appointments per patient account: X th appointment 1st 2nd - 5th 6th - 10th 8 11th - 15th 16th - 20th 21st+

9 4 Doctors increase usage 11% month over month Monthly appointment growth per physician 11% Physicians typically start small with our platform, and continue to add hours as they realize the benefits: Guaranteed pay Working from home Flexible hours Incremental revenue

10 The right business model is required to capture the benefits of telepsychiatry Improve Patient Access to Behavioral Health Services Deliver Clinical Benefits Create a Continuity of Mental Health Care for Patients 4 Create New Revenues and Profit Streams for your Organization 10

11 1 Improve Patient Access to Behavioral Health Services By implementing telemedicine services patients save hours of driving time and gas money Take advantage of a full complement of specialists in a given field: Child and Adolescent Geriatric Addiction 11

12 2 Numerous Clinical benefits Whole System Demonstrator Program, Headline Findings December 2011 (UK): Lowers spending on chronically ill by 13% 45% reduction in mortality rates 20% reduction in ED visits 14% reduction in bed days 14% reduction in elective procedures Ontario Telehealth Network Report (May 2012): % decrease in hospital admissions 72 74% reduction in emergency department visits 16 33% decrease in number of PCP visits 95 97% reduction in walk-in clinic visits High levels of patient and provider satisfaction VA Telehealth Study: 25% reduction in bed days 19% reduction in hospital admissions 56% total utilization reduction for depression Eliminated co-pays for telemedicine sessions Targeted over 200,000 telemed encounters for 2012 Proposed nationwide telemed licensure for VA doctors 12

13 2 Telepsychiatry is just as safe and effective as in-person consultations The Effectiveness of Telemental Health Applications (TMH): A Review Hailey D, Roine R, Ohinmaa A Canadian Journal of Psych; Nov 2008 A review of 65 studies found that in 83% of studies, TMH was judged to have been successful. There was evidence of success with TMH in the areas of child psychiatry, depression, dementia, schizophrenia, suicide prevention, posttraumatic stress, panic disorders, substance abuse, eating disorders, and smoking prevention. Feasibility, acceptability, and sustainability of telepsychiatry for children and adolescents Myers K, Valentine J, Melzer S Psychiatric Services, Nov2007 Telepsychiatry is a feasible and acceptable approach to providing psychiatric services to youths. Is telepsychiatry equivalent to faceto-face psychiatry? O Reilly R, Bishop J, et al Psychiatric Services, Jun 2007 Telepsychiatry produced clinical outcomes that were equivalent to those achieved when the service was provided face to face. 13

14 Soup-to-nuts implementation How we create a marketplace for care: Create supply Source demand Set program in motion Encourage repetition Sell to a hospital or doctor who can benefit by expanding reach and increasing referrals on 1DocWay.com: Limited training, simple interface, no complexity Connect spoke underserved facilities and patients needing access to specialist care with hub hospital/doc on 1DocWay Set in place a regular pattern for usage, identifying doctors and creating dedicated weekly telemed time commitments Create yearlong hub-spoke partnerships AND Measure hospital ROI by tracking inpatient referrals 14

15 3 Increasing access creates revenue and improves continuity Care facilities are reimbursed for care delivered Hospitals receive new referrals through partnership

16 4 Create New Revenue and Profit Streams In addition to the CPT code, you can bill and receive an originating site fee per patient session $24.42 from Medicare Up to $25 from Medicaid programs 16

17 Requirements Needed to Setup a Program Credentialing Licensure Reassigning Benefits Clinical 17

18 For more information or to request a free consultation Samir@1DocWay.com Call:

19 Appendix The 1DocWay Telepsychiatry System 19

20 Telepsychiatry technology is now inexpensive and easy to use Just need a computer, webcam, and high-speed wired internet connection 20

21 1DocWay brings the psychiatrist s office online A marketplace connecting hospitals with underserved care facilities Secure video chat Turnkey implementation Appointment scheduling HIPAA compliance Patient notes Emphasis on ease of use 21

22 and adds efficiency by integrating scheduling, patient notes, and workflows Patient notes Scheduling EHR E-prescribe Labs 22

23 Why some clinics are still hesitant, and why you shouldn t be Reimbursement is too low or nonexistent, ROI is unproven Current technology is expensive and burdensome Telemedicine is not comparable to in-person consultations 23

Avenues for Expanding Telehealth for Mental Health Services

Avenues for Expanding Telehealth for Mental Health Services September 17, 2013 During 2012, Dr. Karen Rheuban, President of the Virginia Telehealth Network, addressed the Healthy Living/Health Services