CMSA-SCC Presentation June 18, By Dr. Stefany Almaden

Transcription

1 CMSA-SCC Presentation June 18, 2015 By Dr. Stefany Almaden

2 Understand historical overview & the passing of ACA Understand the impact of ACA on Telehealth Learn about application of Telehealth in Care Management Understand telehealth impact on Nursing Education & practice Q & A s

3 A doctor who communicates with her patients more can influence the patients better and give them better guidance... There appears to be no better way than telehealth to improve communications with patients." Shahid Shah, CEO, Netspective

4 Anti-trust Laws: Sherman Act: 1890 Clayton Act (1914) Stark Law (1989): I: Lab services II: 1993 expanded conflict of interest services Affordable Care Act (ACA): 2010

5 Federal Trade Commission (FTC): FTC role (Monitor & enforce anti-trust laws ) Sherman Act (1890) vs. power monopoly Clayton Act (1914) prohibitions related to mergers & acquisitions Stark Law: Stark Law I (1989)- Lab services Stark Law II (1993)- Expanded Prohibition to include HH, SNF, Rehab, Radiation etc.

6 March 23, 2010 ACA was passed Sep. 23, 2010: Medicare self-referral disclosure protocol (SRDP) was published on pursuant to Section 6409(a) of the ACA: Ongoing debate re: conflict with Anti-Trust Laws Process for service providers and suppliers to self-disclose actual or potential violations of the physician self-referral statute. ACA & Telehealth Connection

7 AB 415The telehealth Advancement Act of 2011 Signed into law on Jan 1 st, 2012 by Governor J. Brown Updating legal definitions of telehealth, streamlining the approval process for services delivered via telehealth venues, and expanding telehealth services in CA (Senator Logue with Bipartisan support). Older term of telemedicine was replaced by telehealth under AB 415 Expanded the use of store-and-forward technologies that connects primary care providers (PCPs) and medical specialists via secure high-speed, high-definition communications to speed-up treatment without patient s travel or to provide disease-specific education for primary care ---mainly used by Opthalmology, radiology, dentistry, dermatology, & pathology

8 1. Different venues for care delivery through the use of technology 2. Options include: a. Communication between clinicians, patients, and caregivers b. Communications between primary and specialty care as well as payers, TPAs, & Regulators c. Technology to treat or diagnose d. Far-reaching technology (Remote/Rural access challenges)

9 Golden Age of Ambulatory Care (Swan & Haas, 2011). Improving Access and Value of health services (Adler et al., 2014) Closing Care gaps: Remote Rural areas ED/ER visits (off-hours) Behavioral Health (BH) /access to BH providers Home health (HH) tele-monitoring Cross-state lines health and Licensure

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11 Role Traditional Under ACA Primary Care Case Management Care delivery in clinics, hospitals, LTACs, or SNFs Hospital/SNF/IPA/ HH/Field (WC) setting- snapshot in time encounter Care across the continuum is integrated with BH, HH, EOL, & LTSS Complex Care CM Population Health CM role CCM & APNs roles Behavioral Health Parallel track Integrated medical & BH & LTSS Risk Adjustments Fragmented, missed CCs & $s Captured HCC / RAF

12 On May 5, 2011, the Centers for Medicare and Medicaid Services (CMS) released its final rule that makes changes to CMS s Conditions of Participation (CoPs) as they pertain to the credentialing and privileging of telehealth providers. The final rule permits both hospitals and critical access hospitals (CAHs) to utilize a new process to credential and privilege telehealth providers Online prescribing policies vary across the states. Malpractice liabilities remain unchartered waters _

13 Nursing Practice Nursing Education: oinformatics/analytics (Reporting) osoftware design/purchase decisions Multi-State-Licensure

14 BH integration in primary care Improving outreach & Chronic Care Management Performing better, on-time & on-demand assessment at the point of care Promoting access to care in homes and communitybased living Providing 24/7 access to care plans Creating a network of providers that share the same values Decision-making re: software and analytics to facilitate care, decision-making, and care - outcomes

15 Clinicians Engagement in Medical Law & Ethics Embracing Telehealth Advocacy for quality care that provide access and value to patients Investing in the future of the health care workforce and service to community & society Demanding educational system that is tailored to current and future health care delivery for: Delivery & hands-on care (Practice) Reporting & decision-making (Management & Leadership)

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17 Adler-Milstein, J., Kvedar, J., and Bates, D.W. (2014). Telehealth among US hospitals: Several factors, including state reimbursement and licensure policies, influence adoption. Health Affairs, 33(2), Baker, L.C., Johnson, S.J., Macaulay, D., and Birnbaum, H. (2011). Integrated telehealth and care Management program for Medicare beneficiaries with chronic disease linked to savings. Health Affairs, 30(9), Bao, Y., Casalino, L.P., and Pincus, H.A. (2013). Behavioral health and health care reform models: Patient- centered medical home, health home, and accountable care organization. The Journal of Behavioral Health Services & Research, 40(1), Buckley, K.M., Tran, B.Q., and Prandoni, C.M. (2004). Receptiveness, use and acceptance of telehealth by Caregivers of stroke patients in the home. Online Journal of Issues in Nursing, 9(3), Center for Medicare & Medicaid Services (CMS). (2015). Physician self referral. Retrieved from,

18 Center for Connected Health. (2015). Telehealth advancement act. Retrieved from, Ciemins, E., Coon, P., Peck, R., Holloway, B., and Min, SJ. (2011). Using telehealth to provide diabetes care to patients in rural Montana: Findings from the promoting realistic individual selfmanagement program. Telemedicine and e-health, 17(8): Courtney, K.L., Lingler, J.H., Mecca, L.P., Garlock, L.A., Schulz, R., Dick, A.W., and Olhansky, E. (2010). Older adults and case managers initial impressions of community-based telehealth kiosks. Gerontological Nursing, 3(4), Federal Trade Commission (FTC). (2015). Guide to Antitrust law. Retrieved from, Finet, P., LeBouquin-Jeanne s, R., Dameron, O., and Gibaud, B. (2015). Review of current telemedicine Applications for chronic diseases. Toward a more integrated system? DOI: /j.irbm Greenberg, M.E., and Cartwright, J.P. (2001). Identifying best practices in telehealth nursing: The Telehealth survey. Nursing Economics, 19(6), Health resources and Services Administration (HRSA). (2015). Hill-Burton free and reduced-cost health care. Retrieved from,

19 Lamb, G.S., and Shea, K. (2006). Nursing education in telehealth. Journal of Telemedicine & Telecare, 12(2), Toledo, F.G.S., Ruppert, K., Huber, K.A., and Siminiero, L.M. (2015). Efficacy of the telemedicine for Reach, education, access, and treatment (TREAT) model for diabetes care. Diabetes Care, 37, E179- e180. Van Dyk, L. (2014). A review of telehealth service implementation frameworks. International Journal of Environmental Research and Public Health, 11, Weinstein, R.S., Lopez, A.M., Joseph, B.A., Holcomb, M., Barker, G.P., and Krupinski, E.A. (2013). Telemedicine, telehealth, and mobile health applications that work: Opportunities and barriers. DOI: Young, H., Miyamoto, S., Ward, D., Dharmar, M., Teng-Feldman, Y., and Berglund, L. (2014). Sustained effects of a nurse coaching intervention via telehealth to improve health behavior change in Diabetes. Telemedicine and e-health, 20(9),