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1 Challenging the Status Quo of Telehealth in Policy, Technology, & Clinical Care H. Stephen Lieber President and Chief Executive Officer HIMSS Disclosure of Conflict of Interest No Conflict of Interest 1

2 Learning Objectives Explore the policy challenges regarding reimbursement for telehealth services. Discuss clinical and technological challenges related to the enhanced use of telehealth. Assess the appropriateness and role of telehealth in the coordination of care. Definitions and Components of Telehealth Health Resources and Services Administration (HRSA) defines telehealth as the use of telecommunications and/or technology to provide healthcare related services from a distance. However, the definition and role of telehealth continues to evolve. Services associated within the scope of telehealth include: Live video (synchronous transfer): Real-time interaction between a patient and a provider using specialized technology. Store and forward (asynchronous transfer): Non real-time remote transfer of patient information via technology to a healthcare provider for population health management (non- EHR platforms and consumer oriented devices use this extensively). Remote Patient Monitoring (RPM): The use of electronic devices for the remote collection of medical and health data for transfer to providers for healthcare use. 2

3 Telemedicine The Time Has Arrived Telehealth can be harnessed to solve problems around Access Quality Interoperability Cost-effectiveness Care coordination Affordable Care Act Emphasis on decreased costs, increased quality Gaining greater awareness by the C-Suite Meaningful Use Emphasis on patient engagement Telehealth: From Hospital to Home? Patient Seeks Care Patient Transitions to Chronic Care Monitoring Kit Patient with a Planned Procedure at Hospital Patient Enters Hospital Patient Requiring Long-Term Care Early Patient Discharge/Sup plied Monitoring Kit 3

4 Innovation and New Opportunities Centers for Medicare & Medicaid Innovation (CMMI) is providing funding for telehealth initiatives. Frontier Community Health Integration Project Numerous provider sites engaged in the Round 1 Health Care Innovation Awards included telehealth in their programs Concierge services remove many barriers. Health Affairs published a review which shows the potential for expanded access to care, and savings for health plans The VA Board of Medicine s robust discussion on October 1 of its Ad Hoc Committee on Telehealth included several panelists discussing the business model and value of online visits. HIMSS Analytics Survey - Hospitals with a Telemedicine Solution Percentage of U.S. hospitals reporting use of telehealth technology 4

5 HIMSS Analytics Survey - Most Widely Used Telemedicine Technology Hospitals tend to favor visually oriented solutions (two way video/webcam; imaging sharing technologies) while the physician offices tend to lean toward text-based telemedicine solutions ( ; patient portals; scheduling tools, etc). Telemedicine: Primary Drivers Hospitals (335 or 82.5% respondents) Gaps in patient care - Due to remoteness of their community Reduce readmissions Address clinician deficiencies Physician Offices (71 or 18.5% respondents) Gaps in patient care - Due to a patient engagement initiative Enhance physician productivity Primary Drivers for Telemedicine Investment 5

6 Perceived Barriers to Increased Use of Telehealth and mhealth Payment Greatest barrier to use Lack of appropriate reimbursement models for effort Technology Innovation is still evolving, need improvements in hardware Lack of flexibility in application of technology Rural connectivity wireline and wireless improvements for coverage and access Regulatory Ability for policy to keep current Perceived Barriers to Increased Use of Telemedicine and mhealth Clinical Validity and effectiveness of interventions Consumer acceptance Increased virtual access could lead to potential over utilization Quality of services provided in virtual encounters Confusing to implement based on specialty Visit documentation and EHR integration needed to support continuity of care 6

7 Reimbursement, Policy, and Regulatory Issues Ability for policy to keep current with technological advancements Scope of service, prescribing regulations Definitions of practice, i.e., what constitutes a provider encounter or establishment of relationship Data storage of virtual encounter: length of retention Documentation requirements for payment in emerging models of care State Reimbursement, Policy, and Regulatory - Recommendations Communication between state Medical Boards and legislators to facilitate reciprocity and advancements in expanded licensure opportunities Expand Medicaid coverage models States can and should submit a State Plan Amendment to include telehealth for dual eligibles Consideration (by Medicaid) for removing State Plan Amendment in the event telehealth or remote patient monitoring services are employed for Dual Eligibles State HIE models should facilitate telehealth collaborations 7

8 Federal Reimbursement, Policy, and Regulatory Recommendations Streamline and improve FCC Universal Service Fund (USF) for healthcare example extend to cover EMS providers Inclusion of telehealth in ONC Roadmap Medicare should provide broader coverage for CPT codes of care coordination and remote patient monitoring Ensure CMMI (Center for Medicare & Medicaid Innovation) explores the implementation and adoption of telehealth and mhealth and validates their technological and financial benefits to improving healthcare delivery Organizational Needs and Next Steps Expanded use of mobile and wireless technology as an intermediary and an adjunct between visits Need to expand definitions of originating sites to other locations of care i.e. patient s home, ambulance, or long term care facility Expanded industry dialogue on bringing forth requests for CPT Codes for new or existing procedures Specifically, HIMSS is working with the AMA to help determine opportunities to define services and better understand coding, technology, and valuation processes 8

9 Key Topics for Discussion Often reimbursement is noted as a barrier to adoption of new and novel technologies including mobile health. Key topics for discussion: 1. Payment 2. Technology 3. Regulatory 4. Clinical mhealth Summit November 8-11, 2015 Washington, DC The 2015 mhealth Summit theme, Anytime, Anywhere: Engaging Providers and Patients will put a spotlight on the shift to mobile, patient-centered healthcare delivery as well as consumer adoption of wearables, apps and personal health devices. 9

10 Resources HIMSS Analytics Survey: HIMSS Telehealth Physician Focus Group Findings: md-exec-summary-recommendationsformatted-final ?from_action=save HIMSS Executive Brief on Funding Sources: ber=

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