Telehealth It Isn t Just About Reimbursement! Minnesota Rural Health Conference 2010
Poll: Do you have videoconferencing equipment? Do you have other telehealth equipment? Do you use it? Monthly Weekly Daily Do you utilize/provide other TH services?
Telehealth It Isn t Just About Reimbursement! Minnesota Rural Health Conference 2010
Reimbursement
So what IS the story on Reimbursement?
Medicare CPT Codes Eligible Providers Eligible Sites Facility Fee
Reimbursement Telehealth Services under Medicare CPT/HCPCS Codes Consultants 99241-99255 Office or Other Outpatient Visits 99201-99215 Psychiatrist Diagnostic Interview Examination 90801 Individual Psychotherapy 90804-90809 Pharmacologic Management 90862 Individual Medical Nutrition Therapy G0270, 97802, 97803 End Stage Renal Disease (ESRD) Related Services G0308, G0309, G0311, G0312, G0314, G0315, G0317, G0318 Neurobehavioral Status Exam 96116 Follow-up Inpatient Telehealth Consultations G0406, G0407, G0408 Information from Center for Telehealth & e-health Law - www.ctel.org
Eligible Providers CMS has identified these: Physician (MD/DO) Nurse practitioner Physician assistant Nurse midwife Clinical nurse specialist Clinical psychologist Clinical social worker Registered dietician/nutrition professional
Eligible Sites - CMS Physician/Practitioner Office Critical Access Hospital (CAH) Federally Qualified Health Center (FQHC) Hospital Rural Health Clinic Hospital-based or CAH-based Renal Dialysis Center (including satellites) Skilled Nursing Facility Community Mental Health Center
Facility Fee Originating Site only Rate is adjusted regularly For 2010, the facility fee is 80 percent of the lesser of the actual charge or $24.00
Medicaid Often follow Medicare s lead State specific 35 states have established rules for telehealth reimbursement
Minnesota Medicaid Pays for two way interactive and store & forward Do not pay e-mail consults Very small facility fee Medically appropriate codes are paid at same rate as face-to-face GT modifier for interactive; CQ for store and forward
Other States: State Medicaid Reimbursement for Telemedicine Iowa No concern with location or whether by telemedicine or in person Pay for codes that meet the criteria of appropriate code billed and standards of practice within community are met Do not pay for store and forward Do not pay for e-mail consults No facility fee Nebraska Use GT modifier on codes Can bill transmission fee at $.08/min No facility fee North Dakota Recipient must be present during the provision of the services Appropriate CPT codes are used by consulting site along with GT modifier Originating site uses HCPC code Q3014 Physicians at both originating and consulting sites may bill for services Supplies needed for procedures performed are part of the procedure and not separately billed South Dakota Limited codes Pay for interactive (GT modifier) Pay for store and forward (GQ modifier) No facility fee
Health Plans Again often follow Medicare s lead Some are more inclusive of services Identifying the value-add of telehealth Doing their own thing
Others Private Pay 12 states have passed legislation requiring insurance companies to pay for services delivered by telemedicine Contract-based Services
Credentialing Hospital-based services Providers must be credentialed where the patient is located CMS is currently asking for input on a suggested rule change that will allow for credentialing by proxy. Privileges must also be granted
Usually, the Buck Stops Here
It shouldn t There s More!
Take a new look Impact of Telehealth Don t look at it in a bubble A tool of your entire organization Now vs. Future It is more than hard ROI Can you afford NOT to have something
Organizational Access to add l care resources Staff competency Community perception Service stability Patient Experience Peer-to-peer interactions
Budget-Related Stretch a tight travel budget Increase ancillary services Service continuation/expansion Enhance the quality of care Market-leader
Cost of NOT having Lost Market Share? Professional isolation/burn-out Loss of hometown dollars Behind the Times Patient Care Liability High Quality patient experience
Impacting the Patient Experience Patient- and Family-Centered Care Organization Expectation? Make things better from the PATIENT S perspective Telehealth as a core component!
Patient-Centered Healthcare is a team sport Involves the patient s family Coordinating care among providers Moving care to the bed-side Building the emotional connections Becoming a one-stop-shop from Time To Put Patients First; HealthLeaders, May 2010
Why Telehealth? Adds value Strengthens relationships Builds competency Stretches budgets Expands services
Getting Started: Organizational Buy-In Needs vs. Demands Common Applications Don t Wait Track Your Data Prove Your Success
Organizational Buy-In Administrative Leadership Physician Leadership and Participation Departmental Involvement in Pilot and more Project coordination Project leadership IT Awareness and Involvement On-going Budgetary Support
Need vs. Demand Determine if there is a need for the service Do you have disparities to address? Lost your provider? What is the patient volume? But, is there a demand? Are providers asking for the service? Are others already providing the service?
Only Demand? Sometimes that s all you have! Commitment and Interest Physician involvement Then move forward! Likely you ll find there really is a need too.
Common Applications In/Out Patient Specialty Services Dermatology Pulmonology Mental Health Oncology Cardiology Trauma/ER Infectious Diseases Stroke Care Pediatric Services and more Endocrinology Wound Care
Common Apps (cont) Telepharmacy TeleHome Heath (home monitoring) Remote ICU Monitoring Family Interactions Case/Disease Management Education staff, provider, family, community
Don t Wait Take a step even a small one! Figure out what makes sense for your organization If not you ll only get further behind
An Expectation! Patients Providers Partner facilities Payers
Data = Value Track the data, prove the value Why are you doing this? Was it successful? Track it right from the beginning Know what you want/need to track Supports budget/sustainability requests
Tools: Calculating Savings Worksheet Educational/Administrative events Clinical Services Tracking Log Volume Ancillary Services
Keeping Up (or is it Catching Up?)
New Applications mhealth Stroke Care/Emergency Care Pharmacy Home Health/Monitoring
mhealth Glucoboy iphone Apps Wireless monitoring Email & Secure Messaging Social Media
Stroke/Emergency Stroke 24/7 access to stroke expertise Assistive, available on-demand Supported by the American Stroke Assoc. (AHA) Emergency Similar access, or just overnight coverage Access to trauma experts Assistive does not supersede EMTALA
Networks http://www.activase.com/telestroke/telestroke_networks.jsp
Pharmacy Hospital-based Allows for 24 hour coverage Retail-based Maintain small-town pharmacy coverage Patient education
Home Health Monitoring Manage chronic disease Reduce hospitalizations Smart Homes Monitor patients at home Sensors in everyday appliances Helps determine quality of life
GPTRAC: We Help You Get Going!
GPTRAC? Great Plains Telehealth Resource & Assistance Center
Who is the GPTRAC? One of several federally-designated regional TRCs around the nation Established in 2006 Located at University of Minnesota/IHI Extensive telehealth program implementation experience 75+ years, combined
What do we do? Provide guidance Gather information Answer questions Share tools and resources Provide education Encourage collaboration Gather regional information
Who do we serve? Hospitals Clinics Providers Safety-net Organizations Professional Organizations Nursing Homes and more
GPTRAC Area:
How can we help? On-line resources Webinars and workshops Presentations Staff training Peer to peer connections Consultation services and more!
Resources: Roles/Responsibilities Samples Policies Cheat Sheets Guidelines Other Tools
Resources Additional Telehealth Resource Centers www.telehealthresourcecenters.org National Telehealth Law Center AKA: Center for Telehealth & e-health Law www.ctel.org American Telemedicine Association www.americantelemed.org National Rural Health Association www.ruralhealthweb.org
CONTACT US - For Consultation Pricing - Hourly rates available www.gptrac.org
THANK YOU! Great Plains Telehealth Resource & Assistance Center 888-239-7092 www.gptrac.org Mary DeVany Email: medevany@gmail.com