Becky Sanders Senior Director, Indiana Rural Health Association Starting a Telemedicine Program During the COVID-19 Pandemic Program Director, Upper Midwest March 27, 2020 Telehealth Resource Center This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number G22RH30351 under the Telehealth Resource Center Grant Program for $325,000. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
• Introductions • National Consortium of Telehealth Resource Centers (NCTRC) • Upper Midwest Telehealth Resource Center (UMTRC) Agenda • Telehealth and Technology 101 • Federal Medicare Rules and Reimbursement (including COVID-19 Changes) • Resources for state telemedicine rules and reimbursement (including COVID-19 Changes) • Q&A
National Consortium of Telehealth Resource Centers
National Consortium of Telehealth Resource Centers NCTRC Website https://www.telehealthresourcecenter.org/
• Virtual Librarians • Individual Consultation • Technical Assistance UMTRC • Connections with other programs Services • Presentations & Trainings • Project assessments • Updates on reimbursement policy and legislative developments
UMTRC Website Facebook LinkedIn
Telehealth versus Telemedicine • Sometimes used interchangeably • Definitions Two types of distinctions • Telehealth and • Broader field of distance health activities (CME, etc.) Concepts • Clinical remote monitoring (usually at home) • Education • Telemedicine • Billable interactive clinical services
Asynchronous Describes store and forward transmission of medical images or information because the transmission typically occurs in one direction in time Types Store-and-forward telemedicine Pictures, data of Synchronous Telemedicine Describes interactive video connections because the transmission of information in both directions is occurring at exactly the same period Live and Interactive Telemedicine HIPAA Compliant, Secure real-time audio AND video
● Telehealth is not a service; but a delivery mechanism for health care services Telehealth – Live and interactive telehealth services duplicate clinical in-person care is a – Some services are made better or possible with DELIVERY telehealth when distance is a barrier mechanism – Reimbursement should be equal to “in - person” care 9
Medicare and state Medicaid programs have relaxed HIPAA rules See UMTRC COVID-19 Resource Page https://www.umtrc.org/resources/covid-19/ IL – through electronic or telephonic methods, such as telephone (landline or cellular), video technology commonly available on smart phones and other devices such as FaceTime, Facebook Messenger Video Chat, Google Hanouts video, or Skype, and videoconferencing COVID-19 should not use ‘public facing’ applications like Facebook Live, Twitch, TikTok, or similar applications HIPAA Rules IN – any real-time, interactive consultation (including telephonic), but not text or email Relaxed MI – should be audio and visual service delivery; telephonic allowed for up to 30 days after the discontinuation of the emergency, or the 1 st of the following month OH – any audio or video non-public facing remote communication product that is available to communicate with patients should not use ‘public facing’ applications like Facebook Live, Twitch, TikTok, or similar applications UMTRC still recommends HIPAA compliant technology
TTAC Toolkits http://telehealthtechnology.org/toolkits/
TTAC Toolkits http://telehealthtechnology.org/toolkits/
Existing Organizational Epic EMR System Cisco Cerner and Microsoft Meditech Technology
Developing a Telemedicine Program Assess & Define The Culture of Develop & Plan Telehealth Implement & Monitor 14
Who Moved My Cheese? By Spencer Johnson
Personalities on your team
COVID-19
Getting Started Guides
Location / Size Telemedicine Placement of equipment & furniture Room Design Electrical & telecommunications connections Lighting, Acoustics, Wall color 19
• Large enough to move around comfortably • Exam table • Chairs • Telemedicine equipment Existing • Patient • Patient Room Telepresenters • Work surface • Phone/computer, etc. 20
Privacy Seeing Webside Manner patients from Video Etiquette home Consent in their home Vital Signs
S - Specific M - measurable A - achievable R - relevant T - timely Goal Strategies & Activities Responsibility Time Outcomes & Objectives Period Process Measures What How are you What are the Who is going to How long How do you do you going to get steps? do it? will it take? know if you Sample want? there? achieved your goal? Work Plan By 1 st Reduce Provide Find a space Team Lead 1) By the end of 2 nd Quarter 2020, ED wait telepsych Quarter times services in the Invest in video Team member A 2020 we will see 20 for ED technology patients via psych telepsych consults Hire a Team member B psychiatrist 22
Don’t do this!
Clean and Uncluttered 24
• Diffused soft light source • No shadows • Depicts colors naturally Optimal • Place a light in front of a patient to reduce Lighting shadows • Avoid backlight from windows or overhead lights 25
High ceilings and hard surface floors Can create echoes External noises from facility HVAC Acoustics From traffic outside Sound dampening Carpet, drapes, acoustic tiles on the ceiling Sound dampening paint 26
White or light walls can darken faces. A dark wall can lighten faces. Ideal Wall Color A robin’s egg blue or light gray background works well on all skin tones. 27
Professionals are regulated at the state level (doctors, nurses, counselors, etc.) Medicare Pays for certain outpatient professional services (CPT codes) for patients accessing care in rural counties Federal and HPSAs in rural census tracts Telemedicine *No regs; only conditions of payment Medicaid Law & Policy Telemedicine is “a cost-effective alternative to the more traditional face-to-face way of providing medical care… that states can choose to cover” As of Spring 2019, all 50 States and DC cover live and interactive telemedicine
Medicare Telehealth Services Patient in Patient Services Delivered by Reimbursement Designated Outside of a within CPT Eligible Originating MSA Code Range Practitioners Site Requirements ? Waived during the national pandemic
Updated Annually Otherwise eligible sites in Health Professional Shortage Areas (HPSAs) located in rural census tracts of Metropolitan Statistical Area (MSA) counties will be eligible originating HPSA sites (RUCA codes 4-10, also 2-3 in counties over 400 sq. mi., <35/sq. mi. Rural density) Eligibility Lookup Tool Designation http://datawarehouse.hrsa.gov/telehealthAdvisor/telehealt hEligibility.aspx
Published Annually; 13 pages Eligible Originating and Distant Sites Eligible Providers Telehealth Services by HCPCS/CPT Code Medicare Most basic services usually allowed Many screening and prevention Learning services allowed https://www.cms.gov/Outreach- and-Education/Medicare- Network Learning-Network- MLN/MLNProducts/downloads/T elehealthSrvcsfctsht.pdf?utm_s ource=Telehealth+Enthusiasts& Telehealth utm_campaign=2a178f351b- EMAIL_CAMPAIGN_2019_04_1 9_08_59&utm_medium=email& Fact Sheet utm_term=0_ae00b0e89a- 2a178f351b-353223937
Medicare Learning Network Telehealth Fact Sheet
MLN Fact Sheet Example
Rural Originating / Spoke / Patient Site Part B Part B Professional Telemedicine Facility Fee Fee CMS Q3014 Normal CPT Billing Code with Modifiers Urban Distant / Hub / Provider Site
Center for Connected Health Policy Info Graphic https://www.cchpca.org/sites/default/files/2018- 11/Finalized%20PFS%202019%20Infographic%20Final%20V.%204.pdf 2019 Center for Connected Health Policy Fact Sheet Physician https://www.cchpca.org/sites/default/files/2018- 11/FINAL%20PFS%20CY%202019%20COMBINED_0.pdf Fee Schedule Policy Guides
Medicare only allows FQHCs/RHCs to be originating site CARES Bill passed by the Senate on 03/26 would allow them to be distant sites Waiting for House to pass the bill FQHCs IL, IN, MI, and OH Medicaid and allow RHCs and FQHCs to be both originating and RHCs distant site Check out UMTRC or CCHP website for more information
State of the State
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