Telemedicine Credentialing and Privileging Protecting Patient - PowerPoint PPT Presentation

Presenting a live 90 ‐ minute webinar with interactive Q&A Telemedicine Credentialing and Privileging Protecting Patient Privacy, Avoiding Fraud and Abuse Liability, Ensuring Quality Care WEDNES DAY, AUGUS T 21, 2013 1pm Eastern | 12pm Central | 11am Mountain | 10am Pacific Today’s faculty features: T d ’ f l f S arah E. S wank, Principal, Ober | Kaler , Washington, D.C. Kelley Evans, S enior Counsel, Dignity Health , Rancho Cordova, Calif. C. Elizabeth O'Keeffe, Associate General Counsel, University of Mississippi Medical Center , Jackson, Miss. C. Elizabeth OKeeffe, Associate General Counsel, University of Mississippi Medical Center , Jackson, Miss. The audio portion of the conference may be accessed via the telephone or by using your computer's speakers. Please refer to the instructions emailed to registrants for additional information. If you have any questions, please contact Customer Service at 1-800-926-7926 ext. 10 .

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T ELEMEDICINE C REDENTIALING T ELEMEDICINE C REDENTIALING AND P RIVILEGING Protecting Patient Privacy, Avoiding Fraud and Abuse 5 Liability, Ensuring Quality of Care

W ELCOME W ELCOME  Today’s Speakers  Introduction  Credentialing  Implementing a Telemedicine Program  Fraud and Abuse  HIPAA  Other issues to consider 6

T ODAY ’ S S PEAKERS Sarah E. Swank Sarah E Swank Kelley Evans Kelley Evans Principal Senior Counsel OBER | KALER Dignity Health Washington DC Washington, DC Rancho Cordova, CA Rancho Cordova CA (202) 326-5003 Kelley.Evans@DignityHealth.org seswank@ober.com C. Elizabeth O'Keeffe Associate General Counsel University of Mississippi Medical Center Jackson, Miss. , 7 cokeeffe@umc.edu

S TRATEGIC P LANNING  Telemedicine NOT just another service  Telemedicine NOT just another service  Telemedicine a modality to deliver many types of services yp  Strategic because:  A tool to determine where and how to provide services i  An alternative to brick and mortar  Full service delivery or used to supplement services y pp already in place  Show cases expertise 8

S TRATEGIC P LANNING  Strategic planning requires: g p g q  Assessment of relevant markets and environment  Understanding of competition  Determine areas of clinical services  Determine areas of clinical services  Important for counsel to “be at the table” early in the planning process p g p  Requires an understanding of strategic elements of telemedicine and the underlying l legal issues l i  Consider Exit Strategies 9

R EASONS F OR T HE G ROWTH O F T ELEMEDICINE  Advances in technology  Academic medical centers asked to assist other hospitals  Mission driven hospitals seek to assist their  Mission driven-hospitals seek to assist their communities  Physician shortage, especially in rural areas  Aging patient population and an increase of patients with chronic diseases  Current regulatory environment with an emphasis on  Current regulatory environment with an emphasis on care coordination and shifting care settings  Global health care 10

T ELEMEDICINE P ITFALLS  Lack of reimbursement  Lack of reimbursement  Difficult to oversee and regulate with expanding technology p g gy  Patient safety issues  Potential decrease patient satisfaction  Potential decrease patient satisfaction  Quality of care and communication  Fraud and abuse  Fraud and abuse  HIPAA/HITECH 11

S O M ANY T ERMS . . . Are the following Are the following “telemedicine”?  Telehealth  Telehealth  Virtual Care  mHealth  mHealth  Social Media 12

E E XPANDING S ERVICES G S C S Examples of Telemedicine: Examples of Telemedicine:  Videoconferencing  Transmission of still images g  E-health including patient portals  Remote monitoring of vital signs  Nursing call centers  Tele________ [Fill in the blank]  e-Prescribing P ibi NOTE: Not all of these examples are governed by the CMS telemedicine credentialing rule the CMS telemedicine credentialing rule 13

E E XPANDING S ETTINGS S Variety of practice settings Variety of practice settings  Academic medical centers (AMCs)  Large hospital systems  Large hospital systems  Health care clinics  Ambulatory Surgery Centers (ASCs)  Ambulatory Surgery Centers (ASCs)  In the home 14

E E XPANDING T ECHNOLOGY G T C O OG Technology changes drive expansion and gy g p access to telemedicine, even globally 15

CMS C REDENTIALING R ULE 16

O VERVIEW OF C REDENTIALING  The CMS Condition of Participation (CoP) C C p (C ) on Telemedicine Credentialing  Written Agreement  Accreditation  Governance  Medical Staff S ff 17

C ONDITION OF P ARTICIPATION (C O P)  Hospital Condition of Participation: Both p p Hospitals and CAH are permitted to rely upon the credentialing and privileging Decisions made by the distant site hospitals or distant site by the distant-site hospitals or distant-site telemedicine entity  Effective Date: July 5 2011  Effective Date: July 5, 2011 18

P RIOR J OINT C OMMISSION R ULE Required the governing body of the hospital or q g g y p Critical Access Hospitals (“CAH”) to make all privileging decisions based upon the recommendations of its own medical staff after its recommendations of its own medical staff after its medical staff had thoroughly examined and verified the credentials of every single practitioner applying for privileges irrespective of whether that f f practitioner was providing services in person and onsite at the hospital or remotely through a p y g telecommunications system 19

T HE J OINT C OMMISSION ’ S REACTION “The Joint Commission is very pleased that CMS y p has revised its telemedicine requirements to provide more flexibility to hospitals and lessen their regulatory burden This is an especially their regulatory burden. This is an especially positive step for improving access to care for patients in rural areas. Of particular importance is the fact that critical Of f access hospitals will have additional avenues to benefit from the services of particularly skilled p y physicians and practitioners.” Mark Chassin, MD, FACP, MPP, MPH May 6, 2011 20

A CCREDITATION  “Privileging by proxy” for all TJC- g g y p y accredited hospitals and CAHs  Standards: LD.04.03.09, MS.13.01.01 and MS 01 01 01 MS.01.01.01  Goals of TJC Standard  Eliminate duplicative credentialing  Concerns over impeding patient access to health care services  Many agreements already in place under y g y p the TJC standards NOTE: Don’t forget the Joint Commission if it NOTE: Don’t forget the Joint Commission if it 21 is your accrediting body.

I S IT STREAMLINED ? 22

T ELEMEDICINE C REDENTIALING R ULE Governing Body Governing Body Medical Staff Medical Staff Allows the Governing Allows the Medical Staff Body of the hospital to Body of the hospital to to rely upon the to rely upon the rely on the Governing credentialing and Body of the distant site privileging decisions hospital to meet made by the distant site requirements hospital for physicians providing telemedicine providing telemedicine services at the distant site hospital 23