Assessing Telehealth’s Value

A typical value-based care contract (VBC) is extremely complicated, but gauging the overall value something brings is much easier – and telehealth delivers amazing value.

Recently, at the American Association of Nurse Practitioners’ Specialty & Leadership Conference, family nurse practitioner Thanh Nguyen from Providence Health Express in Oregon noted that “we don’t know” what telehealth’s return on investment will be in the new value-based care model. Only about 40% of providers are even using VBC contracts, which means that six out of 10 providers are still using the fee-for-service approach.

But Nguyen is certain about one thing: telehealth is providing undeniable value every day. In her view, it’s saving lives and improving access to care while offering growth opportunities for nurse practitioners.

Nguyen feels that it’s now time for legislators and regulators to bring more telehealth value to clinicians – namely, getting paid for every hour worked.

In a recent speech, the American Medical Association’s immediate past president, Dr. Steven Stack, spoke about the need for a “quadruple aim”: adding “clinician satisfaction” to the current trio of improved access, better care and lower costs. “We need to restore joy to the practice of medicine,” he said – one way to do that is fair compensation for the long hours worked.

Current reimbursement policies don’t allow telehealth providers, like Nguyen, to get paid a penny for the time it takes to respond to patients’ emails. She’s licensed to practice only in Oregon and Washington, and she recently got burned by a Nevada patient who claimed to be visiting friends in Oregon. Ultimately, Nguyen had to waive her fee for the 20-minute session.

The healthcare industry’s journey to value-based care is a worthy effort, but it will only succeed when it brings real value to the clinicians who make it happen – and when it fairly compensates them for the care they provide via telehealth technology.

RPM Is A Proven Winner

How well does Remote Patient Monitoring (RPM) perform when it comes to increasing access, lowering costs and improving quality of care? Extremely well, according to last year’s joint research project conducted by the University of Michigan and University of Kentucky.

Lead researcher at the University of Michigan, Rashid Bashshur, Ph.D., and his associates narrowed the focus of the study to three chronic diseases: congestive heart failure, COPD, and stroke. The team sifted through more than 175 studies that looked at RPM from many vantage points: age, level of patient participation and whether the program was led by a physician or nurse.

The findings: remote patient monitoring and related telehealth services increased both access and quality of care while reducing costs.

This confirms the results of a study called CONNECT, which found that wireless remote monitoring of cardiac patients enabled clinicians to make informed treatment decisions 17 days sooner than with in-person visits alone.

Telehealth has come a long way since the Holter (cardiac event) monitor was introduced in the early 1960s. That device wasn’t portable and required the patient to remain in the hospital for monitoring.

As practiced today, RPM is a continuous two-way process, not just a periodic check-in. One recent RPM study found that diabetes patients showed improvements just by receiving and sending text messages to clinicians.

The word “remote” implies a cold and distant relationship. But with RPM, doctor/patient communication is now continuous and caring and it’s helping to significantly lower healthcare costs. RPM has proven ROI.

Remote Presence Monitoring

Female doctor using remote presence monitoring

CCM’s Huge Potential

Last year, CMS began reimbursing providers about $42/month per patient for spending at least 20 minutes in non-face-to-face Chronic Care Management (CCM) consultations. Yet surprisingly, many providers – including telehealth clinicians – have been slow to take advantage of this supplemental source of revenue.

If a provider offers CCM-defined services to, say, 400 eligible Medicare patients per month, that’s bonus income of more than $200,000 per year. And in most cases, that revenue doesn’t affect reimbursement from Evaluation & Management (E&M) and other services. It’s additional income, pure and simple.

According to the National Chronic Care Survey, there were two major problems with last year’s rollout: many clinicians were spending up to 35 minutes per consultation (when only 20 is required) and about half the participating providers used registered nurses for the checkups (when less expensive clinicians could do the job).

As providers become more efficient in CCM care delivery, it’s likely to gain popularity rapidly this year. That means that CMS auditors will be paying close attention to ensure compliance – and that’s where telehealth has a key advantage: thorough documentation.

Telehealth software makes it easy to identify and document the clinician, patient and length of consultation for each CCM encounter. That’s more than enough to satisfy any Medicare auditor.

The chronically ill Medicare population is the fastest growing patient demographic – and CCM participants appreciate what telehealth delivers: high-caliber, interactive care that’s also very convenient. That gives telehealth a competitive edge because CCM enrollees get to choose their own providers.

It’s time to familiarize yourself with CPT code 99490. It’s the Chronic Care Management billing code that holds enormous promise for telehealth providers in 2016.

Chronic Care and Telehealth

Chronic Care Management

Top 5 Reasons to Start a Telehealth Program in 2016

As we look forward to 2016, here are the top 5 reasons to start a telehealth program next year:

  1. Lower readmission ratesTelehealth is already playing a vital role in hospitals’ efforts to reduce unnecessary (and costly) readmissions.
  2. It’s a financial winner for health systems of all sizes. It’s easy to find fiscal rationales for just about any type of telehealth program. Here’s a detailed analysis of the financial advantages of an acute care telehealth program.
  3. Telehealth offers a competitive advantage. The market intelligence firm Open Minds recently published a report showing how health systems that offer telehealth services can gain a competitive edge over rivals that don’t.
  4. Tax advantages – Some not-for-profit health systems are already using Community Health Needs Assessments to redefine “community” to include remote care, thus protecting their tax-exempt status. It’s completely in line with the interoperable health IT ecosystem envisioned by the Office of the National Coordinator for Health Information Technology.
  5. Telehealth has unstoppable momentum. One by one, the barriers to telehealth are being lifted. Just before Thanksgiving, the National Association of Insurance Commissioners adopted model state legislation allowing telehealth to be used to meet adequacy standards for health plans’ provider networks. Next year, many states will enact the model legislation – and it paves the way for more states to join the 29 that have already passed telehealth parity laws.

Every health system has competing demands on its financial and clinical resources. But it’s hard to ignore these five compelling reasons to start a telehealth program without delay.

InTouchLite_Consultation_LowResolution

Time For FAST Action

Washington DC

Capital Building

In the run-up to an election year, a lot of praiseworthy legislation gets stalled in committee. That’s exactly what’s happened to Senate bill S1465 dubbed the “FAST Act”, which stands for “Furthering Access To Stroke Telemedicine” – a bill introduced by Sen. Mark Kirk (R-Illinois). There’s a similar bill in the House that’s also bottled up in committee.

The FAST Act would require Medicare to expand access to telestroke services regardless of the originating site. Medicare currently only reimburses for telestroke evaluations if the patient presents at a rural hospital, yet an estimated 94 percent of stroke patients present at either urban or surburban hospitals.

In a letter endorsing the bill, American Heart/Stroke Association president Mark Creager estimates that the FAST Act could result in net savings of $1.2 billion over ten years.

Nearly 800,000 Americans experience a stroke each year, and you’d think that Congress would expedite any legislation intended to help them. But that costs money – and lawmakers would prefer to kick the can as long as possible.

In recent years, Congress has gotten clogged with downright silly bills (creating a national jaywalking database for example). It’s a shame that something like the FAST Act – which can save countless lives and $100 million per year – remains in limbo when the Boys Town Commemorative Coin Act sails through.

Sen. John Thune (R-South Dakota) has signed on as a FAST Act co-sponsor, and we encourage lawmakers from both parties to join him. This is no time for business as usual. The FAST Act doesn’t deserve to die a slow death in committee.

 

 

 

 

Care Coordination, VA-Style

The Department of Veterans Affairs has taken a lot of heat lately, but one thing they’ve done right is to be an early and enthusiastic advocate for telehealth.

Veterans with traumatic brain injuries require care coordination that goes above and beyond. The VA starting using telehealth technology in 2003 to foster greater communication between the veteran’s family members, clinicians and rehab providers.

Here are some lessons we’ve learned from the VA’s head start in telehealth:

  • Be decisive – There’s nothing wishy-washy about the military. Once the VA saw the potential in telehealth, the organization jumped in with gusto. That’s the polar opposite of how Accountable Care Organizations (ACOs) have implemented telehealth. The eHealth Initiative found that just 23 percent of ACOs surveyed were actively using telehealth technology. That’s partly because Medicare’s Pioneer ACO model didn’t initially contain enough telehealth incentives. CMS is trying to remedy that in its soon-to-launch Next Generation ACO model. But so far, ACOs haven’t come roaring out of the telehealth gate like the VA did.
  • Have a vision – When the VA began using telehealth twelve years ago, its stated aim was to “improve the health of designated individuals and populations with the intent of providing the right care in the right place at the right time.”

That last phrase has since become the mantra of telehealth: right care, right place, right time. The VA had a vision for what telehealth could provide – and now it’s a reality around the world.

The VA is the poster child for what it means to be an “early adopter” of telehealth technology for care coordination. Now it’s time for CMS and other influential healthcare organizations to likewise have a dream for what telehealth can accomplish — and to move confidently in that direction.

Veterans Affairs

Telehealth Veterans Affairs

 

 

 

 

Telehealth Combats Readmissions

In fiscal year 2016, 2,665 hospitals will receive lower Medicare reimbursements due to excessive readmissions within 30 days. But here’s the good news: 799 of those hospitals won’t be penalized at all – and your facility can join that elite club by skillfully using telehealth technology.

The number of penalized hospitals has been steadily increasing because CMS has added two new conditions – COPD and total hip/knee replacements – to the original trio of monitored conditions: heart attack, heart failure and pneumonia. The maximum Medicare withholding has risen to 3 percent – and only 38 hospitals reached that level in the last monitoring period. But even a 1 percent decline in Medicare reimbursement is a serious blow to any health system, large or small.

According to The Advisory Board, there are four key stages of care that determine whether a provider will incur or escape these penalties – and telehealth plays a vital role in two of them: post-acute care coordination and transitional care support.

At the recent Telehealth Innovation Forum, there were numerous presentations about how telehealth is improving post-acute care coordination across skilled nursing facilities, outpatient rehab, long-term care, home health and imaging centers.

 

Here’s how it worked before telehealth:

A patient would get discharged from the hospital, and the primary care physician often didn’t know about it for weeks, if ever. The skilled nursing facility had questions about the plan of care, but found it difficult to track down specialists. When patients finally went home, they were confused about when to make follow-up appointments – and with whom.

With telehealth technology, patients are better informed and clinicians know exactly who’s accountable every step of the way. The result: patient outcomes improve, hospital readmissions decline, and providers can provide follow-up care within Medicare’s 7- and 14-day timeframe in order to qualify for transitional care incentives. By CMS’s own estimates, timely transitional care can increase physicians’ revenue up to 4 percent.

The key to avoiding readmission penalties is to improve care across the continuum, not just talk about it. Telehealth is by far the best tool for accomplishing that.

 

Hospital Readmissions

Hospital Readmissions

How CIOs Can Fund Telehealth

Several recent CIO surveys indicate that many of them would like to move more boldly into telehealth, but they’re facing a host of challenges, including:

  • Numerous “must-have” implementations like ICD-10 and data security updates – CIOs can’t ignore the Oct. 1 deadline for ICD-10 – and they’re scared that their facilities will experience costly data breaches like the ones that have hit healthcare giants like Community Health Systems.
  • A huge amount of “technical debt” – Most health systems have made major investments in EHRs and revenue cycle systems, not to mention all the servers and network hardware to support them. The ongoing optimization of these systems can be staggeringly expensive.

Some CIOs are dealing with these challenges by implementing “lean” initiatives and arranging innovative financing (like obtaining telehealth software and hardware on a subscription or rental basis).

When CIOs try to fund telehealth programs in cash-strapped organizations, two strategies are the most promising:

Demonstrating how telehealth directly impacts the quality of care – While it’s hard to make the case that a new HR or billing system improves patient care, every dollar spent on telehealth boosts care quality: greater access, less wait time, fewer hospital readmissions, and much more.

Getting clinician buy-in – Many physicians aren’t sold on EHRs because they seem like a more cumbersome way to document what they’ve always done. But telehealth technology clearly makes clinicians’ jobs easier (e.g., the ability to do telerounds without ever leaving home). Once clinicians get past their initial reservations about telehealth, they really love what the technology can accomplish.

It’s true that IT budgets are tight, but CIOs can find the telehealth funding they need by documenting its impact on patient outcomes and long-term financial performance. Telehealth is something that clinicians can get excited about…which isn’t the case with back-office applications like purchasing and timekeeping systems.  And when clinicians clamor for something, they usually get it.

Telehealth Investment

Chief Investment Officer Telehealth

 

 

 

Growing App-etite for Telehealth

Walgreens’ TV slogan is “At the corner of happy and healthy,” but you don’t have to visit the Walgreens on the corner to get prompt care anymore. The retail giant is expanding its partnership with MDLive to offer telehealth services via a smartphone app to customers in 25 states by year end.

According to the ATA, about 15 million people will receive telehealth care this year – and the most explosive growth is in primary care. Half a million patients will see a primary care physician using a secure Internet connection this year – and that’s twice the number seen in 2014.

A Walgreens remote consultation is much easier to schedule than an in-person visit. A recent Accenture study found that scheduling an appointment by phone takes over eight minutes on average – and 63 percent of that time is spent transferring the call from one staff member to another.

Another study by the Medical Group Management Association found that people who connect to doctors via apps are far less likely to cancel. That’s a big improvement over the in-person option, where 12 percent of patients either don’t show up or cancel at the last minute.

A Walgreens virtual visit costs $49 and there’s no wait time like in the doctor’s office. That makes the total cost (time and money) much more attractive to today’s price-sensitive consumers.

The Walgreens/MDLive program has been so successful already that the nation’s top two insurers – UnitedHealth and Anthem – are launching similar programs that aim to bring telehealth convenience to 40 million consumers by the end of next year.

Walgreens executives already have a buzzword for what the new app provides: “anytime anywhere care.” Don’t be surprised if that slogan replaces the old one in the company’s TV ads. It’s catchy and concise – and perfectly captures what healthcare consumers are seeking.

 

Telehealth Apps

Next Generation For Real

For decades, TV ads have been promoting the “next generation” of products, whether it’s a soft drink or smartphone or laundry detergent. The phrase has been so overused that we’re wary of it.

But now there’s a “next generation” announcement that’s the real deal: the Next Generation ACOs (Accountable Care Organization) unveiled last month by CMS (Centers for Medicare and Medicaid Services). There’s much to applaud about this announcement because it offers many things that are indeed “new and improved” – especially when it comes to telehealth.

A Next Generation ACO must have at least 10,000 aligned members – or 7,500 if it’s in a rural area. To qualify for next-gen status, an organization must provide access to both telehealth services and home visits. The new model also has more sensible financial metrics and goals than the preceding Pioneer ACO model.

Next Generation ACOs are now allowed to cover and reimburse for telehealth services just like Medicare Advantage plans do today. The new model lifts the longstanding requirement that beneficiaries must live in a rural community. That’s great news for the 80 percent of Medicare beneficiaries who live in large metropolitan areas.

It didn’t take long for telehealth advocacy groups to sing the praises of the new ACO structure. “This is an important change in CMS policy and attitude,” said Jonathan Linkous, chairman of the American Telemedicine Association. “We hope it will encourage CMS and Congress to further open up all value-based payment plans to telehealth.”

His comments were echoed by leaders of the Alliance for Connected Care. “This policy is a critical step forward in expanding the use of telehealth services in Medicare, which will allow for greater care coordination and improved quality of care,” said Alliance chairman Joe Peterson, M.D. “It represents a major victory for patients and the broader telehealth community, which has been gathering evidence of telehealth’s benefits for decades.”

For years, many telehealth proponents have been patiently waiting for the CMS to take this long overdue step. Now it’s time to pinch ourselves because it’s not a dream any more. The Next Generation ACO model will help bring telehealth services to nearly 40 million Americans who previously didn’t qualify. It’s a bold innovation that truly lives up to its name.