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Telehealth Enterprise Evolution

The 10th InTouch Telehealth Innovation Forum was a showcase for many health systems that are moving beyond telestroke to an enterprise vision for virtual health.

That was the primary focus of a presentation by Chad Miller, MD, the system medical chief for neurocritical care at OhioHealth, where the telestroke program was being underutilized. Most incoming calls did not involve tPA decision-making, but were non-stroke neurological problems like seizures and hypertensive emergencies.

Under Dr. Miller’s leadership, OhioHealth restructured the program to become a round-the-clock virtual health network, spanning 12 hospitals and 20 spoke facilities. This gave doctors the ability to do remote workups and assess a wide range of neurological conditions.

In the OhioHealth network, a neurologist can now provide coverage at a hospital 70 miles away, rather than having to drive, losing valuable time. For cases involving carotid revascularization, a patient can be promptly seen by a vascular neurologist both before and after the procedure.

Miller then turned the podium over to Stephen Klasko, MD, President and CEO of Thomas Jefferson University and Jefferson Health. In a high-energy keynote address, Klasko sang the praises of enterprise virtual networks, noting that enterprise-wide virtual rounds and patient self-scheduling are starting to be utilized. His organization is also rolling out an innovative direct-to-employer model that uses telehealth technology to create strong partnerships with Philadelphia area employers.

At the InTouch Telehealth Innovation Forum, speakers from HCA, The Cleveland Clinic, and Mayo Clinic also discussed how their organizations have successfully transitioned from a telestroke-centric perspective to comprehensive virtual care networks.

Telehealth’s future can perhaps best be described in the title of the Mayo Clinic presentation: An Enterprise Connected Care Strategy. Connected care is the key to a better future for healthcare and must be designed by those who are experts in the telehealth space.

Telehealth Enterprise

Telehealth Enterprise

 

Oasis In The Desert

In a recent MarketWatch report, Phil Miller, from the physician search firm Merritt Hawkins, said that 65 million people in the U.S. live in what’s “essentially a primary care desert.” According to the latest Kaiser Family Foundation research, it’s not just a rural phenomenon. Rhode Island and Connecticut are struggling to find primary care physicians just as much as North Dakota and Nebraska.

 Telehealth technology and osteopathy may soon be providing an oasis in that desert. Telehealth can help improve primary care access in struggling states like Missouri, by leveraging the expertise of first-line physicians in states like Delaware, which are amply supplied. Meanwhile, osteopathic schools are starting to create long-distance alliances to solve the primary care shortage.

The educational requirements for an osteopath are nearly identical to an M.D. program – and more than half of young osteopaths go into primary care. That’s one of the reasons why the New York Institute of Technology recently created an osteopathic medical campus at Arkansas State University in Jonesboro. The first group of 115 students will begin classes this fall.

Innovative programs like these can go a long way toward reducing the projected primary care shortfall. The Association of American Medical Colleges estimates this could be as high as 31,000 physicians by 2025.

Telehealth technology is already helping to improve access to specialty care nationwide, which may encourage more medical students to consider a career in primary care. There’s still significant pressure on medical students to forsake primary care for the higher paying specialties in order to pay back six-figure college loans.

Until there are more incentives to enter primary care (perhaps government funded), telehealth can bring “water to the desert” by connecting patients with physician assistants, nurse practitioners and osteopaths who are ready to help.

 

Telehealth

Oasis in the Desert

The DigiPsych Revolution

The term “telepsychiatry” makes you think of those days when a movie star filming in New York would call a Beverly Hills shrink for a long-distance session.

Today, a land-line telephone is seldom used in remote mental health, so perhaps we should start using the expression “DigiPsychiatric” treatment. That term encompasses not just the traditional provider/patient session, but the enormous amount of data that can be collected (both actively and passively) to aid in diagnoses.

Here are some of the pressing problems that DigiPsych is helping to address:

  • Mental health is the third costliest health condition in America
  • Nearly 60 million Americans have a behavioral health condition, far more than can be treated in conventional brick-and-mortar locations
  • Patients who have a behavioral condition in tandem with a chronic disease cost the U.S. healthcare system 75 percent more than those with physical illnesses alone

There’s a lot of innovative work being done at the crossroads of telehealth and mobile mental health apps. For instance, Centerstone Research in Nashville gave smartphones and the Ginger.io app to patients in a recent pilot. The app was used to gather both active (patient-provided) and passive data gathered on sleep patterns, activity levels and communication trends (e.g., a patient who normally sends 20 texts per day is now sending none). The Centerstone program reduced the participants’ ER days by 23 percent and hospital days by 51 percent.

And we’re just beginning to tap the full potential of wearables like FitBit. In a recent study, a specially designed wearable was able to remotely detect patients’ use of opioids and cocaine in real-time.

In the past, a behavioral care provider had to guess whether a patient was abusing drugs or not sticking to treatment protocol. Now it’s possible to gather meaningful data 24/7 to eliminate the guesswork and greatly improve the quality of care. The DigiPsych revolution has just begun.

TeleBehavioral Session

TeleBehavioral Session

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

“Discharge” Is An Illusion

Health systems and regulatory agencies compile mountains of hospital discharge data – and too often they consider a discharge to be a one-and-done event worthy of a marching band. But some health systems have realized that many patients are never fully discharged. They often move quickly – and invisibly – between inpatient, outpatient and post-acute settings.

Telehealth technology is proving to be a game-changer in this new world where hospital discharge is just a recovery phase, not a grand finale.

According to Modern Healthcare, the Hospital for Special Surgery in New York has developed a telehealth app that allows the staff to easily monitor patients after discharge. For example, clinicians can see how well patients are walking – and that visual confirmation is much more effective than a phone-based check-in.

Telehealth is also the ideal technology for connecting the dots. There are a lot of simple reasons why many patients boomerang back into acute care: not having a primary care physician, not sticking to a medication regimen, etc. A 30-year-old might be able to get away with that, but for seniors it can be a one-way ticket to readmission.

Telehealth technology ensures that physicians, case managers. pharmacists and patients are on the same page (or home page as the case may be).

For a patient recuperating from a stroke, pneumonia or heart attack, discharge isn’t a red-letter day like a college graduation. In the days and weeks following discharge, the care team has to share information every bit as effectively as a coaching staff in the Super Bowl. Every coach wears a headset – and every care coordination team should be using telehealth.

 

Hospital Discharge

Hospital Discharge

 

 

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

Telehealth – A Dementia Care Solution?

Kudos to Linda Kaufman, RN, for a thought-provoking article in Executive Insight about how telehealth can improve care and lower costs for patients with dementia.

Kaufman cites some shocking numbers from the Alzheimer’s Association: the cost of care for Alzheimer’s patients this year is expected to top $226 billion – and that number could go even higher when you include those who suffer from Alzheimer’s plus chronic conditions like diabetes.

In Kaufman’s view, telehealth can play a pivotal role in lowering the staggering cost of care for dementia patients by reducing unnecessary hospital visits and improving communication between skilled nursing facilities and home health providers.

She even outlines how a fledgling telehealth program might be structured. Registered nurses could be available 24/7 for calls and video chats with family members providing dementia care. The nurse would use a series of algorithms and protocols to make recommendations to the caregiver. This early intervention could go a long way toward eliminating unnecessary ambulance transport and ED visits. It can also provide ongoing emotional support for stressed-out caregivers.

The Alzheimer’s Association estimates that there will be more than seven million Medicare-age dementia patients by 2025. Meanwhile, there are only about 1.6 million nursing home beds in the U.S., and Baby Boomers are retiring at the rate of 10,000 per day. It soon may be necessary to provide home-based care for huge numbers of dementia patients – and telehealth may be the only viable solution.

 

Telehealth Solution

Telehealth Solution

No Crystal Ball Needed

For far too long, telehealth has been touted as a future miracle that’s just out of reach. So it’s significant that the theme of a recent U.S. News Hospital of Tomorrow conference was “Telehealth Isn’t The Future – It’s Changing Care Now.”

From beginning to end, the conference highlighted what telehealth is doing in the present: improving care, lowering costs, reducing hospital readmissions and much more.

You don’t need to be H.G. Wells to realize that most Americans are perfectly comfortable getting technology-enabled remote medical treatment. But what is surprising is the scope of what’s already being done nationwide. For example, you don’t automatically think of ophthalmology as a prime candidate for telehealth. But conference speaker Dr. Julia Haller chronicled how Wills Eye Hospital in Philadelphia is using remote home monitoring for patients at the highest risk for the progression of blindness.

Another present-day achievement is how telehealth is transforming the rules of engagement. It’s knocking down the barriers that have long existed between doctor and patient. At the conference, University of Pittsburgh Medical Center telemedicine director Dr. Andrew Watson discussed how today’s patient portals are bringing new spontaneity to physician-patient communication – something not seen since the heyday of house calls.

The recent Disney movie Tomorrowland was only modestly successful at the box office. Maybe what we really need is a movie called Present World – one that celebrates what telehealth is achieving in the here-and-now.

 

Telehealth

Telehealth Today

 

 

 

 

 

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