Chronic Care and Telehealth

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


2016 Telehealth Predictions

While some industries (like the petroleum business) are likely to have a dismal year ahead, the future has never been brighter for telehealth.

Here are some bold predictions from telehealth expert René Quashie, senior counsel in the healthcare practice at law firm Epstein Becker Green:

Strong momentum for licensure compacts – The Federation of State Medical Boards (FSMB) recently introduced an interstate physician licensure compact that 12 states have already enacted. And the National Council of State Boards of Nursing now has a draft compact that allows nurse practitioners to practice in any participating state with just a single license. Look for similar compacts to emerge in 2016.

Big Business buys in – According to the National Business Group on Health, 74 percent of large employers are expected to offer telehealth services in 2016 – up from 48 percent last year.

Telehealth accreditation takes off – Based on the groundbreaking accreditation programs from ATA and the Utilization Review Accreditation Commission (URAC), Quashie anticipates that health systems, health plans and telemedicine companies will develop additional telehealth accreditation programs in the year ahead.

Wearables market gains traction – Quashie notes that Soreon Research projects that the healthcare wearables market will hit the $41 billion mark by 2020. That will make it easier for telehealth clinicians to monitor conditions like diabetes, sleep disorders and cardiovascular disease.

Legislative progress continues – In 2015, more than 200 telehealth bills were introduced in 42 states. Look for more landmark legislation in the year ahead.

When you read Quashie’s full 2016 outlook, one thing is clear: telehealth is ringing in the New Year with industry-wide optimism.


Patient Access



Telehealth for Seniors

How Telemedicine is Transforming Senior Health Care

How Telemedicine is Transforming Senior Health Care  


By Julie Potyraj – Guest Blogger

Polly, age 78, and suffering from obesity-related health issues, is sitting on her sofa on a snowy afternoon. At 3 p.m., it’s time for her wellness appointment. Polly turns on her iPad (supplied by her doctor’s office), and sees her physician’s face smiling back at her. The doctor has already received information on Polly’s blood sugar levels, heart rate, and blood pressure via a remote monitoring system that sends the data directly to his office. After chatting for a bit, Polly shows the doctor a mild rash on her arm. Upon evaluating the condition—made possible by high-definition video conferencing equipment—her physician recommends a round of antibiotics and transmits a prescription to the local pharmacy. Thirty minutes later, the appointment is over, and Polly hasn’t left the warmth and comfort of her home.

This scenario is not from some futuristic film—it’s telemedicine, and it’s gaining momentum in health care settings across the world. Also referred to as telehealth, telemedicine is defined by the industry as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” This is more than just a trend; 52 percent of hospitals already use remote technologies to deliver clinical services.[1]

The Impact for Seniors and Health Care as a Whole

For aging adults with mobility and transportation problems, telemedicine can offer a welcome respite from in-person office visits. Frequent doctor’s appointments become less of a strain for seniors as well as their caregivers, who often must take time off work to accompany their loved one.

The early intervention afforded by telehealth also helps prevent unnecessary emergency room visits and hospital readmissions. While this is good news for patients themselves, it also helps ease the burden on America’s health care system by improving efficiency and reducing costs. Consider the following real-world examples:

  • An Illinois-based skilled nursing home chain is using telemedicine to minimize readmissions and eliminate unneeded ER visits, saving the health system hundreds of thousands of dollars annually. Through this program, which involves using video teleconferencing to enable bedside evaluation by board-certified physicians, approximately 81 percent of patients using the technology can be treated on-site.
  • In North Carolina, telemedicine is helping seniors diagnosed with diabetes, COPD, and heart failure remain in their homes and out of the hospital for longer periods. This is accomplished by monitoring these patients remotely in between skilled nursing visits using specialized telehealth technologies.

Medicare is Warming to Telehealth

In 2015, the Centers for Medicare & Medicaid Services (CMS) delighted telemedicine advocates by adding seven new payment codes covering additional telehealth services, such as annual wellness visits and psychotherapy. However, there is still work to be done. In an effort to help all Medicare recipients enjoy the benefits of telemedicine, organizations such as the American Telemedicine Association continue to actively encourage CMS and Congress to eliminate the arbitrary restrictions that limit coverage.
Would you like to be on the cutting edge of telemedicine and other health care issues? Learn more about MHA@GW, the online master of health administration from the Milken Institute School of Public Health at The George Washington University.


[1] American Hospital Association. The Promise of Telehealth For Hospitals, Health Systems and Their Communities. Trendwatch. January 2015.


Telehealth for Seniors

Skilled Nursing Facility using telehealth


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.


Washington DC

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.





Telehealth Solution

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 Today







Listening Drives Innovation

We listen closely to telehealth analysts and observers because they help us – and the industry in general – meet expectations and remain forward-looking.

Almost a year ago, Chirag Patel from New York-based incubator Highnote Foundry cited three things that need to happen for telehealth use to expand:

  • Combining virtual diagnosis and on-the-spot treatment
  • Providing scalable models capable of integrating data from a variety of devices
  • Supporting post-treatment care and compliance

Here’s how InTouch measures up in these three categories:

Using remote diagnostic devices for immediate treatment – We’ve long been a catalyst in this category. Our Patient Access products provide medical device connections that support all FDA requirements for active patient monitoring.

Scalable technology for integrating data from multiple devices – The InTouch Telehealth Network is a secure, scalable platform that reliably manages network performance to share patient data and clinical documentation from a variety of devices.

Post-treatment care coordination and compliance – You’ll find InTouch technology at every point in the care continuum, not just the ICU or physician office. Our solutions help coordinate post-treatment care in rehab centers, skilled nursing facilities, outpatient imaging, home health and many other locations.

At InTouch, we don’t develop products and services in a vacuum. We listen to the input of telehealth visionaries so that our solutions meet changing clinical needs and help move the telehealth field forward.


InTouch Health is listening

Veterans Affairs

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





Hospital Readmissions

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