Download Telehealth It Isn t Just About Reimbursement

Telehealth
It Isn’t Just About
Reimbursement!
Minnesota Rural Health Conference 2010
Poll:
 Do you have videoconferencing equipment?
 Do you have other telehealth equipment?
 Do you use it?
– Monthly
– Weekly
– Daily
 Do you utilize/provide other TH services?
Telehealth
It Isn’t Just About
Reimbursement!
Minnesota Rural Health Conference 2010
Reimbursement
So…what IS the story on
Reimbursement?
Medicare
 CPT Codes
 Eligible Providers
 Eligible Sites
 Facility Fee
Reimbursement
Telehealth Services under Medicare
CPT/HCPCS Codes
Consultants
99241-99255
Office or Other Outpatient Visits
99201-99215
Psychiatrist Diagnostic Interview Examination
90801
Individual Psychotherapy
90804-90809
Pharmacologic Management
90862
Individual Medical Nutrition Therapy
G0270, 97802, 97803
End Stage Renal Disease (ESRD) Related Services
G0308, G0309, G0311, G0312,
G0314, G0315, G0317, G0318
Neurobehavioral Status Exam
96116
Follow-up Inpatient Telehealth Consultations
G0406, G0407, G0408
Information from Center for Telehealth & e-Health Law - www.ctel.org
Eligible Providers
 CMS has identified these:
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Physician (MD/DO)
Nurse practitioner
Physician assistant
Nurse midwife
Clinical nurse specialist
Clinical psychologist
Clinical social worker
Registered dietician/nutrition professional
Eligible Sites - CMS
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Physician/Practitioner Office
Critical Access Hospital (CAH)
Federally Qualified Health Center (FQHC)
Hospital
Rural Health Clinic
Hospital-based or CAH-based Renal Dialysis
Center (including satellites)
 Skilled Nursing Facility
 Community Mental Health Center
Facility Fee
 Originating Site only
 Rate is adjusted regularly
 For 2010, the facility fee is 80 percent of
the lesser of the actual charge or $24.00
Medicaid
 Often – follow Medicare’s lead
 State specific
 35 states have established rules for
telehealth reimbursement
Minnesota Medicaid
 Pays for two way interactive and store &
forward
 Do not pay e-mail consults
 Very small facility fee
 Medically appropriate codes are paid at
same rate as face-to-face
 GT modifier for interactive; CQ for store and
forward
Other States:
State
Medicaid Reimbursement for Telemedicine
Iowa
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Nebraska
North Dakota
South Dakota
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No concern with location or whether by telemedicine or in person
Pay for codes that meet the criteria of “appropriate code billed and standards of
practice within community are met”
Do not pay for store and forward
Do not pay for e-mail consults
No facility fee
Use GT modifier on codes
Can bill transmission fee at $.08/min
No facility fee
Recipient must be present during the provision of the services
Appropriate CPT codes are used by consulting site along with GT modifier
Originating site uses HCPC code Q3014
Physicians at both originating and consulting sites may bill for services
Supplies needed for procedures performed are part of the procedure and not
separately billed
Limited codes
Pay for interactive (GT modifier)
Pay for store and forward (GQ modifier)
No facility fee
Health Plans
 Again…often follow Medicare’s lead
 Some are more inclusive of services
 Identifying the “value-add” of telehealth
 Doing their “own thing”
Others…
 Private Pay
– 12 states have passed legislation requiring
insurance companies to pay for services
delivered by telemedicine
 Contract-based Services
Credentialing
 Hospital-based services
 Providers must be credentialed
where the patient is located
 CMS is currently asking for input on a
suggested rule change that will allow
for credentialing “by proxy”.
 Privileges must also be granted
Usually,
…the Buck Stops Here
It shouldn’t…
…There’s More!
Take a “new” look
 Impact of Telehealth
– Don’t look at it in a “bubble”
– A tool of your entire organization
– Now vs. Future
 It is more than hard ROI
– Can you afford NOT to have something
Organizational
 Access to add’l care resources
 Staff competency
 Community perception
 Service stability
 Patient Experience
 Peer-to-peer interactions
Budget-Related
 Stretch a tight travel budget
 Increase ancillary services
 Service continuation/expansion
 Enhance the quality of care
 Market-leader
Cost of NOT having…
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Lost Market Share?
Professional isolation/burn-out
Loss of “hometown dollars”
“Behind the Times”
Patient Care Liability
High Quality “patient experience”
Impacting the Patient
Experience
 Patient- and Family-Centered Care
 Organization Expectation?
 Make things better from the PATIENT’S
perspective…
Telehealth as a core component!
Patient-Centered
 Healthcare is a “team sport”
 Involves the patient’s family
 Coordinating care among providers
 Moving care to the bed-side
 Building the emotional connections
 Becoming a “one-stop-shop”
from Time To Put Patients First; HealthLeaders, May 2010
Why Telehealth?
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Adds value
Strengthens relationships
Builds competency
Stretches budgets
Expands services
Getting Started:
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Organizational Buy-In
Needs vs. Demands
Common Applications
Don’t Wait
Track Your Data…Prove Your Success
Organizational Buy-In
 Administrative Leadership
 Physician Leadership and Participation
 Departmental Involvement in Pilot and more
– Project coordination
– Project leadership
 IT Awareness and Involvement
 On-going Budgetary Support
Need vs. Demand
 Determine if there is a need for the service
– Do you have disparities to address?
– Lost your provider?
– What is the patient volume?
 But, is there a demand?
– Are providers asking for the service?
– Are others already providing the service?
Only Demand?
 Sometimes that’s all you have!
– Commitment and Interest
– Physician involvement
 Then move forward!
– Likely you’ll find there really is a need too.
Common Applications
 In/Out Patient Specialty Services
– Dermatology
– Mental Health
– Cardiology
– Infectious Diseases
– Pediatric Services
– Endocrinology
– Wound Care
– Pulmonology
– Oncology
– Trauma/ER
– Stroke Care
…and more
Common Apps (cont)
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Telepharmacy
TeleHome Heath (home monitoring)
Remote ICU Monitoring
Family Interactions
Case/Disease Management
Education
– staff, provider, family, community
Don’t Wait
 Take a step…even a small one!
 Figure out what makes sense for your
organization
 If not…you’ll only get further behind
…An Expectation!
 Patients
 Providers
 Partner facilities
 Payers
Data = Value
 Track the data, prove the value
– Why are you doing this? Was it successful?
 Track it right…from the beginning
– Know what you want/need to track
 Supports budget/sustainability requests
Tools:
 Calculating Savings Worksheet
– Educational/Administrative events
 Clinical Services Tracking Log
– Volume
– Ancillary Services
Keeping Up
(or is it Catching Up?)
“New” Applications
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mHealth
Stroke Care/Emergency Care
Pharmacy
Home Health/Monitoring
mHealth
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Glucoboy
iPhone Apps
Wireless monitoring
Email & Secure Messaging
Social Media
Stroke/Emergency
 Stroke
– 24/7 access to stroke expertise
– Assistive, available “on-demand”
– Supported by the American Stroke Assoc. (AHA)
 Emergency
– Similar access, or just overnight coverage
– Access to trauma experts
– Assistive – does not supersede EMTALA
Networks…
http://www.activase.com/telestroke/telestroke_networks.jsp
Pharmacy
 Hospital-based
– Allows for 24 hour coverage
 Retail-based
– Maintain small-town pharmacy coverage
– Patient education
Home Health
 Monitoring
– Manage chronic disease
– Reduce hospitalizations
 Smart Homes
– Monitor patients at home
– Sensors in everyday appliances
– Helps determine “quality of life”
GPTRAC:
We Help You Get Going!
GPTRAC?
Great Plains Telehealth Resource
& Assistance Center
Who is the GPTRAC?
 One of several federally-designated
regional TRCs around the nation
 Established in 2006
 Located at University of Minnesota/IHI
 Extensive telehealth program
implementation experience
– 75+ years, combined
What do we do?
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Provide guidance
Gather information
Answer questions
Share tools and resources
Provide education
Encourage collaboration
Gather regional information
Who do we serve?
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Hospitals
Clinics
Providers
Safety-net Organizations
Professional Organizations
Nursing Homes
…and more
GPTRAC Area:
How can we help?
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On-line resources
Webinars and workshops
Presentations
Staff training
Peer to peer connections
Consultation services
…and more!
Resources:
 Roles/Responsibilities
 Samples
– Policies
– “Cheat Sheets”
– Guidelines
 Other Tools
Resources
 Additional Telehealth Resource Centers
– www.telehealthresourcecenters.org
 National Telehealth Law Center
– AKA: Center for Telehealth & e-Health Law
– www.ctel.org
 American Telemedicine Association
– www.americantelemed.org
 National Rural Health Association
– www.ruralhealthweb.org
CONTACT US –
- For Consultation Pricing
- Hourly rates available
www.gptrac.org
THANK YOU!
Great Plains Telehealth Resource &
Assistance Center
888-239-7092
www.gptrac.org
Mary DeVany
Email: [email protected]