Post on 14-Dec-2014
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Mom, Maternity, & MonitoringPerinatal Telemedicine
DEXTER M. PAGE, MD, FACOGATLANTA PERINATAL ASSOCIATES
PAGEMED, LLC
OBJECTIVESWhy there is a need?Challenges AdvantagesPossibilitiesPerinatal assessmentScope of service
Why a NEED – DisparitiesAPA experience
Access QualityGeographyContinuityMorbidityPreventionAwareness
Why Bother?
Infant mortality rates 10% higher
Rural child death rate (ages 1-14) 29% higher
Poverty rate 58% higher
Percent of population living in poverty is higher
Percent of the population that is uninsured is higher
Receiving inadequate prenatal care (<or =4 physician visits) 47% higher
Cancer death rate 33% higher
Deaths from motor vehicle accidents 68% higher
Educational levels < ninth grade are two times higher
Why Bother?
“Cure” Growing Needs
Inadequate Prenatal care late or infrequent
Rural neglect minimizing the travel physician back-up/support
Stopgap - Provider shortagesEncourage partnershipsEscalating costsIncreasing demand for care
Quality Deficiencies
Experts - 200 MFM graduates nationally
2/year in GA
Marginalized care does not = managed care
Outdated tools
Infant Mortality Rate Critical measure of access to healthcare services
Georgia ranks 48th in the nationRate in rural counties is 11.4/1,000Infant mortality rates are 10% higherRate in 10.1/1,000 in urban countiesRural child death rate (ages 1-14) is 29%
higherWithout adequate medical infrastructure 33%
higher infant mortality
GOALS Decrease the Disparity in Infant Mortality
Objective 1: Decrease African American infant mortality rate
Objective 2: Increase first trimester initiation of prenatal care among African American women
Objective 3: Decrease the percent of Low Birth Weight (LBW), Very Low Birth Weight (VLBW) African American
Baseline of 15.5 to 13.0 per thousand live births by 5/31/14
Baseline of 85.2% in 2004-2006 to 87.0% by 5/31/14
Baseline to LBW = 10.3% and VLBW = 2.5 % of live births by 5/31/14.
Balancing the Scales
Long appt wait times
Limited resourcesOutdatedPatient anxietyConsolidationRegionalization
ConveniencePatient-friendlyTechnologyReal-time resultsCost-saving
measuresProvider efficiencyAccuracyTimeliness Patient compliance
Rural Healthcare Core problems facing rural health care providers
Declining population
High percentage of the elderly
Poorer health status indicators
Retaining medical and administrative staff
Maintaining sufficient inpatient occupancy and outpatient volume to cover costs
Inability to achieve economies of scale
Difficulty securing capital to renovate old physical structures and to replace outdated medical equipment
High percentage of Medicare/Medicaid and indigent/CHARITY
Rural Healthcare Core problems facing rural health care providers
Lack of planningInability to adaptProblems can be traced to Medicare and
other third party payment practices, including managed care
Result Providers’ inability to shift costsChanges in reimbursement have decreased
LOSShift resulted in more outpatient treatment
Rural Healthcare Core problems facing rural health care providers
ChallengesLead a horse to water….
InfrastructureNot a real “Trekkie”Cost of equipmentRegulatory concernsReimbursement issuesLack of standardizationReimbursementCredentialing of ProvidersHigh administrative costInteractive video
PerinatologistDefinition of a Subspecialist in MFM Is a subspecialist in obstetrics and gynecologyBy virtue of additional education
cares forprovides consultationwomen with complications of pregnancy
Requires advanced knowledge of complications of pregnancyObstetricalMedicalSurgical
The effects on both the mother and the fetusRequires expertise in the most current approaches to
diagnosis and treatment of women with complicated pregnanciespractice in a setting in which such modalities are available.
Perinatal ServicesH&PCounselingGeneticImagingLab interpretationShare infoManage the Risks, AND Transfer liability
Active Assessments
Fetal well-beingPTLCervical compromiseGlucose monitoringFetal developmentFetal arrhythmia
Advantages
Face to faceAccurateCoordinate proper referralsManage, Diagnose Image, MonitorPatient/Provider satisfactionDecreased LOS Reduced anxietyIncreased compliance
Telemedicine AdvantagesProviding immediate access to specialty consultation
Retaining the patient at the rural community hospital
Reducing delays in providing acute careMaintaining continuity of care with the patient’s
primary care physicianProviding effective continuing medical education
(distance learning)Expanding medical capability as well as the ability to
supervise non-physician healthcare personnelDecreasing healthcare costs.
Telemedicine Advantages
Providers want to reside in/near metropolitan areasRemove the feel of isolation from the medical
communityMost of the population in the rural areas are
Medicare/Medicaid recipients and/or are uninsuredThere are fewer opportunities for on-call coverage and
time offRural docs work longer hours for same $$ urban MDsState-of-the-art equipment and technologies are often
unavailablePatient referrals and transportation in emergency
cases may be difficult
Requirementslive or interactive;
Service provided through the use of camera, video, or audio conference equipment on a real-time basis
store-and-forwardtransferring information by sound, images, or images
on videotapemust be provided through the transference of
digital images between locationsallow quality consultation to referring provider
obtain information analyze report back diagnosis and management
Challenges
Perception AcceptanceComplianceLack of understandingBuy-inReimbursementDocumentation
Pregnancy complications
Prenatal diagnosisAmniocentesis CVS
PTL concernsRPLMultiplesFetal anomalies
Pregnancy complications
Maternal medical conditions
Teratogenic concerns
Counseling
Procedures
2nd opinion
Build relationships
help local providers detect and manage maternal and fetal
complications congenital anomalies, oligohydramnios or polyhydramnios, maternal medical disorders
diabetes, hypertension autoimmune disorders
Build Relationships
HospitalsCommunity centersOB/GYNFamiliesReferrals
Telemedicine Services
Ultrasound Level I, Complete: Interpretation (Store & Forward) CPT: 76801, 76802,
76805, 76810 Level II, Detailed Complete: Interpretation (Store & Forward) CPT: 76811,
76812 Transvaginal Ultrasound: Interpretation (Store & Forward) CPT: 76817 Follow-Up (Single item or AFI): Interpretation (Store & Forward) CPT:
76816 Limited Ultrasound: Interpretation (Store & Forward) CPT: 76815 Nuchal Translucency: Physician to co-sign with certified sonographer
CPT: 76813 Real time/online participation of Perinatologist for all ultrasounds can be
scheduled in advance. CPT 76811, 76812, 76817 For all ultrasounds, the remote site will bill for the technical/facility
component, and the referral site will bill for the professional component.
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