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Telemedicine Metrics: 10 KPIs to Maximize Effectiveness
Daniel Marino, Rick Howard and Josette Portalatin
August 12, 2020
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Josette Portalatin
Assistant Vice President, Revenue Cycle
Valley Health System
Today's Presenters
2
Rick Howard
Principal
Lumina Health Partners
Daniel J. Marino
Managing Partner
Lumina Health Partners
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PROGRAM SUMMARY
This presentation will review “best practices” of telemedicine implementations and introduce metrics to maximize the effectivities of such programs. Telehealth program challenges will be discussed and key performance indicators (KPIs) to drive operational and economic impact on the ambulatory services will be introduced. A case study from a hospital-owned medical group will be shared highlighting the operational impact and lessons learned.
LEARNING OBJECTIVES
• Understand how telehealth will continue to disrupt the delivery of care and support value-based care
• List the top 10 KPIs to measure a telehealth’s program success
• Realize how to manage the financial impact of telehealth in the future
Telemedicine Metrics: 10 KPIs to Maximize Effectiveness
Telemedicine:
Progress and Challenges
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• Primary care practices are changing their care delivery model
• Surgical teams are shifting their practices to support the preoperative assessment • Virtual pre-surgery coordination conferences are
aimed at pre-surgical “optimization”• Patients are evaluated for surgical risk factors
• COVID-19 symptomatic patients are triaged before hospital admission
• New “virtual care models” aim to expand access, reduce costs and enhance patient satisfaction
Telemedicine: Changing the Delivery of Healthcare
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• Analysts expect general medical care visits to top 200 million this year (original expectation - 36 million visits)*
• March telehealth visits surged 50% amid the coronavirus pandemic, according Frost and Sullivan consultants
• Telehealth spending could grow to $250 billion a year, according to McKinsey and Co report
• Surveys have revealed favorable patient satisfaction
• Reimbursement remains the same as in-person visits although many believe this will change
• As compared to in-person visits, operational expenses may be reduced by 10% with telemedicine
• The telehealth market is estimated to grow seven-fold by 2025*
Key Statistics and Telemedicine
*Source: https://www.modernhealthcare.com/technology/virtual-care-transformational-change-agent-this-moment-demands
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Leveraging Telehealth for Value-Based Care
• Patient Experience: Serves as additional capacity to physician offices and offers patients/members greater convenience, flexibility and extended hoursAccess
• Personal Outreach: Another avenue to perform outreach and management of attributed populations allowing for face-to-face follow-up on gaps in care, condition and disease management, coordination of health care services and personalizing the relationship with the care managers
Care Coordination
• Visual Monitoring: As patients move among care settings, telehealth can be an efficient median to outreach to patients, monitor post discharge health, perform care hands-offs and educate patients on their continuing care needs
Transitions in Care
• Cost Efficiencies: Telehealth is a low-cost setting to provide the right care at the right time in the right setting by the right provider. Keeps patients from seeking care outside the system. APPs are a key resource for telehealth.
Cost Control
• Value-based Payments: Provides additional opportunities to increase provider reimbursement both FFS visit revenue and potential VBC incentivesReimbursement
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Telehealth’s Impact on Healthcare Delivery
• Work-life balance
• Expand access opportunities
• Safety and wellness
• Compensation and incentive payments
Provider
• Safety, convenience
• Care delivery and access
• Telemedicine
• Innovation and technology
Patient
• Reputation
• Satisfaction scores
• Quality scores (i.e., MIPS and ACO)
• Coding (i.e., HCCs)
Value-based Care
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Current Challenges with Telemedicine
Telehealth technology exists but may not be integrated with the EHR
Unclear how telehealth will impact patient quality, including data aggregation and normalization
Provider productivity can be higher than in-person visits, however, planning and care delivery model redesign is a must
Long-term telehealth reimbursement is still unknown
Long-term reimbursement for telehealth services and patient financial hardship concerns
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Financial Categories of Telehealth Performance
10
• Labor
• Supplies
• Surge Capacity
• Drugs/Vaccines
Expenses
• COVID-19 Cases
• Elective Surgeries
• Perioperative Assessments
• Ambulatory Visits
Revenues
• Emergencies
• COVID-19 Cases
• Non COVID Cases
• Inpatient
• Elective
• Consultations
Volumes
• Government Relief
• Accelerated Payment
• Loans
• Payer Assistance
Subsidies / Loans
Calculate cash flow and impact on margins
Case Study: Valley Medical GroupJosette Portalatin, Assistant Vice President, Revenue Cycle, Valley Health System
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Lessons Learned and Future Opportunities
1.
Launching Telehealth
2.
Provider and Staff Education
3.
Coding/Billing (and Auditing)
4.
Operational Workflows
5.
Financial Policies
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• Prepare to continue telemedicine as a way of daily work and service
• As the reimbursement may change after our pandemic, our processes will be efficient and in compliance
• Our experience will take us to the next journey of medicine!
Future State of Telemedicine
Data Integration and KPIs
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• Aggregation and normalization of clinical data
• In the system and across the entire system
• Semantically normalized longitudinal clinical record
• ONC/CMS regulations to make payer data interoperable
• Predictive or even prescriptive models
• Machine learning algorithms across the data set
• Care management - information from physical and virtual encounters
• Encounter mix tracking
Data Advancing Telehealth
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• Post discharge monitoring of patients and provider appointments
• ONC/CMS rules on provider interoperability with ADTs to show patient movement among systems
• Data collected such as vitals from health devices at home
• Data collected from wearables that provide vitals information
Remote Patient Monitoring
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Changes disrupt the business model by mixing encounter types
Business Model Impact
Revenue cycle
• Billing and coding
• Value-based contracts
Cost
• Need to target expense optimization
Referrals
• Referral patterns in a virtual world
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Top 10 Key Performance Indicators (KPIs)
In-person visit Telehealth visit
Target Actual Target Actual
1. Encounter Mix 00% 00% 00% 00%
2. Charges and Revenue $00 $00 $00 $00
3. Average payment per visit $00 $00 $00 $00
4. Denial rate 00% 00% 00% 00%
5. Cancellation and no-show rate 00% 00% 00% 00%
6. Wait time 00 min 00 min 00 min 00 min
7. Consultation time 00 min 00 min 00 min 00 min
8. Next and third available appointment 0.0 / 0.0 days 0.0 / 0.0 days 0.0 / 0.0 days 0.0 / 0.0 days
9. Patient satisfaction scores and
retention rate 00% 00% 00% 00%
10. Collected patient-provided
information (remote-monitoring) 00% 00% 00% 00%
Future of Telehealth
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1. How will telehealth services impact overall group’s revenue? Should it be viewed as an additive (or replacement) revenue stream?
2. How should providers protect reimbursement from governmental and commercial payers? What contract negotiation opportunities may exist?
3. How will telehealth impact patient and provider satisfaction?
4. How will telehealth continue to support innovation such as telemonitoring, wearables and other sources of electronic health data?
5. How will telehealth impact value-based care and alternative payment models?
Telehealth After COVID-19
20
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• Telehealth is on the fast-track and will continue to expand
• An effective process must be created to best support providers and patients
• Financial leaders must identify and track key performance indicators for sustained financial success
• The new healthcare economy will unquestionably include virtual care
Summary