Discuss various telehealth modalitiesDiscuss

Review policies and regulations related to telehealthReview

Outline factors that DNP educated Providers and Executives need to consider when starting programsOutline

Present telehealth use casesPresent

Identify telehealth resources available to the DNPIdentify

Telemedicine Telehealth Connected Care

!Synchronous

!Asynchronous

!Remote Patient Monitoring

!Mobile Health

!Follow Up Visits

!Pre-Screenings

!Remote Experts

! In-Home Care

• Patient centric• Value-based• Integrated care

Telehealth is:

• High quality• Anytime, anywhere care• Cost effective

Enables providers to

deliver:

!Teams are NOT always co-located

!Telehealth can:

!Close communication gaps

!Enable comprehensive patient care

!Empower and increase confidence in team members

!Promote a team mentality

!Enhance provider knowledge

CONTINUM OF CARE

! PARITY LAW

! 49 states, and DC have some coverage for telehealth under Medicaid

! 32 states and DC have some form of parity law in place for private insurance

! 23 states and DC have full parity

! Missouri, Colorado, and Virginia require payment on the same basis as in-person

! RESTRICTIONS VARY BY STATE

! Used to establish valid provider-patient relationship

! Used after creating a valid provider-patient relationship

! Prescribe non-controlled substances

! Prescribe controlled substances

! CONSENT

! No written guidelines

!Medicaid encounters only

!Written or oral

! Verbal disclosure only

! EVERY STATE IS DIFFERENT

! Know your state policy

! Originating site limitations! Provider must be licensed in the state that the patient is located in

! Compact licensure laws! Applies to telehealth encounters across state lines

! Bordering State! Allows practice of medicine across border state when licensed in

state

! Follow-Up Care! Allows provider to provide follow up care to his or her patient in

another state

! Consultation! Allows an unlicensed MD to provide peer to peer consultation in

a state not licensed in

87%

Of respondents to 2014 survey DID NOT expect patients to be using telemedicine

76%

Of respondents to 2017 survey offer or plan to offer telemedicine survices

60%

Of telehealth cases are solved without an in-person visit

75%

Teleconsults led to a change in diagnosis and treatment

• Anticipated telehealth market by 2020$6.28 billion

• Homes have been wired for remote healthcare monitoring80,000

• Average cost of a telehealth visit$30• Average cost of an in-person visit$75

!Patients and caregivers rate their satisfaction with telehealth highly often above 90%

!70% of patients are comfortable communicating with their providers via text, email, or video rather than in-person

!When oriented elderly report ease of use

!Millennials expect telehealth services

!30% of patients check the internet for information on labs and diagnosis

!Expands stroke telemedicine beyond rural areas (2018)

!Expands telemedicine coverage to homes and independent renal dialysis facilities (2019)

!Allows providers to give free at-home telehealth technology equipment to dialysis patients if certain requirements are met (2020)

!Eliminates rural restrictions and adds the patient home as a qualifying originating site for certain Accountable Care Organizations (2020)

!University of Pittsburg Medical Center’s (UPMC)

!38 colorectal cases

!$5,000 case

!$190,000 in revenue

Florida Hospital! Implemented “round and respond”

patient monitoring in the ICU! Replaced the “around the clock”

intensivist model

! Tertiary hospital provides “round and respond” services to three community hospitals! Decreased LOS by 0.6 days

! Over $2 million in savings per year

UPMC Bedford Memorial! Everette PA (population 2,000)! 59 bed hospital! Allows patients to stay at facility

secondary to consultations! 173 telehealth consultations in one-

year! Cost Breakdown! Polycom Practitioner Cart $25,000! $32,000 billed services! Profit $7,000! 2.5 margin

Centura Health at Home (2010-2011)

! Pilot study for patients with:

! Congestive heart failure

! Chronic obstructive lung disease

! Diabetes

! 30-day admissions dropped 62%

! Saving an estimated $1,000-$1,500 per patient

!Pepsi offered telemedicine to employees

!400% ROI

!389 avoided ER trips

!$200,000 savings

! Long-Term Care! Telehealth consult that results in an avoided transfer to the hospital

! Peer to Peer Consultation! Rural NP consults with specialists at tertiary hospital to determine

patient care and disposition

!University of Iowa Study! Patients were seen six times more quickly in rural hospitals using

telemedicine in their ER’s than in those without

! Surgical Follow-Up! Patients that travel a distance for specialty surgery can be seen remotely for

the 30-60 day global visit

! School Based Telehealth! Children are seen by a NP from the school nurse via telehealth; orders can

be transmitted to the pharmacy immediately.

! Hurricane Harvey! Isolated individuals were seen remotely through TeleDoc and other platforms

while they were in shelters and other remote areas

! American Telemedicine Association (ATA) americantelemed.org

! Center for Telehealth and e-Health Law (CTeL) CTeL.org

! Society for Education and the Advancement of Research in Connected Health (SEARCH) searchsociety.org

! Telehealth Resource Centers (TRC) telehealthresourcecenter.org

! NONPF White Paper (2018)

! ANA Connected Health/Telehealth Professional Issues Panel (unpublished)

! Project ECHO

! eConsults

! Drones

! Holograms

! iPhone with EKG capabilities

! Conduct multicenter studies that show Return of Investment

! Research patient outcomes (patient satisfaction should not be the only question)

! Assure that end users are trained to conduct telehealth encounters

! Become policy advocates at your state level

! Consider “low hanging fruit” when starting programs

! Begin with inexpensive equipment

! Complete an assessment/gap analysis

! Train and/or certify staff including telehealth etiquette

! Strategically plan for integrating into current workflow

! Buy-in from clinicians, staff, & patients (find a champion)

! Determine your state rules and regulations

! Consider reimbursement issues

! Prepare to measure outcomes

! Choose a telehealth platform and equipment – cost, ease of use, clinic/patient/provider needs, tech support

! Pick a start date and pilot your model

! Enjoy using a new tool to provide health care services.

! Know the boundaries of telemedicine respective to your patient population and don’t cross it

! It is not a replacement for in-person visits, it is a supplement

! Use the type of services needed for your practice

! Think out of the box! Be creative! You know what the problems are!

Contact Information:tina.gustin@chkd.orgsgustin@odu.edu757-285-6215