HHS Telemedicine Hack
Week 8: Office Hours #4— Clinical Best Practices
September 9, 2020
7Saving Lives. Protecting Americans.
• 10-week learning community to accelerate telemedicine implementation for ambulatory care providers
• Peer-to-peer learning
Case studies and discussion boards
Modeled after CMS-led learning collaboratives (e.g., Transforming Clinical Practice Initiative)
• Inclusive and diverse
All ambulatory care providers invited to participate
• Designed as 10-week sprint
Urgency due to public health need
Optimize telemedicine readiness in anticipation of fall COVID-19 surge
GOAL: At least 90% of participants will have conducted and billed 1 or more video-based
telemedicine visits by September 30, 2020
Welcome to Telemedicine (TM) Hack!
8Saving Lives. Protecting Americans.
“HHS Telemedicine Hack” Curriculum
Session #1: Telemedicine– Where Do I Start?
July 22nd, 12-1PM ET
Session #2: Workflows & Documentation
August 5th, 12-1PM ET
Session #3: Overview of Telehealth Billing & Reimbursement Policies
August 19th, 12-1PM ET
Session #4: Clinical Best Practices & the Art of the Tele-Physical Exam
September 2nd, 12-1PM ET
Session #5: The New Normal– Making Telemedicine Part of Your Permanent Practice
September 16th, 12-1PM ET
You are here
Office Hours # 1July 29th, 12-1PM ET
Office Hours # 2August 12th, 12-1PM ET
Office Hours # 3August 26th, 12-1PM ET
Office Hours # 4September 9th, 12-1PM ET
Office Hours # 5September 23rd, 12-1PM ET
GOALAt least 90% of participants will have conducted and billed 1 or more video-based telemedicine visits by
September 30, 2020
9Saving Lives. Protecting Americans.
“HHS Telemedicine Hack” Data Use
• Project ECHO® collects registration, participation, questions/answers, chat comments, and poll responses for this program
and shares this data with HHS/ASPR. Your individual data will be kept confidential. These data may be used for reports,
maps, communications, surveys, quality assurance, evaluation, research, and to inform new initiatives
10Saving Lives. Protecting Americans.
Logistics
• Use Q&A function on Zoom for questions and comments for speakers
• Use Chat function on Zoom for technical/logistical issues
• This session is being recorded. Your attendance is consent to be recorded.
• CME/Continuing Professional Development (CPD) credits—Link is in today’s Project ECHO email announcement and will also
be placed in the Chat at end of session.
11Saving Lives. Protecting Americans.
Today’s Agenda• Case #1: Innovative Telehealth Services at a Rural FQHC – Darrick Nelson, MD—Chief Medical Officer, Hidalgo Medical Services, Silver City,
NM (10 min)
Q&A Follow-up (5 min)
• Ask Our Panelists Your Clinical Best Practices Questions (35 min) – Moderated by Dr. Christian Ramers. Panelists are:
Darrick Nelson, MD—Chief Medical Officer, Hidalgo Medical Services, Silver City, NM
Dale Alverson, MD— Past ATA President, Professor Emeritus, University of New Mexico, Albuquerque, NM
Susan Kressly, MD, FAAP—American Academy of Pediatrics, Warrington, PA
Andrew Watson, MD, MLitt, FACS— Past ATA President, Assistant Professor of Surgery, UPMC, Pittsburgh, PA
Aileen Deogracias, OTR/L—Owner and Occupational Therapist, Therapy Works, PC, Lawrenceville, GA
Tina Gustin, DNP, CNS, RN—Assistant Professor, Director of the Center for Telehealth Innovation, Education, and Research, Old Dominion University, Norfolk, VA
Patrick Hawkins, DNP, ANP, NP-C— Adult Nephrology Nurse Practitioner, Kidney Disease and Hypertension Consultants, Flint, MI
Carolyn Rutledge, PhD, FNP-BC—Professor, Associate Chair of Nursing, Old Dominion University, Norfolk, VA
John Scott, MD, MSc – Professor of Medicine, Medical Director of Digital Health, UW Medicine, Seattle, WA
Kathy Wibberly, PhD—Director, Mid-Atlantic Telehealth Resource Center, Charlottesville, VA
Two TRC staff—Janine Gracy (Heartland TRC) and Elizabeth Krupinski (SWTRC)— will answer questions in Q&A box that are not posed to the panel.
12Saving Lives. Protecting Americans.
Case #1: Innovative Telehealth Services at a Rural
FQHC
Darrick Nelson, MD
Chief Medical Officer and Program Director
Hidalgo Medical Services
Silver City, NM
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CASE STUDY: Background
Population: Rural and Frontier, ~ 35k
population spread over 7,414 mi² (19,202
km²)
Services: FQHC, Primary Medical, Mental
Health, Dental and Family Support Services
and Family Medicine Residency Program
Telemedicine Before COVID: <5% of
Mental Health visits and 0% Medical visits
Telemedicine Now: 76% of Mental Health
visits and ~30% Medical visits
H i d a l g o M e d i c a l S e r v i c e s
My telemedicine lifehacks are…
1. Communicate often with patients about availability of telehealth visits
2. Find innovative ways to take advantage of telehealth technology
[MAPS OR PHOTOS of practice area]
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Impact of Billable Encounters
0
50
100
150
200
250
300
350
400
450
20-Jan 10-Mar 29-Apr 18-Jun 7-Aug 26-Sep
Billable
24% Decrease
Beginning 3/13/2020
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Weekly Telehealth Visits
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Safety in COVID-19
• Patients arriving at our clinics are screened for
influenza-like symptoms
If positive screen, patients are offered
telehealth visit from their car
If test is needed, patients tested from car
17Saving Lives. Protecting Americans.
Telehealth and + COVID-19
• If an HMS patient is positive for COVID-19
Patient is offered Telehealth visit within 24 hours
of positive test notification
A second Telehealth follow-up visit is offered for
4-7 days after first visit
Additional visits as necessary
Feedback from + patients early in the pandemic
indicated that after they were notified of + test, they felt
isolated and forgotten about
18Saving Lives. Protecting Americans.
Mental Health and Telehealth
0
50
100
150
200
250
300
350
400
450
500
3/25 3/30 4/6 4/13 4/20 4/27 5/4 5/11 5/18 5/25 6/1 6/8 6/15 6/22 6/29 7/6 7/13 7/20 7/27 8/3 8/10 8/17 8/24
Total
Face to Face
Televideo
Telephonic
Telephonic and Televideo visits account for 76% of Mental Health visits
19Saving Lives. Protecting Americans.
Innovative Telehealth Services (Pediatrics)
• Pediatrician working from home due to high risk of
morbidity or mortality
Children come in to clinic as usual
Medical Assistant rooms patient and connects
with Pediatrician via televideo
MA uses EKO digital stethoscope and
Pediatrician listens to heart and lungs remotely
MA uses Firefly Otoscope while pediatrician
conducts video exam
20Saving Lives. Protecting Americans.
Innovative Telehealth Services (Medication Assisted Treatment for Opioid Use
Disorder)
• Some stable patients receiving medication
assisted treatment (MAT), commonly called
“Suboxone” therapy, may benefit from telehealth
Decrease distant travel
Decrease undue risk of exposure
May increase compliance
Relapse and overdose rates are increasing!
https://www.ama-assn.org/system/files/2020-
08/issue-brief-increases-in-opioid-related-
overdose.pdf
21Saving Lives. Protecting Americans.
HMS Future and Telehealth
• We intend to expand patient access with telehealth
Offer after hour and weekend telehealth visits to our patients
Decrease unnecessary ER visits
Decrease costs to the healthcare system
Decrease unnecessary travel
Increase patient satisfaction
Improve quality of care
Commercial insurers already offer telehealth visits for their members in order to
satisfy the above points
Why not accomplish the same with the PCP?
22Saving Lives. Protecting Americans.
Your Telemedicine Questions,
Answered
Please submit your questions through the Q&A box
23Saving Lives. Protecting Americans.
TRAIN is Your One-Stop Shop for TM Hack Resources
• Visit www.train.org
Login if you have an account, or create an account if you don’t have one
• To access discussion boards, slides, and recordings
Click on “Your Profile” (under Your Name on the top right) to access the “Manage Groups” screen
Enter “TMHACK” under “Join by Group Code”
Save your profile and then click the Discussions tab
Click here for a TRAIN User Guide with step-by-step instructions
• Other TRAIN benefits
HHS training certificate, if you complete 8/10 TM Hack sessions
Access to other trainings, including COVID-19 resources
24Saving Lives. Protecting Americans.
TRAIN Discussion Boards
• Discussion Boards (n=11)
Slides, Recordings, and Session Materials
8 topical boards
Getting Started in Telemedicine (Week 1)
Workflows & Integration (Week 3)
Regulations, Compliance, and Documentation (Weeks 3 & 5)
Billing Policy, Coding, and Reimbursements (Week 5)
Scaling Up & Sustainability (Week 9)
Equitable Access
Miscellaneous
Technology
Specialty Connect
Telehealth Resource Centers (TRCs)
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TM Hack Updates
• Next week’s session (Week 9): “The New Normal: Tips to Make Telemedicine Part of Your Permanent Practice”
Didactic presented by a telehealth expert subject matter expert/internist from UW Medicine
Case presenters include: 1) Pediatric provider from a tribal healthcare facility in Anchorage, AK, and 2) Family medicine physician
assistant from an independent Rural Health Clinic in Shoshone, ID
• Week 10—Office Hours #5 (final TM Hack session)
26Saving Lives. Protecting Americans.
“HHS Telemedicine Hack” Curriculum
Session #1: Telemedicine– Where Do I Start?
July 22nd, 12-1PM ET
Session #2: Workflows & Documentation
August 5th, 12-1PM ET
Session #3: Overview of Telehealth Billing & Reimbursement Policies
August 19th, 12-1PM ET
Session #4: Clinical Best Practices & the Art of the Tele-Physical Exam
September 2nd, 12-1PM ET
Session #5: The New Normal– Making Telemedicine Part of Your Permanent Practice
September 16th, 12-1PM ET
You are here
Office Hours # 1July 29th, 12-1PM ET
Office Hours # 2August 12th, 12-1PM ET
Office Hours # 3August 26th, 12-1PM ET
Office Hours # 4September 9th, 12-1PM ET
Office Hours # 5September 23rd, 12-1PM ET
GOALAt least 90% of participants will have conducted and billed 1 or more video-based telemedicine visits by
September 30, 2020
27Saving Lives. Protecting Americans.
Pay It Forward
(Use this email to
reach TM Hack
organizers directly)
28Saving Lives. Protecting Americans.
TRC Picks—Frequently Used Telehealth Resources
• Telehealth COVID-19 Policies—Federal and State
• State Medicaid Telehealth Policies
• How to Select Technology–TTAC Tool Kits
• What to Expect in a Telehealth Visit (for patients)
• Telehealth Implementation Checklist
• FDA Medical Devices Fact Sheet