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Telemedicine: Ready or not Here it Comes


By Cindy Lamar
Regional Director
Go Telecare


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Original Publish Date: February 9, 2016

A looming telemedicine crunch is coming. Telemedicine is here, the crisis will be for those providers not ready. On December 15, 2015, the National Law Review reported that Centers for Medicare & Medicaid Services (CMS), announced plans for 30 percent of Medicare payments to be made in alternative payment models by the end of 2016. That number will increase to 50 percent by the end of 2018. Additionally, CMS seeks to have 85 percent of Medicare fee-for-service payments in certain value-based purchasing categories by 2016 and up to 90 percent by 2018. The alternative payment models by and large pertain to telemedicine.

CMS has expanded its reimbursement for telemedicine effective January 1, 2016. CMS reimbursed for 74 codes in 2015. The number of codes increased to 80 in 2016. For a full list of reimbursable codes, go to https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.html.

Now What?

We can no longer wait to do something about telemedicine. We have a crisis in the patient to doctor ratios in that we cannot efficiently deliver the required level of care to all patients without using technology. Parity laws are in place, will you be ready? What will your future practice do when patients ask you about Telemedicine? If you don’t have it, will you lose your existing patient base, fail to grow and contain your costs?

If you are not searching for a telemedicine provider by now, I urge you to get it on your agenda as soon as possible. With 2018 being the landmark year that telemedicine will have widespread reimbursements per CMS policy. Let’s face it; telemedicine is a culture shift for your organization but It’s also an industrial shift. If you wait too long, you could be putting your stakeholders in a position of forced change.

You don’t want to be behind the curve in this shift, a simple path to success can be had by choosing a small population of patients in your network; start with them. Approaching the topic today can help you be proactive and carefully introduce change to make a smooth transition in the use of this technology. Don’t let this become a crisis management situation.

Here are some suggestions for uses:

Pre-op and Post-op surgical procedures: Surgical staff can give patients pre-op preparation instructions on telemedicine. As some surgery teams have experienced, patients may misinterpret or forget important instructions about stopping medications before the surgery. With clear instructions delivered prior to surgery, telemedicine reduces patient no shows and saves valuable scheduled operating room time.

For post-op patients, the use case is both clinical and educational. Physicians and staff can check the patient’s drains and bandages visually, confirming adequate wound healing with high-definition video. Through readily accessible remote monitoring and automated follow-ups, providers are empowered to deliver the guidance that many patients need as they go through the healing process. Continuous connection can ensure that patients are following their treatment plans as well creating needed adjustments. These virtual check-ins ensure the patient is on the road to recovery, reducing readmission rates all without the patient ever having to leave home.

Remote patient monitoring: Devices are now blue tooth enabled to remotely monitor chronic patient conditions and send the data directly to providers. If the readings are normal, then no further action is required. If the readings are outside of normal, then a telemedicine consultation between the provider and patient will help the provider understand what is happening with the patient. Often the issue can be addressed over the telemedicine consultation. On rare occasion the provider may want the patient to come in to be examined.

Large employers: When an employee needs to see their health provider, they often have to leave work, drive to the doctor’s office, wait to be seen, then return to work. This takes the employee away from work for hours and the employer loses their productivity. Employers are realizing the benefits of offering telemedicine consultations on their premises. The employee can see their provider and take 15 minutes out of their day instead of hours away. The employer pays for the visit as the cost/benefit factor is in their favor.

Senior Living Facilities: Providers, payers and other organizations should consider teaming up with senior living communities (SLC) on telemedicine to reduce visits to the emergency department. Studies show that patients living at communities that are more engaged with the technological advantages of telemedicine see a decrease in Emergency Room (ER) use, according to a study published in Telemedicine and e-Health.

The researchers, from the University of Rochester School of Medicine and Dentistry and the University of Wisconsin School of Medicine and Public Health, examined a total of 1,219 seniors. Of those, 479 received telemedicine care, while 740 did not. This demonstrates the under utilization of this technology in the past and SLC’s not truly understanding the benefits to their residents and staff. Notably, authors found that at the care communities where technology literacy and engagement was higher, more senior residents used telemedicine platforms to interact with their physicians. The report also noted that at the facilities with higher technological engagement, just under half of all seniors - around 45 percent - used telemedicine technology for e-health visits.

Perhaps most significantly, the researchers discovered that senior citizens living in care communities that are more engaged with health technology reported few incidences of going to the emergency department at a hospital for treatment. Consequently, researchers are hopeful that telemedicine solutions could help substantially reduce unnecessary hospital trips in the future, saving physicians and patients alike valuable time and money.

Skilled Nursing Facilities: Providers connecting with patients in SNFs via telemedicine can do so from their office, the comfort of their home, or while traveling. As long as the provider is licensed in the same state as the facility where the patient is located, the telemedicine visit is virtual and the provider can be anywhere. This is a great way to care for a population of patients efficiently thereby reducing expenses, increasing outcomes, and improving the patient experience.

Satellite Office. If your organization has a small satellite office, this is a great way to start. Offer telemedicine as an additional way for your patients to see your providers. Your telemedicine provider can help you with utilization and soon your organization recognizes the benefits.

Although the above is not a singular list, they are examples on how you can start to implement telemedicine into your future. The technology is here. Now is the time.

Cindy has been in the healthcare arena for over 18 years, largely in the capacity of CFO overseeing 15 assisted living facilities. She is currently the Regional Director for Go Telecare, a Telehealth and Medical Billing Company and can be reached at 360-909-7472 or cindy.lamar@gotelecare.com. See the Go Telecare web site at www.forewardhealthcare.com.