Telemedicine Metrics: 10 KPIs to Maximize Effectiveness

Telemedicine Metrics: 10 KPIs to Maximize Effectiveness

Daniel Marino, Rick Howard and Josette Portalatin

August 12, 2020

Telemedicine Metrics | Aug. 12, 2020 2

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


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


• 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


• 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

https://www.modernhealthcare.com/technology/virtual-care-transformational-change-agent-this-moment-demands


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


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


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


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


Lessons Learned and Future Opportunities

1.

Launching Telehealth

2.

Provider and Staff Education

3.

Coding/Billing (and Auditing)

4.

Operational Workflows

5.

Financial Policies


• 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


• 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


• 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


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


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


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


• 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

Documents

Telemedicine Metrics: 10 KPIs to Maximize Effectiveness