Perspectives on Telehealth

Policy and Reimbursement

Physician Focus Group

Problem Statement

Often reimbursement is noted as a barrier to adoption of

new and novel technologies including mobile health.

HIMSS organized a group of distinguished physicians to

discuss the state of telehealth reimbursement.

The group addressed the following key areas:

1. Reimbursement Issues

2. Concerns Regarding Quality and Patient Safety

3. Opportunities to Better Leverage Technology

• Identify barriers to adoption in light of the growing availability of novel mHealth technologies.

• Compare and contrast reimbursement, policy and regulatory issues between traditional telehealth models and new alternative and concierge models of healthcare delivery.

• Identify areas and opportunities (both financial and technological) for physicians to better leverage and implement technology in the delivery of healthcare.

Primary Objectives of Focus Group

• Payment

– Greatest barrier to use

– Lack of appropriate reimbursement models for effort

• Technology

– Innovation is still evolving, need improvements in hardware

– Lack of flexibility in application of technology

– Rural connectivity – wireline and wireless improvements for

coverage and access

• Regulatory

– Ability for policy to keep current

Perceived Barriers to Increased Use of Telehealth and mHealth

Perceived Barriers to Increased Use of Telemedicine and mHealth

• Clinical

– Validity and effectiveness of interventions

– Consumer acceptance

– Increased virtual access could lead to potential over utilization

– Quality of services provided in virtual encounters

– Confusing to implement based on specialty

– Visit documentation and EHR integration needed to support

continuity of care

• Ability for policy to keep current with technological advancements

• Scope of service, prescribing regulations

• Definitions of practice, i.e., what constitutes a provider encounter or establishment of relationship

• Data storage of virtual encounter: length of retention

• Documentation requirements for payment in emerging

models of care

Reimbursement, Policy, and Regulatory Issues

• Reimbursement

- Hampered by CMS and Congressional Budget Office (CBO)(scoring). CBO scoring lacks comprehensive understanding of care delivery, overestimates potential cost(s), benefits not well studied

- Reimbursement restrictions: Need to remove reimbursement restrictions, i.e., only beneficiaries in a health professional shortage area (HPSA) or not in a metropolitan statistical area (MSA) eligible

• BIPA 2000 study request of CMS did not occur – CMS reimbursed only $12 million in telehealth claims nationwide in 2013

Reimbursement, Policy, and Regulatory Issues

Recommendations & Opportunities

• Communication with state Medical Boards and

legislators should be enhanced

• Expand Medicaid coverage models

• State HIE models should facilitate telehealth collaborations

• States can and should submit a State Plan Amendment to

include telehealth for dual eligibles

• Consideration (by Medicaid) for removing State Plan

Amendment in the event telehealth or remote patient

monitoring services are employed for Dual Eligibles

• Interstate Licensure – Must be modified to optimize utility of

telehealth

•

State Reimbursement, Policy, and Regulatory - Recommendations

• Streamline and improve FCC Universal Service Fund (USF) for healthcare – example covers EMS providers

• Include telehealth in Meaningful Use

• Medicare should provide broader coverage for CPT codes of care coordination and remote patient monitoring

• Ensure CMMI (Center for Medicare & Medicaid Innovation) explores the implementation and adoption of telehealth and mHealth and validates their technological and financial benefits to improving healthcare delivery

Federal Reimbursement, Policy, and Regulatory – Recommendations

• Expanded use of mobile and wireless technology as an intermediary and an adjunct between visits

• Patient empowerment and engagement

• Need to expand definitions of originating sites to other locations of care i.e. patient’s home or long term care facility

Clinical – Opportunities

• Educational programs needed for all clinical stakeholders about the utility of telehealth

• Introduce the use of technology (telehealth & mHealth) and billing into medical education

• Training needed in virtual visit communication and analysis

• Federation of State Medical Boards (FSMB) unifies physician practices among states, no similar body for other providers

• Work with the specialty societies to develop practice guidelines for the appropriate provision of telehealth particularly for the direct to consumer models; practice guidelines will also help establish credibility with payers

Educational – Opportunities

• Provide standardized training to providers and medical billers which enables better understanding of telehealth reimbursement opportunities

• Expanded industry dialogue on bringing forth requests for new CPT Codes for new or existing procedures

• Specifically, work with AMA to help determine opportunities to define services and better understand coding and valuation processes

Educational/Financial – Opportunities

Name Title Affiliation

Ricky Bloomfield, MD Director, Mobile Technology Strategy Assistant

Professor, Internal Medicine-Pediatrics

Duke Medicine

Duke Medicine

Guenevere Burke, MD Department of Emergency Medicine

GW Medical Faculty Associates

George Washington University

Harry Greenspun, MD Director Deloitte Center for Health Solutions

Peter Hollmann, MD Chair, CPT Editorial Panel American Medical Association

Shaiv Kapadia, MD Shaiv Kapadia, MD FACC

Principal and Founder

C3 Nexus

Susie Lew, MD Professor of Medicine; Division of Renal Diseases and

Hypertension

George Washington University

Karen S. Rheuban, MD Senior Associate Dean for CME and External Affairs

Medical Director, Office of Telemedicine

University of Virginia

Brian Rothman, MD Medical Director, Perioperative Vanderbilt University Medical Center

Neal Sikka, MD Associate Professor

Chief, Section of Innovative Practice & Telehealth

Department of Emergency Medicine

GW Medical Faculty Associates

George Washington University

Nick van Terheyden, MD Chief Medical Information Officer Nuance Communications

Contributors

Name Title Affiliation

Rebecca Kartje, MD, MBA University of Illinois at Chicago

Karen Remley, MD, MBA, FAAP Chief Medical Director – Virginia Anthem Blue Cross and Blue Shield

Douglas Smith, MD, LTC, FACEP Executive Vice President Emcare

Reviewers

Staff

Name Title Affiliation

Robert Jarrin, JD Senior Director, Govt. Affairs

HIMSS mHealth Committee Chair (volunteer)

Qualcomm Incorporated

David Collins, MHA, CPHQ,

CPHIMS, FHIMSS

Senior Director, Health Information Systems HIMSS

Thomas Martin, Ph.D., MBA Director, Health Information Systems HIMSS