Transcript Session Title April 24, 2015 (GEN

2015 User Conference
TeleMedicine to Compete with RBCs
April 24, 2015 (GEN-A33)
Presented by:
Susan Kressly, MD FAAP, Medical Director
Sally Texidor, Training Specialist
General Session
Touch Points
▪ A look back: Telehealth history
▪ Why Telehealth?
▪ How can Telehealth be used to extend the Patient
Centered Medical Home?
▪ Painting the picture: Case studies
▪ Identify barriers to implementing Telehealth
2015 Office Practicum User Conference
A Look Back...
2015 Office Practicum User Conference
A Look Back...
1960s
2015 Office Practicum User Conference
A Look Back...
“Telemedicine is the use of electronic communications
and information technologies to provide clinical services
when participants are at different locations.”
-American Telemedicine Association
Telehealth literally means “Healing at a distance.”
2015 Office Practicum User Conference
The AAP’s History on Telehealth
▪ Started as the “Section on Telephone Care”
▪ 1990’s saw a major launch of “after hours” call
centers & AAP members were concerned about
quality of advice
▪ Now believed that nearly 30% of pediatric care is
provided via electronic visits, among which telephone
care is primary, but advanced technologies are
becoming more widespread
▪ AAP changed the name to the “Section on Telehealth
Care”
2015 Office Practicum User Conference
Why Telehealth?
2015 Office Practicum User Conference
Are Patients Interested in Telehealth?
▪ A Software Advice Survey revealed:
▪ 75% of patients who have never used
telemedicine said they were interested in trying
such services in place of an in-person medical
visit
▪ 39% of those above said they were “extremely” or
“very” interested
▪ 71% of all respondents claimed they would
“strongly prefer” or “somewhat prefer” online care
for minor medical ailments
▪ Only 6% of respondents said they saw no benefits
to telemedicine
2015 Office Practicum User Conference
Why are Patients Interested?
▪ Convenience
▪ Don’t have to travel
▪ Access to care outside “routine office hours”
▪ Removes burden of missing work/school
▪ For many problems, they view the experience as
having equal quality of care
▪ Potential lower cost to patient
▪ Why isn’t this done already?
2015 Office Practicum User Conference
Why are Payers Interested?
▪ Both public (Medicare/Medicaid) interested
▪ Reduced costs related to
▪ Unnecessary ER visits
▪ Unnecessary Urgent Care visits
▪ Improved access to care
▪ For specialties without adequate number of
providers in a geography
▪ To expand specialty network “virtually”
▪ Marketing advantage to employers
2015 Office Practicum User Conference
Why are Employers Interested?
▪ Reduce overall healthcare costs associated with:
▪ Unnecessary ER visits
▪ Unnecessary Urgent care visits for employee and
family members
▪ Reduce employee absence from work
▪ For office visits for self and family
▪ Evening access may allow more rapid return to
work during illness
▪ Overall employee health/wellness = more
productive/less costly workforce
2015 Office Practicum User Conference
Employer Savings
The Kiosk Will See You Now...
Why are Communities Interested?
▪ Opportunities to connect care/services
▪ Schools/daycares to medical homes
▪ Mental health visits
▪ Visiting nurse services connect to specialists and
medical homes
▪ Integrated payment models to reduce total healthcare
spending (ACO and other models)
▪ Overall wellness programs
▪ Patient communities with shared conditions such
as obesity, heart failure, asthma collaboratives
▪ Improved community overall health decreases
public service costs and improves productivity
2015 Office Practicum User Conference
Why should YOU be interested?
▪ Our patients and other stakeholders are demanding it
▪ As pediatricians, young families are the most
comfortable with technology and demand innovation
▪ Others are filling the void
▪ It threatens the medical home
2015 Office Practicum User Conference
Extending the Medical Home
▪ Patient in your office
▪ Connect with specialist for consult
▪ Connect with specialist for coordination of shared
patient care
▪ Patient at daycare or school
▪ Connect with your office to discuss care of chronic
disease or change in baseline
▪ Consult with your office regarding acute care
recommendations
▪ Patient at home/traveling
▪ Useful for follow-up visits
▪ More effective triage
2015 Office Practicum User Conference
Case Study 1: Chronic Disease
SL is a 4 year old with special healthcare needs you
have known since birth. He has a chromosomal
abnormality and pulmonary compromise requiring
ventilator dependence.
Both of his parents work outside the home, he has
nursing care for 18 hours per day and his specialists at
the tertiary care center are 2 hours away.
How might telehealth improve care for your patient?
2015 Office Practicum User Conference
Case 1: Improving Care Coordination
The home nurse notices he has some redness around
his tracheostomy site.
▪ Would you bring this patient to the office for a
visit with all of the transportation difficulties this
requires?
▪ Or arrange a telehealth visit with the nurse, mother
and your office to make an evaluation. The virtual
visit shows the patient is at his baseline with
minimal erythema. The nurse collects a
culture, drops off at the office for processing
and you arrange for a follow-up virtual visit in
2 days.
2015 Office Practicum User Conference
Case 1: Medical Home to Specialist
The same patient is in your office due to parental
concern of thicker secretions and increased PM oxygen
requirement. On exam you note rales and mild increase
in work of breathing. Do you....
▪ Instruct the parents to take him to your local ED
where he will be likely transported to the Children’s
Hospital ED 2 hours away and maybe sent home?
▪ Or arrange a telehealth visit with his pulmonologist at
the Children’s Hospital and agree to get a sputum
sample, increase his ventilatory support and start
empiric antibiotics
▪ AND, the pulmonologist arranges to have a virtual
visit with the home care nurse the next day?
2015 Office Practicum User Conference
Case 2: Medical Home Follow-up Visit
GA is a 14 year old male who you have been managing
for depression for 15 months. You see him in the office
and he says he is having trouble sleeping, his grades are
falling but he is not suicidal. You adjust his medications
and want to reconnect in 10 days. Do you....
▪ Struggle to find a mutually agreeable time in your
schedule where he can get a ride to the office for a
follow-up visit
▪ Or he and his mother agree to a virtual visit in 10
days connecting you in your office and the patient in
his home where you ask him to show you where he
studies, sleeps, etc?
2015 Office Practicum User Conference
Case 3: Acute Care of the Established Patient
EW is 20 months and the youngest of 4
children in a family well known to your
practice. It’s Friday night (your office is
closed) and the parents call you from
outside the Urgent Care center where they
have come because they have an 8 AM
flight for vacation and EW has a rash.
There is a 1 hour wait to be seen, and the
parents think it is probably nothing
(because she is acting fine now), but she
had a high fever for the prior 4 days.
2015 Office Practicum User Conference
Case 3: Acute Care of the Established Patient
Do you.....
▪ Advise them to wait to be seen at the Urgent Care?
▪ Interrupt family game night at home and tell them to
meet you at your office?
▪ Or, offer a virtual visit where you recognize the rash
as classical roseola, give them appropriate advice
and wish them a terrific vacation.
2015 Office Practicum User Conference
Barriers to Implementing Telehealth
▪
▪
▪
▪
▪
▪
Practice attitudes
Patient attitudes
Medico-legal considerations
Technology
Payment
Logistics
2015 Office Practicum User Conference
Attitudes
▪ Does your staff embrace new, innovative
ideas and technology?
▪ Do your patients embrace new, innovative
ideas and technology?
2015 Office Practicum User Conference
Medico-Legal Considerations
▪ All care, including telephone and web advice
▪
▪
▪
▪
▪
▪
has associated risks
Identify them and minimize the risks where
possible
Use Telehealth resources for assistance
Discuss with your malpractice carrier
Reduced risk with established patients where
you already have a relationship
State licensing issues
Medical Home has the ability to change
from a virtual visit to a face-to face one!
2015 Office Practicum User Conference
Technology Barriers
▪ Privacy/security barriers being overcome
▪ Multiple companies entering the telehealth
technology space
▪ Video recording capture/storing vs
capture/storing of logistical elements of visit
(time, person, length of connection,etc.)
▪ Firewall issues within networks
▪ Integration into EHR?
2015 Office Practicum User Conference
Payment Barriers
▪ Definition of “face-to-face”
▪ Some current payment systems exist “outside” the
health insurer/payer system
▪ employer sponsored
▪ direct-to-consumer payment model
▪ Current “GT” modifier defines connecting with the
patient in “another healthcare facility”
▪ works for connecting the medical home with the
specialist
▪ needs to be broadened or new code for allowing
for meeting the patient “wherever they may be”
2015 Office Practicum User Conference
Logistics Barriers
▪ What devices will we use in the office and at home?
▪ How will we schedule these visits?
▪ Will we use telehealth to extend our work day without
need for extra staff?
▪ Will we use it for triage or just follow-up?
▪ How will we make sure the patients have the
appropriate technology on their end?
▪ How will we define and limit “no shows?”
▪ How will we document these visits?
2015 Office Practicum User Conference
What is the AAP doing about Telehealth?
2015 Office Practicum User Conference
What is the AAP doing about Telehealth?
▪ #3 Priority from the Annual Leadership Forum. The
Board of Directors MUST respond.
▪ Business Case for Telehealth in process of review by
AAP Board of Directors
▪ Committee on Coding and Nomenclature developing
and advocating for specific CPT codes with
appropriate RVUs
▪ Section on Telehealth developing tools and
educational materials to assist members
▪ Dr. James Perrin, immediate AAP past-president
heading up efforts on practice transformation which
include telehealth and collaborative extension of the
medical home
2015 Office Practicum User Conference
Challenge:
How might you
incorporate Telehealth in
your practice?
2015 Office Practicum User Conference
Resources
▪ Telehealth Resource Center
▪ American Telemedicine Association
▪ AHRQ: Telemedicine Connects Kids, Docs for
Better Care
▪ American Academy of Pediatrics: Section on
Telehealthcare
2015 Office Practicum User Conference
Questions
?
2015 Office Practicum User Conference
We want your feedback!
2015 Office Practicum User Conference