Removing Telehealth Barriers With National Licensing

Our new President is billed as a pragmatist, not a politician. That’s why healthcare leaders are calling on Mr. Trump to make medical license portability the law of the land.

In an open letter to the President from Federation of State Medical Boards (FSMB) CEO Humayun Chaudhry, the organization urged swift passage of the Interstate Medical Licensure Compact, which would simplify multi-state licensing and improve healthcare access, especially in rural and underserved communities. FSMB also asked the President to remove barriers to telehealth services, including those provided to military personnel and veterans.

President Trump has pledged to improve Veterans Affairs services, but he can’t fault the VA for its policy on medical licensure. The department already allows physicians to work in any of their facilities, even if they’re licensed in just a single state.

Mr. Trump has vowed to eliminate unnecessary regulations – and many would argue that state-by-state medical licensure falls into that category. If a New York physician wants to get licensed in nearby New Jersey and Connecticut, she must provide much of the same information and pay a hefty fee and yearly renewal for each application.

This places a special burden on Alaska and Hawaii – states that don’t share a border and are geographically distant. Patients in these states are often forced to fly to the lower 48 for care because many specialists feel it’s pointless to get licensure when their practices are thousands of miles away.

We’ve all heard about the organization Doctors Without Borders who provide free medical care around the globe. In the U.S., we urgently need doctors without state borders. National licensure would make doctors’ lives easier by eliminating red tape and expenses – and would improve patient care by making telehealth transparent nationwide.

Assessing Telehealth’s Value

A typical value-based care contract (VBC) is extremely complicated, but gauging the overall value something brings is much easier – and telehealth delivers amazing value.

Recently, at the American Association of Nurse Practitioners’ Specialty & Leadership Conference, family nurse practitioner Thanh Nguyen from Providence Health Express in Oregon noted that “we don’t know” what telehealth’s return on investment will be in the new value-based care model. Only about 40% of providers are even using VBC contracts, which means that six out of 10 providers are still using the fee-for-service approach.

But Nguyen is certain about one thing: telehealth is providing undeniable value every day. In her view, it’s saving lives and improving access to care while offering growth opportunities for nurse practitioners.

Nguyen feels that it’s now time for legislators and regulators to bring more telehealth value to clinicians – namely, getting paid for every hour worked.

In a recent speech, the American Medical Association’s immediate past president, Dr. Steven Stack, spoke about the need for a “quadruple aim”: adding “clinician satisfaction” to the current trio of improved access, better care and lower costs. “We need to restore joy to the practice of medicine,” he said – one way to do that is fair compensation for the long hours worked.

Current reimbursement policies don’t allow telehealth providers, like Nguyen, to get paid a penny for the time it takes to respond to patients’ emails. She’s licensed to practice only in Oregon and Washington, and she recently got burned by a Nevada patient who claimed to be visiting friends in Oregon. Ultimately, Nguyen had to waive her fee for the 20-minute session.

The healthcare industry’s journey to value-based care is a worthy effort, but it will only succeed when it brings real value to the clinicians who make it happen – and when it fairly compensates them for the care they provide via telehealth technology.

Survey Reveals Positive Views For Telehealth, Part II

From Ross Perot to the fictional J.R. Ewing from Dallas, business people rule the roost in Texas. And their powerful voices are providing strong tailwinds for telehealth in the Lone Star state.

The Texas Association of Business (TAB) recently published a report called “Telemedicine: The 21st Century Answer To The Call For Better Healthcare.” In our previous blog, we discussed why patients across Texas are pumped about the prospects for telehealth. Now let’s take a look at what influential business leaders are saying:

  • A Texas-size 77% favor using telehealth to diagnose common medical conditions.
  • 70% feel that access to providers has gotten more difficult in recent years.
  • 18% of Texas companies surveyed already offer telehealth as part of their health benefit programs.
  • Of that 18%, a unanimous 100% of the companies plan to continue offering telehealth benefits – and 24% plan to expand their current programs.
  • 66% received positive feedback on telehealth from their employees – and not a single employer received negative feedback.

States like Texas, California and New York are early adopters who greatly influence initiatives in the other 47 states. It’s not surprising that those three states have already passed telehealth parity laws, encouraging holdout states like Utah and Wisconsin to join their ranks.

When the Texas business community wants something, they get it – usually without delay and they’re demanding a wider use of telehealth technology. Why would J.R. Ewing drive from Dallas to Ft. Worth to see a specialist when telehealth is available?

Five Encouraging Trends

In certain fields, things seem to continuously trend upwards. That’s true with smartphones, where device ownership increased 30% in just the last four years. It’s also true for the Golden State Warriors basketball team, which saw its win totals increase from 51 to 67 to a record-setting 73 over the past three seasons.

We can now add telehealth to that list, where usage has increased by an astonishing 50 percent since 2013. Nearly 15 million people used telehealth services last year.

The ATA recently identified five trends that are creating favorable tailwinds for our industry:

  • More telehealth legislation – To date, 29 states and the District of Columbia have passed laws requiring commercial payers to cover telehealth. Eight more states are considering legislation this year.
  • Employers jump on the bandwagon – Telehealth is rapidly gaining popularity with employers like Nissan and Google that offer onsite health clinics. By 2018, many of these companies will use telehealth.
  • Older adults see the value of telehealth – People approaching Medicare age are quite comfortable with web surfing and smartphone apps. More than half of older adults say that “health information” is one of their primary reasons for digital engagement.
  • App adoption has doubled in the last three years – In 2013, only 16 percent of Americans had a health app on their smartphone. Now that number has doubled to 32 percent.
  • Medicaid is loosening distance requirements – 86 percent of states now cover Medicaid telehealth services statewide rather than imposing distance restrictions.

Many industries are envious of these positive trends. Fax machine manufacturers are no doubt having a lousy year. But things are definitely looking upbeat for the telehealth sector.

Five Telehealth Trends

Five Trends

Embracing The Network

There have been dozens of books published on how to “fix” healthcare, but probably one of the best is “Where Does It Hurt?: An Entrepreneur’s Guide To Fixing Healthcare” by Jonathan Bush (who also happens to be CEO and co-founder of healthcare software giant athenahealth).

In a recent article, Bush proclaimed that the “future of the hospital is the network.” He praised Mt. Sinai Hospital in New York for its marketing campaign headlined “If Our Beds Are Filled, It Means We’ve Failed.” Those ads show that Mt. Sinai is serious about moving away from isolated, intermittent care to continuous, coordinated care – a shift that Bush feels all hospitals should make.

Bush believes that successful hospitals are rapidly moving from the EHR-centric model, to the patient-centric world of cross-continuum connectedness, a/k/a the network. Telehealth is an integral part of that brave new world.

Telehealth is the arterial system that can connect acute care specialists, home health providers, Ambulatory Surgery Centers, imaging centers, and all points between. Bush foresees a day (coming soon) when a patient can get an immunization at a retail clinic, an outpatient surgery at an ASC, and a telehealth consultation at home all in a single week.

That’s the “right care, right time” mantra that has long been the guiding principle of telehealth.

Bush sees a bright future for telehealth because relying on a robust network is the only way to “unbreak” our healthcare system.

 

Telehealth Network

Telehealth Network

 

 

Oasis In The Desert

In a recent MarketWatch report, Phil Miller, from the physician search firm Merritt Hawkins, said that 65 million people in the U.S. live in what’s “essentially a primary care desert.” According to the latest Kaiser Family Foundation research, it’s not just a rural phenomenon. Rhode Island and Connecticut are struggling to find primary care physicians just as much as North Dakota and Nebraska.

 Telehealth technology and osteopathy may soon be providing an oasis in that desert. Telehealth can help improve primary care access in struggling states like Missouri, by leveraging the expertise of first-line physicians in states like Delaware, which are amply supplied. Meanwhile, osteopathic schools are starting to create long-distance alliances to solve the primary care shortage.

The educational requirements for an osteopath are nearly identical to an M.D. program – and more than half of young osteopaths go into primary care. That’s one of the reasons why the New York Institute of Technology recently created an osteopathic medical campus at Arkansas State University in Jonesboro. The first group of 115 students will begin classes this fall.

Innovative programs like these can go a long way toward reducing the projected primary care shortfall. The Association of American Medical Colleges estimates this could be as high as 31,000 physicians by 2025.

Telehealth technology is already helping to improve access to specialty care nationwide, which may encourage more medical students to consider a career in primary care. There’s still significant pressure on medical students to forsake primary care for the higher paying specialties in order to pay back six-figure college loans.

Until there are more incentives to enter primary care (perhaps government funded), telehealth can bring “water to the desert” by connecting patients with physician assistants, nurse practitioners and osteopaths who are ready to help.

 

Telehealth

Oasis in the Desert

Telehealth Serves The Neediest

Yenagoa, Nigeria, is about a 7-hour drive from Nigeria’s largest city, Lagos – and many of its residents weren’t able to get high-quality specialty care close to home. That is until the InTouch 7 (previously, RP-7) arrived.

Thanks to a grant from the Sonoma West Medical Center Foundation (SWMC), the Sebastopol, Calif., Sunrise Rotary Club and InTouch Health, who donated the robot and connectivity services, there’s now an InTouch 7 on-site at Federal Medical Center in Yenagoa. The Sonoma West grant also paid for six Nigerian doctors to travel to SWMC in Sebastopol for eight days of intensive InTouch 7 training.

The Federal Medical trainees can now consult easily with colleagues in California (and vice versa). SWMC Medical Director, Dr. James Gude, also taught the visiting group how to set up grand rounds training sessions so the students can return the favor and train others in Nigeria.

This type of transcontinental collaboration, though not yet common, is helping to save lives in some unlikely settings. Fast Company reports that Dr. Rogy Masri recently used telehealth technology to make a difficult diagnosis at a Syrian refugee camp in northern Lebanon.

The Syrian patient presented with an incredibly red lesion on one hand. The patient was suffering no pain or itching, yet the condition never improved. So Dr. Masri posted a photo on a telehealth app called Figure1 – and within hours, internal medicine resident Yusuf Dimas at St. Paul’s Hospital in Vancouver offered a diagnosis of Leishmaniasis, which soon proved correct.

The World Health Organization estimates that at least 400 million people worldwide lack access to basic healthcare – and some organizations feel that the actual number might be as high as 1.3 billion people.

By delivering expert care to underserved communities around the world, telehealth is making access more timely and affordable – especially for those most desperate for that care.

 

Refugee telehealth

Refugee Telehealth

 

 

The DigiPsych Revolution

The term “telepsychiatry” makes you think of those days when a movie star filming in New York would call a Beverly Hills shrink for a long-distance session.

Today, a land-line telephone is seldom used in remote mental health, so perhaps we should start using the expression “DigiPsychiatric” treatment. That term encompasses not just the traditional provider/patient session, but the enormous amount of data that can be collected (both actively and passively) to aid in diagnoses.

Here are some of the pressing problems that DigiPsych is helping to address:

  • Mental health is the third costliest health condition in America
  • Nearly 60 million Americans have a behavioral health condition, far more than can be treated in conventional brick-and-mortar locations
  • Patients who have a behavioral condition in tandem with a chronic disease cost the U.S. healthcare system 75 percent more than those with physical illnesses alone

There’s a lot of innovative work being done at the crossroads of telehealth and mobile mental health apps. For instance, Centerstone Research in Nashville gave smartphones and the Ginger.io app to patients in a recent pilot. The app was used to gather both active (patient-provided) and passive data gathered on sleep patterns, activity levels and communication trends (e.g., a patient who normally sends 20 texts per day is now sending none). The Centerstone program reduced the participants’ ER days by 23 percent and hospital days by 51 percent.

And we’re just beginning to tap the full potential of wearables like FitBit. In a recent study, a specially designed wearable was able to remotely detect patients’ use of opioids and cocaine in real-time.

In the past, a behavioral care provider had to guess whether a patient was abusing drugs or not sticking to treatment protocol. Now it’s possible to gather meaningful data 24/7 to eliminate the guesswork and greatly improve the quality of care. The DigiPsych revolution has just begun.

TeleBehavioral Session

TeleBehavioral Session

CCM’s Huge Potential

Last year, CMS began reimbursing providers about $42/month per patient for spending at least 20 minutes in non-face-to-face Chronic Care Management (CCM) consultations. Yet surprisingly, many providers – including telehealth clinicians – have been slow to take advantage of this supplemental source of revenue.

If a provider offers CCM-defined services to, say, 400 eligible Medicare patients per month, that’s bonus income of more than $200,000 per year. And in most cases, that revenue doesn’t affect reimbursement from Evaluation & Management (E&M) and other services. It’s additional income, pure and simple.

According to the National Chronic Care Survey, there were two major problems with last year’s rollout: many clinicians were spending up to 35 minutes per consultation (when only 20 is required) and about half the participating providers used registered nurses for the checkups (when less expensive clinicians could do the job).

As providers become more efficient in CCM care delivery, it’s likely to gain popularity rapidly this year. That means that CMS auditors will be paying close attention to ensure compliance – and that’s where telehealth has a key advantage: thorough documentation.

Telehealth software makes it easy to identify and document the clinician, patient and length of consultation for each CCM encounter. That’s more than enough to satisfy any Medicare auditor.

The chronically ill Medicare population is the fastest growing patient demographic – and CCM participants appreciate what telehealth delivers: high-caliber, interactive care that’s also very convenient. That gives telehealth a competitive edge because CCM enrollees get to choose their own providers.

It’s time to familiarize yourself with CPT code 99490. It’s the Chronic Care Management billing code that holds enormous promise for telehealth providers in 2016.

Chronic Care and Telehealth

Chronic Care Management

Time For FAST Action

Washington DC

Capital Building

In the run-up to an election year, a lot of praiseworthy legislation gets stalled in committee. That’s exactly what’s happened to Senate bill S1465 dubbed the “FAST Act”, which stands for “Furthering Access To Stroke Telemedicine” – a bill introduced by Sen. Mark Kirk (R-Illinois). There’s a similar bill in the House that’s also bottled up in committee.

The FAST Act would require Medicare to expand access to telestroke services regardless of the originating site. Medicare currently only reimburses for telestroke evaluations if the patient presents at a rural hospital, yet an estimated 94 percent of stroke patients present at either urban or surburban hospitals.

In a letter endorsing the bill, American Heart/Stroke Association president Mark Creager estimates that the FAST Act could result in net savings of $1.2 billion over ten years.

Nearly 800,000 Americans experience a stroke each year, and you’d think that Congress would expedite any legislation intended to help them. But that costs money – and lawmakers would prefer to kick the can as long as possible.

In recent years, Congress has gotten clogged with downright silly bills (creating a national jaywalking database for example). It’s a shame that something like the FAST Act – which can save countless lives and $100 million per year – remains in limbo when the Boys Town Commemorative Coin Act sails through.

Sen. John Thune (R-South Dakota) has signed on as a FAST Act co-sponsor, and we encourage lawmakers from both parties to join him. This is no time for business as usual. The FAST Act doesn’t deserve to die a slow death in committee.