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



“Discharge” Is An Illusion

Health systems and regulatory agencies compile mountains of hospital discharge data – and too often they consider a discharge to be a one-and-done event worthy of a marching band. But some health systems have realized that many patients are never fully discharged. They often move quickly – and invisibly – between inpatient, outpatient and post-acute settings.

Telehealth technology is proving to be a game-changer in this new world where hospital discharge is just a recovery phase, not a grand finale.

According to Modern Healthcare, the Hospital for Special Surgery in New York has developed a telehealth app that allows the staff to easily monitor patients after discharge. For example, clinicians can see how well patients are walking – and that visual confirmation is much more effective than a phone-based check-in.

Telehealth is also the ideal technology for connecting the dots. There are a lot of simple reasons why many patients boomerang back into acute care: not having a primary care physician, not sticking to a medication regimen, etc. A 30-year-old might be able to get away with that, but for seniors it can be a one-way ticket to readmission.

Telehealth technology ensures that physicians, case managers. pharmacists and patients are on the same page (or home page as the case may be).

For a patient recuperating from a stroke, pneumonia or heart attack, discharge isn’t a red-letter day like a college graduation. In the days and weeks following discharge, the care team has to share information every bit as effectively as a coaching staff in the Super Bowl. Every coach wears a headset – and every care coordination team should be using telehealth.


Hospital Discharge

Hospital Discharge



Behavioral Telehealth Is Booming

Thanks in part to the pioneering efforts of the Veterans Health Administration’s National Telemental Health Center, the number of remote behavioral care consultations is rising rapidly.

Behavioral care is a natural fit for telehealth because a psychiatric visit doesn’t require any physical examination, just face time. And many U.S. communities simply don’t have enough psychiatrists to meet the growing need. In fact, more than half the counties in America don’t have a single psychiatrist, psychologist or social worker. Here’s the scope of the problem:

  • About 25% of Americans (60 million people) experience mental illness each year
  • An estimated 80% of behavioral health patients present in EDs and primary care clinics, where providers often lack the training to diagnose and treat their conditions
  • 70% of EDs have a boarding time of up to 24 hours for patients waiting for an in-person behavioral health evaluation
  • Patients who have a mental illness in tandem with chronic physical conditions have healthcare costs up to 75 % higher than those dealing with physical ailments alone

Telehealth is a viable way to stem the crisis – and there are a host of new technologies and apps that are making a real difference. For example, behavioral care providers are now monitoring “passive data.” That’s where the patient uses a smartphone or FitBit-type device that captures a wealth of information on sleep patterns, movement (patient is isolating at home) and communication (patient is ignoring clinician emails). Armed with this data, behavioral care providers can often spot worrisome trends before they turn into full-blown depression or other disorders.

The public would be outraged if an ED patient had to wait 20 hours for a cardiac consultation. They should be equally outraged at the behavioral care bottleneck. Fortunately, telehealth technology is dramatically reducing that wait time while improving the quality of behavioral care across America.

TeleMental Health

TeleMental Health is Booming

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

2016 Telehealth Predictions

While some industries (like the petroleum business) are likely to have a dismal year ahead, the future has never been brighter for telehealth.

Here are some bold predictions from telehealth expert René Quashie, senior counsel in the healthcare practice at law firm Epstein Becker Green:

Strong momentum for licensure compacts – The Federation of State Medical Boards (FSMB) recently introduced an interstate physician licensure compact that 12 states have already enacted. And the National Council of State Boards of Nursing now has a draft compact that allows nurse practitioners to practice in any participating state with just a single license. Look for similar compacts to emerge in 2016.

Big Business buys in – According to the National Business Group on Health, 74 percent of large employers are expected to offer telehealth services in 2016 – up from 48 percent last year.

Telehealth accreditation takes off – Based on the groundbreaking accreditation programs from ATA and the Utilization Review Accreditation Commission (URAC), Quashie anticipates that health systems, health plans and telemedicine companies will develop additional telehealth accreditation programs in the year ahead.

Wearables market gains traction – Quashie notes that Soreon Research projects that the healthcare wearables market will hit the $41 billion mark by 2020. That will make it easier for telehealth clinicians to monitor conditions like diabetes, sleep disorders and cardiovascular disease.

Legislative progress continues – In 2015, more than 200 telehealth bills were introduced in 42 states. Look for more landmark legislation in the year ahead.

When you read Quashie’s full 2016 outlook, one thing is clear: telehealth is ringing in the New Year with industry-wide optimism.


Patient Access



Top 5 Reasons to Start a Telehealth Program in 2016

As we look forward to 2016, here are the top 5 reasons to start a telehealth program next year:

  1. Lower readmission ratesTelehealth is already playing a vital role in hospitals’ efforts to reduce unnecessary (and costly) readmissions.
  2. It’s a financial winner for health systems of all sizes. It’s easy to find fiscal rationales for just about any type of telehealth program. Here’s a detailed analysis of the financial advantages of an acute care telehealth program.
  3. Telehealth offers a competitive advantage. The market intelligence firm Open Minds recently published a report showing how health systems that offer telehealth services can gain a competitive edge over rivals that don’t.
  4. Tax advantages – Some not-for-profit health systems are already using Community Health Needs Assessments to redefine “community” to include remote care, thus protecting their tax-exempt status. It’s completely in line with the interoperable health IT ecosystem envisioned by the Office of the National Coordinator for Health Information Technology.
  5. Telehealth has unstoppable momentum. One by one, the barriers to telehealth are being lifted. Just before Thanksgiving, the National Association of Insurance Commissioners adopted model state legislation allowing telehealth to be used to meet adequacy standards for health plans’ provider networks. Next year, many states will enact the model legislation – and it paves the way for more states to join the 29 that have already passed telehealth parity laws.

Every health system has competing demands on its financial and clinical resources. But it’s hard to ignore these five compelling reasons to start a telehealth program without delay.


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.





Telehealth Combats Readmissions

In fiscal year 2016, 2,665 hospitals will receive lower Medicare reimbursements due to excessive readmissions within 30 days. But here’s the good news: 799 of those hospitals won’t be penalized at all – and your facility can join that elite club by skillfully using telehealth technology.

The number of penalized hospitals has been steadily increasing because CMS has added two new conditions – COPD and total hip/knee replacements – to the original trio of monitored conditions: heart attack, heart failure and pneumonia. The maximum Medicare withholding has risen to 3 percent – and only 38 hospitals reached that level in the last monitoring period. But even a 1 percent decline in Medicare reimbursement is a serious blow to any health system, large or small.

According to The Advisory Board, there are four key stages of care that determine whether a provider will incur or escape these penalties – and telehealth plays a vital role in two of them: post-acute care coordination and transitional care support.

At the recent Telehealth Innovation Forum, there were numerous presentations about how telehealth is improving post-acute care coordination across skilled nursing facilities, outpatient rehab, long-term care, home health and imaging centers.


Here’s how it worked before telehealth:

A patient would get discharged from the hospital, and the primary care physician often didn’t know about it for weeks, if ever. The skilled nursing facility had questions about the plan of care, but found it difficult to track down specialists. When patients finally went home, they were confused about when to make follow-up appointments – and with whom.

With telehealth technology, patients are better informed and clinicians know exactly who’s accountable every step of the way. The result: patient outcomes improve, hospital readmissions decline, and providers can provide follow-up care within Medicare’s 7- and 14-day timeframe in order to qualify for transitional care incentives. By CMS’s own estimates, timely transitional care can increase physicians’ revenue up to 4 percent.

The key to avoiding readmission penalties is to improve care across the continuum, not just talk about it. Telehealth is by far the best tool for accomplishing that.


Hospital Readmissions

Hospital Readmissions

Consumers Have Spoken

To say that healthcare consumers want convenience is like saying that Californians want rain. But a new Advisory Board survey shows that they don’t just want convenience – they crave it.

The survey found that 56 percent of healthcare consumers would gladly visit a retail clinic for episodic care (flu, cold, etc.) – and 42 percent would welcome an e-visit. In fact, access and convenience blew away every other category in the survey, which explains why the telehealth message is falling on fertile ground these days.

And here’s a big surprise: when it comes to service location, consumers liked the idea of an e-visit even better than going to a retail clinic near their home or workplace.

The survey calls into question many of the branding principles that have guided healthcare for half a century. For some would-be patients, convenience may trump a lofty reputation.

Survey respondents ranked cost as another key attribute. More of them said they’d switch PCPs if the annual cost rose $250, than if the doctor made a medical mistake. That’s likely to send the “patient experience” pundits back to the drawing board.

Here’s another takeaway that’s relevant to telehealth: consumers value convenience over continuity – the ability to see the same doctor on every visit. Seeing the same friendly face is much less important to them than seeing someone with the necessary expertise.

The survey concludes that on-demand care is now the front door to the health system. Fortunately, telehealth is poised and ready for the doorbell to ring.

Doctor using a digital tablet. Technology and medicine concept

Doctor using a digital tablet for telehealth consultation




Telehealth Goes Turbo

Apple and Google will undoubtedly grow a lot by 2020, but nothing like the pace forecast for telehealth. The American Medical Association predicts that the telehealth market will expand from about $1 billion next year to $6 billion by 2020.

This astonishing growth is being fueled by a number of converging trends. Because of the expanded coverage under the Affordable Care Act, millions more patients are needing treatment – and a significant number of them live in either remote or underserved areas where MDs (particularly specialists) are in short supply. Meanwhile, the use of telehealth for chronic disease management is going through the roof. According to IHS Technology, the number of people being remotely monitored for congestive heart failure in the U.S. will increase 68 percent to 578,000 cases in the next year alone – and remote monitoring of diabetes patients will rise about 73 percent to 236,000 cases.

Many health systems are already starting virtual health departments, like the Virtual Urgent Care recently introduced by CHI Franciscan Health in the Tacoma, Washington area. The program enables area residents – not just existing patients – to receive care 24/7 via phone or video chat on smartphones, tablets and PCs.

Franciscan’s Virtual Urgent Care program is already receiving rave reviews from community members. In fact, it’s achieving a 96 percent satisfaction score from patients – a higher rating than many brick-and-mortar facilities get. There have been unexpected benefits, too. Since the program began, the number of pages to on-call doctors has decreased by 50 percent.

When describing the pace of growth in telehealth, you almost need terms like “warp speed” and “turbo-charge.” Get set for the most exciting – and fastest moving – chapter in telehealth history.


Telehealth Goes Turbo