In the wake of the 2012 Sandy Hook Elementary School and Aurora, Colorado, theater shooting, a Texas telepsychiatry program was launched to help schoolchildren and teens deal with potential mental health issues that could lead to later violence or suicide. School violence may get all the attention, but suicide is the second most common cause of death among American teenagers. Both situations often stem from untreated mental or behavioral health issues among children and teenagers. In the years since those shootings, at-risk students at these Texas schools have received the psychiatric care they need and, in some cases, have even been removed from the school setting amidst safety concerns. Read more
Thanks to an ongoing shortage of psychiatrists in Idaho, patients are often unable to seek help for mental or behavioral health issues until the condition has become severe enough to require hospitalization. In an effort to provide relief, Saint Alphonsus Health System has partnered with the University of Washington to create a telepsychiatry program, bringing psychiatric residents virtually to rural Idaho and Oregon. Read more
WASHINGTON – Saturday, Nov. 1, 2014 — Yesterday, the Centers for Medicare and Medicaid Services (CMS) issued a rulemaking that includes significant additional coverage for telemedicine services.
“This Halloween, Medicare beneficiaries got an important treat for home care of chronic care management, remote patient monitoring of chronic conditions, and other services when provided via telehealth,” said Jonathan Linkous, CEO of the American Telemedicine Association. The association has been asking CMS for such coverage for over five years.
Buried in an almost 1200-page rulemaking about 2015 Medicare payments to physicians and practitioners were provisions paying for remote chronic care management using a new current procedural terminology (CPT) code, 99490, with a monthly unadjusted, non-facility fee of $42.60. Also, Medicare will pay for remote-patient monitoring of chronic conditions with a monthly unadjusted, non-facility fee of $56.92 using CPT code 99091. Prior to this, Medicare did not pay separately for such services, requiring that such billing be bundled with an “evaluation and management” code.
Also in the rulemaking were seven new covered procedure codes for telehealth including annual wellness visits, psychotherapy services, and prolonged services in the office.
“It has been a long time coming, but this rulemaking signals a clear and bold step in the right direction for Medicare,” added Linkous. “This allows providers to use telemedicine technology to improve the cost and quality of healthcare delivery.”
Read the full document here: http://www.regulations.gov/#!documentDetail;D=CMS-2014-0094-2363. To learn more about telemedicine and public policy, visit http://www.americantelemed.org/policy/overview-news.
About the American Telemedicine Association
The American Telemedicine Association is the leading international resource and advocate promoting the use of advanced remote medical technologies. ATA and its diverse membership work to fully integrate telemedicine into healthcare systems to improve quality, equity and affordability of healthcare throughout the world. Established in 1993, ATA is headquartered in Washington, DC. For more information visit www.americantelemed.org.
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In a merger of telehealth, mobile and cloud, Massachusetts-based swyMe is offering video conferencing in ambulances. The basic system includes three cameras in the vehicle: a standard “fish eye” 360º camera mounted high on the ambulance wall; a webcam attached to a touch screen monitor; and a handheld HDTV 720p IP camera.
The combination of the three affords a remote physician a view of the overall situation in the ambulance, the ability to communicate face-to-face with attending EMS workers and capability to zero in to close-up views of the patient. The system is HIPAA compliant and uses AES256 security.
swyMe COO Jeff Urdan explained that Read more
As with last month, this is largely geared to updates about legislation along with reminders about the upcoming Fall Forum conference in Palm Springs, CA, which I’ll have to consider as I live out Orange County.
This month’s takeaways are a little more subdued than last month which had some pretty big news (see here). The ATA had just done a survey on online consultations and had over 500 respondents.
1) 45% of respondents are using telemedicine TODAY. This is fantastic news and, in my mind, is possibly underreported because, as Mr. Linkous and Mr. Capistrant pointed out on the last call (and pointed out in our 3 Things from last month), nearly every institution is already using some form of telemedicine and the boards don’t realize it.
2) Specialty Care and Behavioral Health were the leading segments. Not terribly surprising, as specialty care often needs to use leading edge tools to leverage resources for special care, and behavioral health lends itself well to an old-school videoconferencing set up (patient and doctor meet via video), leading to less push-back on its use while providing maximum benefit to both patients and providers. The industry will have to really work, I think, to make sure providers and CDOs are aware of the more specialized applications and the benefits to be had. Telemedice will not yield a large harvest if we only pick the low-hanging fruit. As if to prove that point:
3) 77% use video, 57% use audio and 28% use medical peripherals. Just over a quarter are using peripherals, while three times that are using video. Being at a video-primary solution provider: Yay! Being a proponent of telemedicine as a whole: We can do better. Even the video-primary medical solutions offer a lot of specialized or integrated offerings that provide more than just adding a visual element to distance care. Again, the question is, how do we get this to the doctors and CDOs?
4) Of the 55% of respondents that replied they are not using telemedicine today, 75% plan to implement it very soon. I present that as Exhibit A to the tipping point naysayers…although I concede that if you responded to a survey about telemedicine from the American Telemedicine Association, you’re probably already predisposed to an interest in telemedicine. Having said that, interest in telemedicine has been on the rise, and 75% of that growing crowd being interested in giving it a shot can only be a good thing.
4) Mr. Linkous pointed out something toward the end that I assumed would be a primary driver (or at least remove an obstacle) but assumed would take several more years: Private insurance is increasingly taking the lead in pushing telemedicine. I’ve been noting that the reduced cost/better outcome/reduced readmissions scenario HAS to eventually turn private insurance into champions of telemedicine. Amongst the names he mentioned were Kaiser Permanente, Aetna, WellPoint, and others.
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River Edge Behavioral Health has been praised by SAMHSA for its forward-thinking, efficient and effective use of technology.
One critical component of their strategy is using VeaMea as a telehealth platform to:
- Increase access
- Reduce physician turnover
- Improve productivity
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I TOLD YOU SO!
Almost 4 months ago, I wrote that TelePsychiatry is the Killer App for Video Conferencing. It may put a kink in Lucy’s walk-in practice, but the benefits to the rest of society are clear. (And if Lucy would like to Expand Her Presence, there is a place she can go)
Who should come along to back me up, but the American College of Emergency Physicians (ACEP). Their July 2011 issue of ACEP News includes an article titled “ED Telepsychiatry Cuts Admissions, Saves Money.”
The article tells the story of implementations in South Carolina and includes a commentary by the vice chair for Emergency Medicine at Lehigh Valley Hospital in Pennsylvania where a telepsychiatry program is also in place.
The following data are from the South Carolina study:
- Admission rates (33% lower)
- Length of Emergency Department stays (25% shorter)
- Outpatient follow-up rates (nearly 4x higher)
- Cost (29% lower for Medicaid patients, 38% lower for private insurance)
- Patient satisfaction: 80%
- Physician Satisfaction: 90%
- Physicians who believe they are more productive using telepsychiatry: 75%
Per the study, “the patient receives a higher quality of care, and the hospitals have reduced costs.”
WHAT’S NOT TO LIKE ?
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The Health Resources and Services Administration (HRSA), a division of Health and Human Services (HHS) has a database where you can search for information about shortages of access to primary care, dental and mental health services. A quick search for mental health services reveals a significant shortage in almost every area across the nation.
Top 5 Reasons Why TelePsychiatry is a Killer App for Video Conferencing
1) Mental health services means different Read more
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