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Maybe You Can get Reimbursed for That…

Treasure In Paper

Last week I posted a press release from the ATA about expanded Medicare coverage for Telemedicine.  Well, I decided to actually read the 1200 page rulemaking from the Centers for Medicare and Medicaid Services (CMS).  You can guess why it’s taken a week to write a follow up article…

Actually, no.  I didn’t read the entire rulemaking, only the pages relevant to all things “tele” in medicine and healthcare.  In doing so, I was reminded of something interesting:

There are a number of procedures already covered by Medicare without specific telemedicine codes.  In fact, of the seven bullet points listing the 22 codes rejected or deleted from inclusion, five noted the affected codes were largely unnecessary due to either an existing telehealth code or because Medicare does not distinguish whether the procedure is tele or not.

Here are a few examples:

Regarding electrocardiograms and echocardiograms: “By definition, Read more

ATA Celebrates Halloween Telemedicine Treats for Medicare Beneficiaries

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.

Media Contact:
Mimi Hubbard
mhubbard@americantelemed.org
202-659-7616

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An Open Letter and Call To Action to the Telemedicine Industry

 

reimbursement boulder in road crop

“Is your cucumber bitter? Throw it away. Are there briars in your path? Turn aside. That is enough.”
Marcus Aurelius, Meditations.

For an industry full of innovators, there’s a distinct lack of innovation in overcoming the reimbursement issue.  I believe this is largely because we’ve trained ourselves to continue focusing on reimbursement, rather than discovering how to make the lack of reimbursement work for us or on creating a new model of telemedicine that makes reimbursement an afterthought.

If you believe telemedicine won’t expand until reimbursement is solved, why are any of us involved in Telemedicine?  (I assume it’s to improve healthcare, which means we shouldn’t let reimbursement stop us.)

This is not to say that reimbursement is not impo Read more

swyMe selected to present at the Innovators Challenge

Dateline Boston: Sept 11, 2014

swyMe, a leader in delivering secure, mobile, high quality video for connected health, mHealth and telehealth through their swyMed product, announced that it has been selected as one of 10 organizations in the Partners Healthcare Innovators Challenge (http://symposium.connected-health.org/innovators-challenge). swyMe will be presenting at the Partner’s Connected Health Symposium 2014 (http://symposium.connected-health.org/) in Boston on October 23rd and 24th, 2014 at the Seaport Hotel and World Trade Center.

“Partners HealthCare was Read more

Prioritize Patients

prioritize patients

I attended a webinar last week where the speaker, Jeff Robbins, Director of Neurodiagnostics and Telehealth at Tift Regional Medical Center, recounted the following (paraphrased) story:

Eight years ago Tift had purchased their first batch of telemedicine equipment.  For the first year or so they mostly stared at it, with no idea how to go about using it.

They wondered whether they could be reimbursed for anything they used it for and whether they could figure out how to use it and wondered what it could do.  They weren’t using their equipment.  They weren’t using telemedicine.

Then Jeff said they decided to “put the patients first.”  They purposefully forgot about reimbursement, coverage regulations, computer abilities of the doctors, or whether the possible uses fit into the business plan of the hospital.  They focused on finding out, through actually doing it, if telemedicine could help their patients.  When that happened…

All those things took care of themselves.

Or, as Jeff put Read more

Bikers and Teddy Bears: 9th Annual Teddy Bear Ride

biketeddys

photo credit: Jeff Schrier | MLive.com

Starting at 2 p.m. this Saturday, children in the pediatric center of Covenant Healthcare in Saginaw, MI, which is a customer using HitCast, an earlier release of what has become our swyMed solution, will be receiving between 200 and 400 teddy bears courtesy of the Great Lakes Harley Davidson and Tri-County Michigan Hogs.

This is a fantastic tradition that’s been as wonderful for the kids in the hospital as for the bikers giving of their time and resources.  However, the children generally are not able to go outside the hospital to see the bikers arriving with teddy bears often attached to the bikes, or to see them dismounting and coming in.  Covenant has, in the past, utilized some of the telemedicine capability to stream video of the bikers arriving into the pediatric center.

Please follow these links for more of the story, and be inspired to do something similar in your area if you can:
http://www.abc12.com/story/26164728/ninth-annual-teddy-bear-ride-to-take-place-this-saturday
http://www.minbcnews.com/news/story.aspx?id=929540#.U-TSmvm-2-0

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5 Things I Learned on ATA’s This Month in Telemedicine Webinar

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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iPods and Raising Telemedicine Adoption

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What about the Doctors?

telemediPod 2000 try it bdr

The seeds of this article began when my CEO forwarded a Gartner case study from 2008[1]with the question, “If a hospital could do 345,000 video visits up to 2007, why hasn’t telemedicine expanded more?  Is the issue technological, cultural, managerial, or..?”

Fantastic question.  The issue definitely isn’t technological–at least from a capabilities standpoint.  It may be from a design standpoint…but more on that later.  I’d argue that it is indeed cultural and managerial, although some of that culture and management reflects back on us, the telemedicine solution providers.

We are presented with a quandary: 1) Where telemedicine has been systematically implemented, it has radically improved patient care, lowered costs, improved doctor/staff morale, and even increased revenue…even in the face of lingering payor reimbursement questions currently being worked out by insurers and state legislatures, and yet… 2) Adoption by both individual healthcare providers and organizations has been, well, lackluster, and often outright resisted.

The gap is caused because Read more

Telemedicine Reimbursement vs. Decreased Readmissions

readmission

The question of reimbursement is very, very important. But not as important as you might think.  As promised a couple weeks ago, we want to look more in depth at the third of our takeaways from the 2014 American Telehealth Conference…especially in light of new developments that have popped up in the news since then.

First, to  bring new readers up  …read more…

Past the Tipping Point

tipping point

Last Thursday I promised to discuss our takeaways from the ATA conference individually in more detail, starting with

#1 We’re past the tipping point.

I won’t belabor the point of the overall importance of this takeaway, as you can read about it here.  However, I will re-quote ATA CEO Jonathan Linkous because his numbers make a good launching point: “Today, 20 million Americans get some part of their healthcare remotely, and that number will grow as telemedicine expands its reach.”  And the ATA President, Edward Brown, believes that mHealth/Telemedicine will grow by 50% every year.

According to a study by IHS Technology and published in January, the almost 350,000 telehealth patients in 2013 will swell to Read more