Increasing Telemedicine’s Visibility

At this year’s ATA 2012 Conference ATA President Stewart Ferguson challenged the telehealth community as a whole to raise the visibility of telemedicine through a unified public awareness campaign. For the last six years, The Great Plains Telehealth Resource and Assistance Center (gpTRAC) has been working to further this goal by hosting a telehealth awareness booth at the Minnesota State Fair.

The Minnesota State Fair is one of the largest and best-attended expositions in the United States, attracting nearly 1.8 million visitors every summer. During the fair, gpTRAC gives fairgoers a hands-on telemedicine experience by connecting them with University of Minnesota doctors for teledermatology screenings via videoconferencing. Last year, over 240 attendees received free screenings and thousands more were able to watch the sessions in action.

“Many of these fairgoers hadn’t made it a priority to get screened until they came upon our booth. I think this demonstrates that telehealth services can help increase access to specialty care, like dermatological screenings, to ultimately help reduce overall healthcare costs through earlier diagnosis, management and treatment of disease,” said Stuart Speedie, Ph.D., Principal Investigator of gpTRAC. “Clearly, we accomplished something very positive at the State Fair.”

To date, gpTRAC has showcased teledermatology, pulmonology, and stroke screenings, and this summer plans to add cardiology for their seventh year.

“Last year’s event wouldn’t have been possible without the generous support of dermatologists at the University of Minnesota who volunteered their time to conduct free screenings during the fair. With their help raising awareness of telehealth, we hope that access to telehealth services will continue to grow across the state of Minnesota,” added Dr. Speedie.

For more information on gpTRAC at the Minnesota State Fair, visit our “News and Events” Page.

Learn How to Create Revenue for your Telehealth Initiative

By Mike Grove
Based on the ATA 2012 Informational Session “Learn How to Get Paid and Create Revenue for your Telehealth Initiative” hosted by
Nina M. Antoniotti, RN, MBA, PhD, Director of TeleHealth Business. Marshfield Clinic, Marshfield, WI, USA. 

For someone like me who is relatively new to telehealth and not as familiar with reimbursement issues, this was a highly informative session as my three pages of single-spaced notes attest!  I certainly wasn’t alone as this was the most well-attended concurrent session I visited at ATA 20 12.  No surprise as everyone from vendors to clinicians to policy experts is interested in understanding how the money flows vis a vis telehealth applications.   Dr. Antoniotti is clearly one of the foremost telehealth reimbursement experts in the country which was evidenced by her ability to address state-specific questions thrown her way by the audience.

Dr. Antoniotti defined the payment buckets as coming from one of three sources:  Medicare, Medicaid, and everyone else (including private payers and out-of-pocket).  As simple as that may sound, she emphasized the profoundly different rules each has for payment which explains much of the misunderstanding around payment for telehealth services.   She presented a helpful and decidedly simple payment algorithm used by CMS when considering reimbursement and noted that the variation in state-administered Medicaid payments which require localized understanding of payment issues. 

Several general reimbursement strategies were highlighted which suggested a sort of philosophical reconsideration of institutional revenue.  Most broadly, vertical alignment of patient ancillary services was mentioned as a strategy to keep a patient within one’s system for as much of the care process as possible.  She also suggested that cost avoidance and expense reduction should really be thought of as a revenue source, meaning that readmissions and length of stay (LOS) are areas to be reexamined when considering telehealth services.  Specifically, targeting clinical services that historically have high no-show rates as prime candidates for telehealth efforts is a good way to begin to build the internal business case.  

The take-away point from Dr. Antoniotti  was “if you get reimbursed for an in-person service, assume you will for a telehealth service as well.”  To me, this sounded like an interesting problem as it appears that there is room for creative thinking when it comes to use of telehealth services.  It solidified the point I heard over and over during ATA…that telehealth should be embedded within processes and essentially synonymous with healthcare delivery.

Establishing an Evidence-Base for Telemental Health

By Mike Grove
Based on the ATA 2012 Informational Session “Establishing an Evidence-Base for Telemental Health” hosted by:

Lisa J. Roberts, PhD, Global Clinical & Innovations Manager1, Eve-Lynn Nelson, PhD, Associate Professor, Pediatrics and Telemedicine2, Kathleen M. Myers, MD, MPH, Associate Professor3,4, Carolyn Turvey, PhD, Associate Professor5,6. 1Viterion TeleHealthcare: A Business of Bayer HealthCare, Bellevue, WA, USA, 2University of Kansas Medical Center, Kansas City, KS, USA, 3University of Washington School of Medicine, Seattle, WA, USA, 4Seattle Children’s Hospital, Seattle, WA, USA, 5University of Iowa, Iowa City, IA, USA, 6VA Iowa City Health Care System, Iowa City, IA, USA.

No area seems to be as obvious a candidate for telehealth service delivery as mental health.  Given the talk-therapy nature of much of the domain of mental health services and the lack-of-access issues especially in rural communities, using communication technology to facilitate care delivery makes sense.  Many practitioners likely disagree as they feel strongly that the patient-therapist alliance requires face-to-face contact as body language and other subtle cues are key to effective diagnosis and treatment.  It’s an interesting dialogue and one that I now realize after attending this session, presents far more nuance and consideration than I had previously understood.

Like many of the topics discussed at ATA, reimbursement is a driving factor for telemental health service delivery.  Demonstrations of effectiveness are required to justify payment for services and though there appear to be intriguing preliminary results from a number of studies, some fundamental research issues remain.  For instance, how exactly can the field agree to define the metrics of clinical encounters that can be universally captured, measured, and compared?  And how can research be designed that informs telepsychology implementation programs? 

What emerged to me as a non-domain expert was the emphasis by all panel members placed on measurement of patient satisfaction with telemental health services.  Implicit in this theme was the idea that a patient who feels engaged in a therapeutic program will likely demonstrate better outcomes and that the field is acutely aware of this.  Thus, it seems as though there is broad acceptance of telemental health services by clinicians and that they are working diligently on improving the patient experience and “buy-in” factor.  Most interestingly, panel member Carolyn Turvey, PhD noted there is a fine line between patient empowerment and “patient-centered” care.  She has learned through her research that “patient-centered” care is evolving into the patient having to perform the clinician’s job and that we should be mindful of how much burden is being placed on the patient when using telemedince technologies.

ATA 2012 Days Two and Three

Days Two and Three of the American Telemedicine Association’s 2012 Annual International Meeting and Exposition continued with educational meetings, exhibitor presentations, the conference’s keynote plenary, and a concluding networking event.  Some of the highlights from the past two days included:

-Educational Sessions including:  Reimbursement 101:  Learn How to Get Paid and Ceate Revenue for Your Telehealth Initiative; Mobile Health Innovations in Disease Management; FDA’s Role in Telemedicine; Innovative Telemedicine and Medical Information Exchange in Military Settings; Mobile Apps for Mental Health; Successes and Challenges Implementing Telemedicine in Private Practice; Policy Priorities; and Incorporating Telemedicine into Baccalaureate, Graduate and Medical School Education.

– A Keynote Speech by Steve Wozniak (Co-founder of Apple, Technology guru) on The Future of Personal Healthcare Technology.  Soundbite:  “I love the fact that telemedicine fits into this category of people trying to do good things for those that don’t have access. I love that.”

-One-on-one interviews and demonstrations with some of the most interesting technology representatives (videos to come).

-And a larger than life ATA Networking Event at the San Jose Tech Museum where guests were able to mix, mingle and discuss the conference while testing out the museum’s hands on technology and science exhibits.

The general theme of the ATA2012 conference has been this:  The next year is going be a transformational one for the healthcare industry and the adoption of Telemedicine.  We certainly agree, and are looking forward to assisting organizations in the Great Plains region as they navigate both.   
Interested in more information on organizations that have successfully adopted Telemedine programs?  Read these Telehealth Success Stories.