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Penn Medicine Opens Up Telehealth Hub

February 16, 2018
by Rajiv Leventhal
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Philadelphia-based Penn Medicine has opened its Center for Connected Care to centralize the health system’s telemedicine activities.

According to officials in an announcement this week, “Connected Care telemedicine programs use advanced approaches and technologies to serve a wide variety of patient populations without having to travel to Philadelphia.” This includes Penn Medicine’s almost 15-year-old Penn E-lert eICU for the critically ill, a tele-homecare service for the chronically ill, as well as a telemedicine service linking obstetricians to trauma surgeons caring for critically injured pregnant women, and a tele-urgent care service which eliminates the need for physical visits in some cases.

The Center for Connected Care also houses the Home Telehealth program, which provides post-hospitalization remote monitoring for more than 160 patients each month in their homes. Often, this work employs a concept known as “automated hovering,” which combines new technologies such as wireless devices that can track patients’ vital signs and other indicators with new reimbursement strategies that hold providers more accountable for keeping recently hospitalized patients from being readmitted. Penn Medicine officials note that this program has successfully reduced readmissions by 35 percent in a medically complex patient population.

Penn Medicine was one of the first healthcare systems to invest in telemedicine when the Penn E-lert eICU was first launched. The unit provides 24/7 coverage by using two-way video and audio technology to monitor patients who are, for instance, at risk of falls or sepsis, and alerts for on-site providers to act fast when help is needed. Now, the service covers more than 250 critical care beds across the health system.

In sum, the center looks to address the ever-growing demand for telehealth services. Located at Penn Medicine Rittenhouse in center city Philadelphia, it is the largest telehealth center in the region and one of the largest telehealth hubs in the country, officials attest. The center will have 50 full-time employees who will work to support patients 24/7 as well other Penn Medicine staff in a variety of settings across Pennsylvania, New Jersey, and Delaware.

What’s more, Penn Medicine also provides tele-medical specialty services in fields such as transplant services, dermatology, ophthalmology, radiology, adolescent and young adult medicine, sleep medicine, and complex neurological conditions to patients at a regional, national, and international level. Other tele-medical specialty services include post-operative surgical visits in various specialties as well as hematology oncology consultations and veteran’s mental health services.

And, an additional suite of programs provide specialized, academic medical center-based services to patients who live outside Penn Medicine’s typical service region. For example, a tele-genetics program through Penn’s Abramson Cancer Center provides genetic counseling for patients living with or at-risk of inherited conditions via remote video conferencing.

“Patients today increasingly expect to engage with healthcare providers with the same clickable convenience as buying holiday gifts online or ordering a ride-sharing service from their phone,” Penn Medicine’s CMIO, C. William Hanson, III, M.D., said in a statement.

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How Virtual Care is Improving Access and Affordability of Healthcare

November 20, 2018
by Lee Horner, CEO of Synzi, Industry Voice
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The Centers for Medicare & Medicaid Services (CMS) has made strides in providing more affordable, accessible care for all patients. A new rule allowing Medicare Advantage beneficiaries to access telehealth from home was recently proposed. CMS also released its CY 2019 Physician Fee Schedule final rule, which includes reimbursement for telehealth and virtual care services.

CMS’ proposed changes to Medicare Advantage will help enrollees obtain better access to healthcare via virtual care and telehealth. Instead of incurring travel costs and time to go to a healthcare facility for an appointment, Medicare Advantage beneficiaries will be able to participate in virtual visits from the comfort and convenience of their home. This change will be of tremendous value to MA enrollees who may have challenges in securing reliable transportation and may have to travel considerable distances in order to reach a provider or a hospital. This will commence in 2020 as part of the government-funded “basic benefits.”

According to CMS, the CY 2019 Physician Fee Schedule can support access to care using telecommunications technology. Medicare will pay providers for these kinds of services, including quick check-ins between patients and providers. CMS is also expanding the list of Medicare-covered telehealth services. The proposed ruling helps patients—whether rural or not—access care on their terms and helps increase provider adoption due to better reimbursement. 

The Cost of Chronic Conditions

Healthcare organizations are focused on better engaging and caring for patients with chronic conditions. Patients with chronic conditions face the risk of recurring readmissions, burdening the overall ecosystem with costs and complexities in providing the right kind of care, at the right time. The majority of older adults are living with chronic conditions; 92 percent of older adults have at least one chronic disease and 77 percent are challenged with at least two chronic conditions according to the National Council of Aging.

CMS indicates that chronic illnesses account for 75 percent of the $2.2 trillion spent annually on healthcare in the U.S. Investing in better disease management will impact health and financial outcomes, and offering affordable access to virtual care is one way to help these patients receive the treatment they need. 

Better Benefits for Patients and Providers

The recent CMS developments will help the chronic care patient population remain at home as they participate in the ongoing care needed to treat and manage their conditions. Patients will be able to receive care outside the four walls of a healthcare setting. By being able to participate in virtual visits and receive SMS, text, or email reminders about upcoming appointments, medication requirements, and diet/lifestyle recommendations, patients will be better informed, engaged, and involved in their care. As a result, these patients will be less likely to return to the emergency department or be readmitted as more providers leverage technology to monitor and motivate their patients on a consistent basis.

CMS’ initiatives will also help providers overcome some of the obstacles to telehealth and virtual care adoption. By updating the reimbursement structure, providers will be more inclined to utilize technology in their delivery of care. For example, home health agencies will recognize the benefits on their productivity and profitability.

Virtual care technology can help visiting nurses remain in more frequent touch with their patients by augmenting or even replacing many of their traditional in-home visits. The technology improves staffing productivity by enabling nurses to “put eyes and ears” on more patients vs. spending much of the day behind-the-wheel and en route to and from patients’ homes. Home health agencies will be able to expand their patient base and referral stream. By keeping patients at home—but still providing them with access to specialized care on-demand—nursing staff will help boost their revenue stream from referral sources focused on partnering with agencies that can help their CMS ratings. During a virtual visit with a patient, the nurse can quickly include a specialist to resolve patient questions in real-time and/or diagnose emerging conditions.

By addressing these concerns during the virtual visit, home health agencies are improving the timing, quality and impact of their care. Specialists will not always need to make a home visit to resolve the situation; patients will not necessarily need to return to the ER for specialized care. For many questions and conditions, nurses and specialists can remotely handle a patient’s issue in a timely and cost-effective way via technology. The use of virtual care will help home health agencies reduce patient readmissions, leading to improved quality scores and enhanced health and financial outcomes for all.   

The Value of Virtual Care

With CMS’ recent advancements in expanding access and reimbursement, patients, hospitals, and home health providers will realize the value of virtual care technology in helping patients stay on track with their treatment plan and address any issues which may cause unnecessary (and costly) readmissions. Patient and provider satisfaction will increase as the provided care is more efficient and effective for all stakeholders within the healthcare ecosystem.  

Lee Horner is the CEO of Synzi, where he is responsible for corporate strategy and development, with an emphasis on revenue growth, product direction and customer satisfaction.

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Medi-Cal Telehealth Proposal Called ‘Remarkable Step Forward’

October 30, 2018
by David Raths, Contributing Editor
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Covers payment for dental services as well as treating homebound, seasonal and homeless patients

The California Department of Health Care Services (DHCS) is proposing significant changes to its telehealth policy in the state’s Medicaid program known as Medi-Cal. The nonprofit Center for Connected Health Policy (CCHP) calls the proposal “a remarkable step forward.”

Since the passage of and enactment of AB 415, the Telehealth Development Act, CCHP has noted that DHCS had the ability in law to create a more expansive telehealth policy. Now it has proposed one.

A CCHP report notes that DHCS is soliciting feedback from stakeholders on a proposal that would clarify when services provided outside of the “four walls” of a federally qualified health center (FQHC) or rural health center (RHC) are eligible for the prospective payment system (PPS). The department is proposing that all such services be paid the PPS when rendered to homebound, migratory, seasonal workers and homeless patients, patients in the hospital, dental services rendered to established patients by a contracted dental provider, and telehealth services provided to its established patients when certain requirements are met.  

Providers would still have to document services with the same specificity as would be required when services are provided within the four walls; the FQHC or RHC must provide written policies that describe all of the services that will be provided outside of the four walls, along with circumstances for which the services will be provided; and all HRSA policies and procedures for approved scope of projects apply.

The proposal also lays out specific rules for billing as well as for store-and-forward services provided for ophthalmology, dermatology, and dentistry for its established patients. 

DHCS also is proposing to update and clarify its telehealth policy manuals within the Medi-Cal program. Among the most intriguing proposals in the draft, according to CCHP, is allowing the distant site/treating provider to decide when it is appropriate for telehealth to be used and whether it should be via live video or store-and-forward. 

E-consult (provide-to-provider consultation), falling under the auspices of store-and-forward, would also be reimbursed through two CPT codes, making California and Connecticut the only state Medicaid programs in the country reimbursing for that particular service. Under Medi-Cal’s proposed draft policy, the services would still need to be a Medi-Cal-reimbursable service and the CPT or HCPCS code definition should allow for technology to be used, but CCHP said this proposed policy is far more advanced than most any other Medicaid policies in the country.



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CMS Proposes to Expand Telehealth Benefits Under Medicare Advantage Plans

October 29, 2018
by Rajiv Leventhal, Managing Editor
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The Centers for Medicare & Medicaid Services (CMS) is proposing to implement several sections of the Bipartisan Budget Act of 2018, including expanding telehealth benefits under Medicare Advantage plans.

In a recent proposed 362-page rule that updates Medicare Advantage (MA or Part C) and the Medicare prescription drug benefit program (Part D), CMS is suggesting to implement a section of the Bipartisan Budget Act of 2018 that enables MA plans to offer “additional telehealth benefits” not otherwise available in original Medicare to enrollees starting in plan year 2020 as part of the government-funded “basic benefits.”

Under this specific proposal, MA plans will have broader flexibility than is currently available in how they pay for coverage of telehealth benefits to meet the needs of their enrollees, CMS stated. “In addition, we solicit comment on how to implement the statutory provision that if an MA plan covers a Part B service as an additional telehealth benefit, then the MA plan must also provide the enrollee access to such service through an in-person visit,” the proposal read.

The proposal went on to note that the original Medicare telehealth benefit “is narrowly defined and includes restrictions on where beneficiaries receiving care via telehealth can be located.” As such, CMS believes that the additional telehealth benefits in MA will increase access to patient-centered care by giving enrollees more control to determine when, where, and how they access benefits.

The proposed rule, according to CMS, would also give MA plans more flexibility to offer telehealth benefits to all their enrollees, whether they live in rural or urban areas. “It would also allow greater ability for Medicare Advantage enrollees to receive telehealth from places including their homes, rather than requiring them to go to a healthcare facility to receive telehealth services. Plans would also have greater flexibility to offer clinically-appropriate telehealth benefits that are not otherwise available to Medicare beneficiaries,” CMS stated.

As such, the federal agency stated that although MA plans have always been able to offer more telehealth services than are currently payable under original Medicare through supplemental benefits, this change in how such additional telehealth benefits are financed makes it more likely that MA plans will offer them and that more enrollees will be able to use the benefits.

The Bipartisan Budget Act of 2018 was signed into law earlier this year, and includes major telehealth advances. Now, CMS believes that this latest proposal will promote “flexibility and innovation so that MA and Part D sponsors are empowered with the tools to improve quality of care and provide more plan choices for MA and Part D enrollees.”

CMS Administrator Seema Verma said in a statement accompanying the proposed rule, “President Trump is committed to strengthening Medicare, and an increasing number of seniors are voting with their feet and choosing to receive their Medicare benefits through private plans in Medicare Advantage. Today’s proposed changes would give Medicare Advantage plans more flexibility to innovate in response to patients’ needs. She added, “I am especially excited about proposed changes to allow additional telehealth benefits, which will promote access to care in a more convenient and cost-effective manner for patients.”

The agency believes that if finalized, the proposed changes would result in an estimated $4.5 billion savings to the Medicare Trust Funds over 10 years, largely arising from recovery of overpayments to MA plans.

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