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Rush University Medical Center Unveils Mobile Stroke Unit

October 31, 2016
by Rajiv Leventhal
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Rush University Medical Center in Chicago has unveiled a mobile stroke treatment unit that encompasses an ambulance outfitted with telemedicine technology and a CT scanner enabling brain imaging.

The event unveiling was at Rush Oak Park Hospital, where the mobile stroke treatment unit will be based. One of only a handful of specially designed and built units of its kind in the U.S., it will serve Illinois Region VII, which includes parts of the western suburbs, Rush officials stated. The mobile stroke unit brought to Rush Oak Park Hospital by the manufacturer, Excellence, is identical to one still being outfitted for Rush. It will be delivered in January.

“Presently patients cannot be treated for their stroke until they get to an emergency room. This new mobile stroke treatment unit will bring immediate stroke diagnosis and treatment to patients at their homes, or wherever they’re in need, which will improve their chances of a good recovery,” James Conners, M.D., medical director of the mobile stroke unit, said in a statement.

According to a Rush announcement, the mobile stroke treatment team will respond to 911 calls reporting symptoms indicating stroke along with a regular ambulance. If the paramedics determine the person did not have a stroke but has another medical problem, the mobile stroke unit will simply return to their base station. But, if a stroke is suspected, the team can perform CT scans of patients and using telemedicine, Rush stroke neurologists will evaluate the patients remotely and decide what kind of treatment is indicated.

At that point, the emergency medical technician and critical care nurse staffing the mobile unit will administer the appropriate stroke medication after conferring with the stroke neurologist at the same time they are transporting the patient to the most appropriate stroke center. The goal is to provide optimal treatment to stroke victims within the first "golden hour" after symptom onset, when it will do the most good, officials said.

"We know patients are up to four times more likely to have a good outcome if they are treated with tPA. Also, the sooner we treat patients, the more likely it is they will have minimal or even no disability,” Conners said. “With our standard process, it’s rare to be able to treat people within the first hour after onset, but with the mobile stroke unit we anticipate even better outcomes.”

The mobile stroke unit also will enhance treatment for patients who suffer from a hemorrhagic stroke, which occurs when a blood vessel in the brain leaks or bursts. Those patients can’t receive tPA, which could be fatal to them, and need a different type of medication to stop their bleeding.

The hope is that the new program will capture 75 percent of strokes in the service area in time to deliver optimal treatment for all stroke patients, officials attested.

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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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Study Shows Effectiveness of Tele-Rehabilitation Platform

October 23, 2018
by Rajiv Leventhal, Managing Editor
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The Duke Clinical Research Institute (DCRI) has teamed up with a virtual rehabilitation therapy company to test how its digital rehabilitation platform delivered physical therapy following total knee replacement (TKR) surgery.

The randomized controlled clinical trial, "Virtual Exercise Rehabilitation In-home Therapy: A Research Study (VERITAS),” was designed to evaluate the cost and clinical non-inferiority of using a virtual rehabilitation platform from Reflexion Health to deliver physical therapy following total knee replacement surgery.

In the study, VERA, Reflexion Health's virtual exercise rehabilitation assistant, with clinician oversight enabled a substantial reduction in post-acute costs and rehospitalizations while being as effective as traditional physical therapy, according to officials who touted the results this week.

Per the company’s website, VERA is a tele-rehabilitation platform that coaches patients through their prescribed physical therapy exercises, measures progress, and reports outcomes back to their physical therapist. VERA aims to guide and encourage patients to do their best on the path to recovery—all from their own home.

VERITAS was a multi-center, randomized controlled trial that enrolled 306 adult participants scheduled for TKR surgery at four U.S. sites. Of the consented participants, 287 completed the trial. The treatment group concluded with 143 adults who received Reflexion Health's VERA both pre- and post-surgery, compared with a control group of 144 adults who received traditional in-home or clinic-based physical therapy at participating sites. Clinical outcomes, health service use, and costs were examined for three months after surgery.

The study results demonstrated an average cost savings of $2,745 per patient for those who received virtual physical therapy using VERA technology with clinical oversight when compared to usual care with traditional physical therapy. Virtual physical therapy met its secondary effectiveness endpoints of non-inferiority for reducing disability and improving knee function. Compared with usual care, safety endpoints for patients with virtual physical therapy were similar, the results revealed.

"Physical therapy is a critical component of recovery for patients following total joint replacement surgery. As people live longer and these surgeries become more common, it is important to identify solutions that maintain or improve outcomes while decreasing the burden on patients and providers," Janet Prvu Bettger, Ph.D., associate professor with the Duke Department of Orthopedic Surgery and principal investigator of the study, said in a statement. "We are pleased with the results of the study which show that Reflexion Health's VERA coupled with remote clinician oversight, is a cost-effective paradigm for physical therapy—one that is more convenient for patients while providing clinicians greater insight into the recovery process."

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