integrating telemedicine into your practice

John Steinmann, DOCalifornia Orthopedic Association

Friday May 17, 2019

Integrating Telemedicine Into Your Practice

• Introduction• Telemedicine Today• New Patient• Established Patient

Post-OperativeRoutine Follow-up

• Reimbursement• Practice ROI• Questions/Answers

• Disclosure• Telemedicine Today• Laws Re: Telemedicine• Available Technologies• Indications

Established PatientPost-OperativeRoutine Follow-up

New Patients• Reimbursement• Practice ROI• Questions/Answers

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Faculty Financial/Conflict of Interest Disclosure

Founder, CEOAxS Health

Digital Health and Telemedicine Platform

AGENDA

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Our patients will increasingly demand convenience, access and affordability.

All of these are fulfilled by telemedicine.

q Telemedicine in an orthopedic surgery practice?q What are the available telemedicine technologies?q Can telemedicine really make me more efficient?q Will Medicare and private insurers pay for telemedicine?q How well is this technology accepted by patients?q What laws support, restrict or govern telemedicine?q Indications for telemedicine in an orthopedic practice?q What are the economics regarding this technology?

• Introduction• Telemedicine Today• Laws Re: Telemedicine• Reimbursement• Available Technologies• Indications


New Patients• Practice ROI• Questions/Answers

AGENDA


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AGENDA

• As of 2016 Kaiser conducted more than half their visits virtually

• Telemedicine’s expected annual growth rate is 27.5%• Telemedicine visits have increased from 350,000 in 2013

to 7,000,000 in 2018• 86% of physicians and as high as 98% of patients

reported high satisfaction with telemedicine services • 76% of patients care more about access to healthcare

and convenience than the human interaction• 44% of private practices are making telehealth their #1

priority


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AGENDA

Benefits of a Telemedicine Platform• Patient Convenience• Time Efficiency/Automation• Enhanced Revenue• Stability and Growth of your Practice

Risks of not employing Telemedicine• Intrusion into your market or loss of market share• Failed Revenue Opportunity• Failed Efficiency Opportunity • Patient Inconvenience


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AGENDA

q Laws governing in-office visits pertain to telemedicineq Securely protect the exchange of PHIq Obtain written or verbal patient consentq Obligated to the same standards of careq Adhere to State licensing standardsq Adhere to laws governing location of service


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AGENDA

Telemedicine parity laws “mandate [that] commercial payers provide coverage and reimbursement for telemedicine services comparable to in-person services.” As of May 2017, 40 states approved or proposed legislation allowing for telemedicine parity.

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AGENDA

q Must negotiate individual contracts with payers q Define modifiers and codes availableq Define indications and address frequencyq Find areas where payers bear the cost of seeing patientsq Medicaid HMO who pays for transportationq Work Comp who pay for time and transportationq Employers who pay for time and transport q Post-op Telemedicine with-in the post-op global period

does not require a contract


Reimbursement almost does not matter

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AGENDA

(Reimbursement-Cost)/Time In-office

($91-$72)/10min = $114/hr

(Reimbursement-Cost)/Time Telemedicine

($49-$24)/2min = $750/hr


For every 5 telemedicine appointments I free up 4 slots for new patients

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AGENDA

Synchronous(video)

Asynchronous(text)

Combined(text with optional video)


In the majority of use cases, Asynchronous or a Combined Platform Telemedicine will be preferred by both patient and provider

TelemedicineSynchronous Telemedicine (Video)• Advantages

• More personal and formal• Allows for Limited Exam• Improved Reimbursement?

• Disadvantages• Technical Resource Intensive• Lacks Time efficiency• Lower ROI

Asynchronous Telemedicine (Text)• Advantages

• Time Efficiency• Patient and Provider Convenience• Less Technical Requirements• Greater ROI

• Disadvantages• Reimbursement • Less Formal or Personal

Asynchronous Telemedicine platforms use logical algorithms to ask patients a series of questions, and gather relevant pictures for the provider to review within an appointment window.

Asynchronous Telemedicine

Combined platforms use similar logical algorithms to ask patients a series of questions, but include an optional audio-video communication between the patient and provider.

Combined Platform

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AGENDA

30%


What percentage of in-office orthopedic visits better performed via telemedicine?

If a patient does not need a hands on exam they do not need to be in your office

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AGENDA


Post-op TelemedicineCandidates• 1st and 3rd, or 2nd visits• Relative Contraindications

• Lack of a smart phone• Necessary X-rays• Necessary suture removal

Post-op Telemedicine

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AGENDA


Follow-up TelemedicineCandidates• 1/2 of all follow-up patients• Assessing treatment result• Review MRI• Medication refills• Work Comp awaiting authorization• Relative Contraindications

• Lack of smart phone• Re-examination necessary• Contract preclusion

Scheduling and Onboarding

Other Uses

“Walk-in” Specialty Care

Other Uses

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AGENDA


Eligible Post Operative Appts% Post-Operative Visits Eligible for Telemedicine 33%Percent Patients Opt-In to Telemedicine 70%Number of Post-Ops converted to telemedicine/year/provider 254

Eligible Routine Follow-Up ApptsPercent of follow-up visits eligible for telemedicine 33%Percent patients opt in to telemedicine 70%Visits converted to telemedicine 427

Additional In-Office Visits (Time freed by Telemed)Telemedicine Appointments/Day 6.2Mins saved/day - MD/DO 49.5Mins required, New Patient Visit - MD/DO 13.0Additional New Visits/Day 3.8

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q Telemedicine has been a very positive addition to my practiceq Patient acceptance and appreciation has been outstandingq The benefits are immense but adoption will be slow q Telemedicine is inevitable – do not wait too long




AGENDA


Summary

Questions?

Thank you

integrating telemedicine into your practice

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