u.s . telemedicine public policy
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U.S . Telemedicine Public Policy. Gary Capistrant September 25, 2014 Columbia, SC. Some Problems Addressed. Barriers of time and distance Professional shortages Disparities in access to care Quality of care Hospital readmits, ER overuse Costs of delivery Convenience and patient choice. - PowerPoint PPT PresentationTRANSCRIPT
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U.S. TelemedicinePublic Policy
Gary Capistrant
September 25, 2014
Columbia, SC
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Some Problems Addressed
Barriers of time and distance
Professional shortages
Disparities in access to care
Quality of care
Hospital readmits, ER overuse
Costs of delivery
Convenience and patient choice
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Public Policy Goals
Knock down government barriers
Promote “value” innovative payment and service models
Address care delivery problems• Cost, access, outcome, productivity
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Major Government Roles
Rendering
Reimbursement
Regulation
Research
Resources
Readiness and recovery
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Innovative Pay Models
TweaksValue-based purchasing
Pay for performance
ReformsBundling (services, time)
Case-mix
Sharing (risk, savings, gains)
Salary-based
Reference pricing, indemnity
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Medicare Today
36.6M in fee-for-service
15.7M in Medicare Advantage
1.9M in Special Needs Plans (SNPs)
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Medicare FFS Barriers
Limited live videoOnly rural counties (20% of beneficiaries)
Limited originating sites
Limited providers
Only specific procedures
No store & forward
No remote patient monitoring
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Medicare Bills
S. 2662 (Thad Cochran) /
H.R. 3306 (Gregg Harper)
Telehealth Enhancement Act
H.R. 5380 (Mike Thompson)
Medicare Telehealth Parity Act
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Rural Telehealth
Enhancement Act, Cochran (S. 2662) / Harper (H.R. 3306)
Medicare Telehealth Parity Act, Mike Thompson (H.R. 5380), Phase 1 of 3
Store-and-forward for—
Critical access hospitals ♦
Sole community hospitals ♦
Federally-qualified health centers ♦
Rural clinics ♦
Into homes for--
Kidney dialysis (video and RPM) ♦
Hospice patients ♦
“Homebound” patients ♦
Physician recertifications for home health care
♦
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Metro FringesTelehealth Enhancement Act, Cochran (S. 2662) / Harper (H.R. 3306)
Medicare Telehealth Parity Act, Mike Thompson (H.R. 5380), Phase 1 of 3
All critical access hospitals ♦
All sole community hospitals ♦
Restore coverage for 104 counties that lost it in 2013
♦
Video for metro counties with < 25,000 population
♦
Video and store-and-forward for metro counties with < 50,000 population
♦
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All BeneficiariesTelehealth Enhancement Act, Cochran (S. 2662) / Harper (H.R. 3306)
Medicare Telehealth Parity Act, Mike Thompson (H.R. 5380), Phase 1 of 3
Hospital readmissions: shared savings for a hospital beating its reduction benchmark
♦
For accountable care organizations ♦
For bundled payments ♦
For medical homes
Medicare counterpart for Medicaid “health homes” for chronic care
♦
Authorize specialty care oriented ♦
Stroke diagnosis ♦
Federally-qualified health centers – video and store-and-forward
♦
Remote patient monitoring for--
Congestive heart failure ♦
Chronic obstructive pulmonary disease ♦
Diabetes by federally-qualified health centers ♦
More covered providers
Diabetes educators ♦
Therapies – PT, OT, RT, speech & hearing ♦
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50 State Medicaids Today
All cover imaging
45 states cover something41 telemental health
18 home telehealth
14 remote patient monitoring
11 store-and-forward
Comprehensive risk-based managed29.1M (51%)
26 states with >50% of recipients
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State Ratings – Coverage and Reimbursement
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SC ProgressPARITYMedicaid C
MEDICAID COVERAGE & CONDITIONS OF PAYMENTDistance or Geography Restrictions AInformed Consent APhysician-provided Services BMental/behavioral Health Services BPatient Setting CEligible Technologies CTelepresenter C
INNOVATIVE PAYMENT OR SERVICE MODELSState-wide Network ✔
HCBS Waiver ✔
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SC OpportunitiesPARITY
Private Insurance U
State Employee-based Plan U
MEDICAID COVERAGE & PAYMENT
Eligible Providers U
Home Health U
Rehabilitation N/A
INNOVATIVE PAYMENT OR SERVICE MODELS
Medicaid Managed Care
Medicare-Medicaid Dual Eligibles
Health Home
Corrections
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Medicaid Best Practices for Telehealth Uses
Telemental and Behavioral Health
Stroke
Managed Care
High-Risk Pregnancy
Rehabilitation
Patient Monitoring & Home Video
School-based
Store-and-forward
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Medicaid Prospects
Parity – urban, store-and-forward
Managed care flexibility
Focused initiatives
Specialty – at-risk pregnancies, autism
Chronic - health homes
Sites – home, school-based
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Private Insurance
Obamacare HIE parity
Today21 states + DC w/parity
7 w/10+ years experience
Many insurers choose to cover
Prospects29 w/o parity
14 with 2014 proposals
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State Ratings – Physician Practice Standards
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SC Telemed Practice Rules
PHYSICIAN STANDARDS & LICENSUREPhysician-patient encounter ATelepresenter AInformed Consent ALicensure & Out-of-State Practice C
INTERNET PRESCRIBING POLICY OR STATEMENT
✔
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Federal Interstate “One State License” Model
Defense -- STEP Act (H.R. 1832)
enacted December 2011
Pending
VA: VETS Act, H.R. 2001
Medicare: TELE-MED Act, H.R. 3077
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Other Major Regulatory
FederalFDA on medical devices and software
FCC on universal services and net neutrality
HIPAA privacy and security
DEA for controlled substances prescribing
ONC/CMS electronic health records and health information exchange
StateProf licensure & practice rules at both ends
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Market Opportunities
Mobile and home
Specialty care
Urban
Provider productivity
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AmericanTelemed.orgATAwiki.org
Gary Capistrant
Senior Director, Public [email protected]
202-233-3333