USE OF TELEMEDICINE

FOR BEHAVIORAL

HEALTH TREATMENT

WITHIN PRIMARY CARE

Presenters:

Jessica Bosecker, LMHC

Donna Vaughan, DBH, LMHC

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WINDROSE CLINIC LOCATIONS AND PROVIDERS

• 7 Clinic Locations (Hope, Trafalgar, Franklin, CounyLine, Whiteland, Epler Parke, Edinburgh)

• 26 Providers

• 7 Pediatricians

• 8 Adult MDs

• 5 Family Nurse Practitioners

• 4 Behavioral Health Providers

• 1 Behavioral Health Clinicians

• 4 Community Mental Health Workers

• 2 Tele-Psychiatrists

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TODAY’S AGENDA

•Brief overview of telemedicine/telehealth

• Implementing telemedicine services in primary care

•Discuss barriers/successes

•Workflow/Billing/Reimbursement

TELEMEDICINE SERVICES

• Distant site: Location of the provider rendering healthcare services

• Originating site: Location where the patient is physically located for service

• Attendant to connect the patient to the provider

• Equipment: computer/monitor, interactive, face to face communication

• “The use of videoconferencing equipment to allow a medical provider to render an exam or other service to a patient at a distant location.”

2019 FSSA Indiana Health Coverage Program Provider Reference Module

TELEMEDICINE

“It provides the tools necessary for connectivity when providers and recipients of care could not be in the same place at the same time”

2010, S. Ryu History of Telemedicine: Evolution, Context, and Transformation

HISTORY OF TELEMEDICINE

• Ancient Greece

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2010, S. Ryu History of Telemedicine: Evolution, Context, and Transformation

Transmission of heart rhythms via phone lines

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1920

Radio transmission

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1940

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1950

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1959Video communication for medical purposes

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1960

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under CC BY-SA

1970

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1980 – PRESENT DAY

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2019

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licensed under CC BY-SA-NC

FROM THE WALL STREET JOURNAL

“Amazon.com Inc. is positioning Alexa, its artificial-intelligence assistant, to track consumers’ prescriptions and relay personal health information, in a bid to insert the technology into everyday health care.”

CURRENT VARIATIONS

• Live (synchronous)

• Store-and-forward (asynchronous)

• Remote patient monitoring (RPM)

• Mobile health (mHealth)

TELEMEDICINE SERVICES

• Began March 2017

• 200+ patients have accessed psychiatric care

• Partnered with Regroup & Genoa Telepsychiatry to provide psychiatry hours

• 10 hours of adult psychiatry per week

BARRIERS

• Tele-providers who are NOT a good fit

• PCPs who have not bought in

• Limited number of hours resulting in long wait time for services

• Managing staff related issues at multiple separate locations

• Workflow in each clinic (daily staff shortages)

• Ease of transition/communication between medical and psychiatric providers

• Cost involved

SUCCESSES

• Patients can attend one of four WHN locations

• Access to mental health medications that primary care is typically unable to provide

• 200 patients engaged

• Positive patient feedback regarding quality of services

• Reimbursement rate of 86% for telepsychiatry services

WORK FLOW MATTERS

• Pt arrives

MA - Vitals

• Pt is connected to tele-psychiatrist

Visit Ended• Follow up

scheduled

Labs

WORK FLOW MATTERS

• Pt arrives

MA - Vitals

• Pt is connected to tele-psychiatrist

Visit Ended• Follow up

scheduled

Labs

TELEMEDICINE SERVICES

• BHPs are the gatekeepers

• Referral is sent to the scheduler

• Waitlist

• Schedule accordingly

• Day of the visit need a workflow process

TELEMEDICINE FOR SUBSTANCE USE TREATMENT

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BILLING & REIMBURSEMENT

• POS code (Place of service code) 02

• Modifier GT

• Modifier 95

BILLING

•90792 GT Initial Psychiatric Assessment

•99213 GT Follow up visit

BILLING

•90792 GT Initial Psychiatric Assessment

•99213 GT Follow up visit

•Approximately 80% reimbursement

REFERENCES

http://evisit.com/resources/history-of-telemicine/

Ryu, Seewon, 2010, History of Telemedicine: Evolution, Context, and

Transformation, The Korean Society of Medical Information