Telemedicine—The How, the Why, the Cost, Benefit Nipa R. Shah, MD University of Florida, College of Medicine, Jacksonville Chair, Dept. of Community Health and Family Medicine

TELEMEDICINE VS TELEHEALTH Telehealth: Encompasses all aspects of health that is administered using remote technology services Telemedicine—Clinical services are provided utilizing this technology

Technology and Health Care

TAKE HOME MESSAGE—it’s simple and it’s not simple There’s no difference in the health care provided, just the modality. Yet, many laws, policies, procedures play a role.

WHO can practice, and WHERE? Interstate Medical Licensure Compact Currently at 18 states Licensure in multiple states-an expedited process Allows a physician to render care in the state where the patient resides. http://www.fsmb.org/policy/advocacy-policy/interstate-model-proposed-medical-lic https://www.fsmb.org/Media/Default/PDF/Advocacy/Interstate%20Medical%20Licensure%20Compact%20(FINAL).pdf

BENEFITS Speedier diagnoses Increased access to care, esp. underserved/rural populations Reduced health care costs Can relieve physician shortages

HOW? AMA has some free resources….STEPS FORWARD program https://www.stepsforward.org/modules/a dopting-telemedicine

Florida Report on Telehealth Utilization and Accessibility Highlighted findings contained within this initial report include: • Utilization of telehealth is expanding in Florida and nationally, both in terms of the variety of applications and use cases as well as patient volume and demand. • Nearly half (44.8%) of Florida hospitals responding to AHCA’s telehealth survey indicated that telehealth services are available through their facilities.

A state survey

Florida Report on Telehealth Utilization and Accessibility Utilization of telehealth is expanding in Florida and nationally, both in terms of the variety of applications and use cases as well as patient volume and demand. Nearly half (44.8%) of Florida hospitals responding to AHCA’s telehealth survey indicated that telehealth services are available through their facilities.

Florida Report on Telehealth Utilization and Accessibility Benefits reported from health care facilities and professionals offering telehealth services include improved convenience for both patients and providers, improved efficiencies, and improved patient care outcomes. Financial barriers are the most frequently reported obstacles among health care facilities and providers during both implementation and ongoing operations of telehealth programs.

Florida Report on Telehealth Utilization and Accessibility Due to multiple and often conflicting definitions of telehealth at every level (Federal, State, and among private payers and policymakers), there is significant uncertainty …purposes of coverage and reimbursement. There remain significant challenges with interoperability between providers across the state and nationally,

Florida Report on Telehealth Utilization and Accessibility Few providers have achieved a financial Return on Investment (ROI) attributable to the implementation of telehealth services; although some examples do exist. Many providers reported a lack of detailed knowledge about telehealth services, and indicated interest in gaining access to evidence-based best practices, educational resources, or training opportunities associated with telehealth.

UF Health Virtual Visits 22 (out of 35 Primary care clinics) in NE Florida and Southern Georgia Payers: Capitated plan with Florida Blue Gatorcare Medicaid Self-pay ($49 introductory visit)

Steps Consent form-verbiage added (1 year) Training Access/Call Center personnel CSRs/MAs Physicians/Providers

Steps Infrastructure How to schedule the appointment IT software/hardware (microphone, headset, webcam) Legal EPIC EMR (changes with upgrades) Political (legislature worried about overuse, lack of parity)

Steps Marketing (Employers, Payors, Patients) Financial Competition, national/international Parity Payors Contracting Billing and Coding

Steps Task Force/Committee/Division Problem solving Dissemination Psychiatry, Pathology, Surgery, Neurology, Neurosurgery, Anesthesiology, Pharmacy, Orthopedics, OMFS, Pediatrics, Ophthalmology Future: Physical Therapy, Dermatology, OB-Gyn

UF Health Virtual Visit

Contact information Nipa R. Shah, MD Nipa.shah@jax.ufl.edu 904-244-3196