The Doctor is IN Online! Lew Benedict The latest on Telemedicine & what physician recruiters need to know about it September 16th, 2015 Lew Benedict

Agenda Defining Telemedicine History Successful Uses Why It’s Growing and Where it’s Going Telemedicine Regulatory Information Staffing Telemedicine This presentation will cover some high-level information on telemedicine as an industry. Then, we’ll get into some helpful tips that you, as physician employers, can employ to help you transition, if you need to, to recruiting for telemedicine practices.

What is Telemedicine? Telemedicine is the remote delivery of healthcare services and clinical information using telecommunications technology. This includes a wide array of clinical services using internet, wireless, satellite and telephone media. The American Telemedicine Association is the most widely-recognized industry group for telemedicine. This is the official definition they use. Confidential and Proprietary LocumTenens.com © 2014

History of Telemedicine William Einthoven transfers electrocardiograms electronically 1905 First used by NASA to monitor health of astronauts in space 1960s Telemedicine matures; wide-spread acceptance of teleradiology practices 1990s Telemedicine seen as a viable means for improving access, decreasing costs. Now The history of telemedicine varies by who you ask. One of the earliest known uses was in 1905, with the transmission of electrocardiograms. We in healthcare first widely felt the impact in the 1990s with the growth of teleradiology, which dramatically impacted the radiology specialty.

Specialties in Telemedicine Allergy/Immunology Anesthesia Cardiology Critical Care Dermatology Otolaryngology (ENT) Emergency Medicine Endocrinology Family Practice Gastroenterology Infectious Diseases Internal Medicine Neurology Oncology/Hematology Ophthalmology OB/GYN Pediatrics Psychiatry Pulmonology Rheumatology Surgery Urology This isn’t an exhaustive list of specialties using telemedicine, but gives you an idea for how telemedicine is impacting all specialties. It can be used in different ways, including physician-to-physician consultation, physician-to student (physician, nurse, other care giver) teaching, physician-to-patient examination and consultation, and physician-to-patient treatment. Give dermatology example In California, UC Davis has a widely-used pediatrics telemedicine program that treats children across the state, including critical care. Confidential and Proprietary LocumTenens.com © 2014

“To date, no studies have identified any patient subgroup that does not benefit from, or is harmed by mental healthcare provided through remote video conferencing.” -American Telemedicine Association Confidential and Proprietary LocumTenens.com © 2013

“78 % of ER, urgent care, and doctors visits can be handled safely and effectively over the phone. -American Medical Association Confidential and Proprietary LocumTenens.com © 2013

Growth of Telemedicine Globally $9.8 billion 2010 Market Size $13.8 billion 2012 Market Size 278% Growth Rate Expected Between 2010-2016 --BCC Research, 2013

By the Numbers U.S. Market Size (ATA) +50% More than half of U.S. hospitals now use telemedicine applications 230 telemedicine networks (hub & spoke) >3,800 U.S. service sites Over 1 Million Americans are currently using remote cardiac monitors Networked programs link hospitals and clinics with outlying clinics and community health centers in rural or suburban areas. The links may use dedicated high-speed lines or the Internet for telecommunication links between sites. ATA estimates the number of existing telemedicine networks in the United States at roughly 200 providing connectivity to over 3,000 sites. Confidential and Proprietary LocumTenens.com © 2014

Successful Uses of Telemedicine Goal Scenario Results Improving Mental Health Services Access Albemarle Hospital Foundation founded a telepsychiatry program in 2011 to reduce patient length of stay, improve access to psych care. National survey revealed that more than 70% of EDs board psychiatric patients for hours or days, with 10% keeping them for weeks. 47% reduction in length of stay 35% reduction in 30 day recidivism rates.  Reducing ED Overcrowding/Wait Times From 2003 - 2009, the mean wait time in U.S. emergency departments (EDs) increased 25%, from 46.5 minutes to 58.1 minutes. (Source: CDC) UC-San Diego currently running a pilot program to attempt to reduce wait times for its patients by utilizing telemedicine consults. (Source: ATA)

Successful Uses of Telemedicine Goal Scenario Results Increasing Access to Specialist Care All head injuries must be evaluated by a pediatric neurosurgeon (AAP). Billings Montana: Nearest specialist 500 miles away. Transport to Denver = $15,000+ cost. Now: Child gets a CT. Remote neurosurgeon reviews via video patient assessment. Remote neurosurgeon works with local surgeon to help children at low risk for complications avoid transport. Staffing During Low Volume Hours A new study analyzed Florida state hospital discharge data to investigate the potential market for a nighttime telehospitalist services. The study found 19% of common hospitalist admissions occurred between 7 p.m. - 7 a.m., with the range of admissions per night only between 0-10 patients. 80% of admissions occurred before midnight.

Why Healthcare Organizations are Turning to Telemedicine Physician Shortages/High Cost of Physician Employment Cost Reduction/Efficiency Improvement Efforts Improved Access for Patients Better Technology/More Acceptance from Patients, Physicians Better Reimbursement Parity Retain Patients (Example: Stroke)

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Barriers Complex Telemedicine Equipment System Downtime Security and Privacy Confidential and Proprietary LocumTenens.com © 2013

Reimbursement Parity Laws for Telemedicine Reimbursement for Telemedicine: -20 states plus D.C. require private insurance reimbursement -Almost every state Medicaid plan covers some telemedicine services -Medicare Advantage plans cover all teleservices; some rural enrollees have access -Items such as teleradiology are covered by Medicare as “physician services” Source: American Telemedicine Association Data current as of June 2014 Confidential and Proprietary LocumTenens.com © 2014

Staffing Basics for Telemedicine The healthcare provider must be licensed in the state where the patient is physically located and being “seen”. Strict compliance to HIPAA is required. Malpractice coverage guidelines differ by state. Some policies only cover face-to-face encounters. Malpractice coverage should extend into every state where patient encounters occur. Physician benefits

Staffing for Telemedicine Implementation Appoint a physician champion for telemedicine service lines. This helps reduce internal resistance to telehealth programs. Provide regular training for physicians, support staff before patient encounters occur. This should include physician documentation of encounters in the organization’s EHR system, if required. Have contingency plans in place for emergencies (technology issue, patient distress, etc.). ALL telehealth should be supported 24/7.

Tips for Vetting Candidates Questions & Fact Checking: Always conduct a video interview with candidate. “Tell me about your experience with telemedicine & EMR usage”. “Discuss comfort level & experience with technology”. “Willing to accept lower pay for telehealth opportunity?” “How important is onsite culture to you?” “What has been your experience in terms of building relationships with patients and your team while working remotely?” Vetting candidates for telemedicine is not that much different than vetting physicians for onsite work. The only exception is you have to make sure the physician’s presence can carry virtually to not negatively impact patient experience.

Tips for Vetting Candidates Carefully evaluate level of “virtual” engagement, eye contact, and bedside manner. Will the provider commit to training others (nursing staff, etc.) in utilizing or supporting telemedicine activities and consultations? Can this physician comply with all rules and regulations, such as HIPAA, as well as the clinical guidelines of your organization? Confidential and Proprietary LocumTenens.com © 2013

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