1. Telehealth
Survey Update

2. Chapter 2016-240, Laws of Florida:
Survey for current capabilities, utilization and coverage levels:
National and state utilization of telehealth
Barriers to using or accessing telehealth services
Types of health care services provided via telehealth
Costs and cost-savings associated with using telehealth
Extent of insurance coverage and how such coverage compares to coverage for in-person health services
AHCA to submit a report of survey findings to the Governor, Senate President, and Speaker of the House by 12/31/2016
As I shared with the Council at the last meeting the Agency was charged with surveying our licensed facilities to obtain information about the usage and barriers to usage currently occurring in Florida
The Office of Insurance Regulation is currently conducting a survey of insurers and the Department of Health is surveying practitioners as they come up for renewal
We did offer some volunteer surveys – one for practitioners & a second for facilities not licensed by AHCA (Rural Health Center/Clincs, FQHC, & CHD) but received very limited response. Because of the low response rate information from the volunteer survey are not incorporated into this presentation.
Since the DOH and OIR are still receiving survey information – We will be showing you some high level findings –from the Agency’s facility survey only.
A few things to note about the response rates:
We are still cleaning up some of the data – so as the data is adjusted the rates will change
Low response rate for clinical labs -- Many physician offices – obtain clinical lab licenses in order to do some lab testing in their offices – if we calibrate for that difference the response rate will look different

3. Survey Methodology Agency for Health Care Administration
Direct (with survey link) to listed contacts of selected facility types (11,902 contacts)
Follow-up requests to facility types with low response rates
Department of Health
Integrated survey into license renewal system (ongoing data collection)
Coordination and promotion of voluntary effort for rapid data collection
Office of Insurance Regulation
Deployed survey through internal systems
Targeted follow-up with non-responsive plans

4. Response Rates and Telehealth Usage
We surveyed 16 licensed facility types – and were really pleased with the overall response rate, which was 52%.
Based on the responses received – about 9% of all the facilities replying indicate they are using telehealth
We were not too surprised with the facility type that has the highest rate of telehealth usage: Hospitals at 48%
It is interesting that birth centers seem to be the second highest user of telehealth at 24%
Also of note is that the Hospices, Intermediate Care Facilities for Developmentally Disabled, and Prescribed Pediatric Extended Care Centers (P-PECC) indicated NO use of telehealth
The length of time that a majority of facilities responding have been offering health services through telehealth is between 3-5 years – followed closely by those that implemented these services only 1-2 years ago.
One additional comment on those that indicate they are using telehealth – it appears that there may be a knowledge gap on the definition of telehealth. Deeper in the survey when asked what type of telehealth services were used – some responded with Electronic Health Record systems, Patient Portals, Health Information Exchange.
*Segment of Clinical Laboratories in Physicians Offices

5. Barriers to Implementing Facilities currently using telehealth
“On a scale of 1- 5, with one (1) being no barrier and five (5) being a major barrier, how would you rate the barriers experienced by this facility during implementation of telehealth services?”
The survey did ask facilities to share what the strongest barriers to implementing the use of telehealth technology – for those that are currently using telehealth within their facilities – the top barrier for implementing was identified as lack of health insurance reimbursement at 43%, followed by lack of funding at 32%, and then inability to determine ROI at 25%. Of particular note is that these facilities report most of these items as low barriers and for those identified as higher – there are a significant number of facilities that identified those areas as lower barriers.
I do want to point out that although often brought up as a high barrier antidotal – practitioner licensure was only considered a barrier by 11% of those responding.
Note: This was a “select all that apply question”

6. Barriers to Implementing Facilities that have tried to used telehealth
“On a scale of 1- 5, with one (1) being no barrier and five (5) being a major barrier, how would you rate the barriers experienced by this facility when trying to implement telehealth services.”
The survey also ask facilities if any of the facilities that are not offering telehealth – if they had ever attempted to do so… there were right at 3% that had. The top barriers for implementing telehealth in this group were similar to those that are currently using telehealth - lack of health insurance reimbursement at 54%, followed by lack of funding at 51%, and then inability to determine ROI at 36%. Again licensure was not identified as a strong barrier to implementing telehealth services. You will notice for this group of responders more barriers were identified as higher and the disparity between high and lower barriers is much greater.
Note: This was a rate each question

7. Barriers to Implementing Comparison of Current and Former
This chart shows a comparison between facilities that are currently providing telehealth services and those that formerly offered telehealth services
I really shows that those facilities that could not continue found many more barriers than those that have been able to persist. Of particular note for the former telehealth providers – are the following barriers: inability to get physician support; in ability to develop partnerships with presenting (presenting being the higher) or originating sites; and inability to electronically exchange patient records.

8. On-Going Challenges
“On a scale of 1- 5, with one (1) being no challenge and five (5) being a major challenge, how would you rate the on-going challenges this facility encounters in offering telehealth services?”
In addition to barriers we asked facilities about on-going challenges that they face – lack of insurance reimbursement was by far identified as the greatest challenge for these facilities. 46% facilities indicated this as a greater challenge than other potential challenges.
Note: This was a rate each question

9. Reimbursement
“On average, what percentage of telehealth services are reimbursed by health plans at this facility?”
Since the barriers and on going challenges indicate reimbursement as a leading issue – we also wanted to share information on reimbursement from the facility perspective.
Although a majority indicate that they receive no reimbursement – it is notable that there are some facilities that are getting reimbursed 100% for telehealth services

10. Facility Benefits
“What benefits has your facility attained as a result of implementing telehealth services? (Select all that apply)”
The facilities providing telehealth service did indicate that they are seeing benefits – the strongest benefits seem to be patient focused – with care coordination and patient convenience topping the list in a tie – and better patient outcomes coming in a close second.
Other: convenience for physicians, time to get patient to a specialist, some indicated that the benefits were yet unknown because of the short duration of implementation
Note: This was a select all that apply question

11. Cost Savings “What percent of cost-savings to this facility, if any,
can you attribute to providing telehealth services ?”
Unknown – is significant – in the comments section of this question there we several references to being too new to provide a valid response…other comments noted reduced length of stay for patients and reduced or off-set staffing (i.e. instead of hiring a specialist can hire other personnel)

12. Reported Needs Education, training, and evidence based resources
“What would assist you, if anything, in implementing, sustaining, or expanding telehealth services?”
Education, training, and evidence based resources
Reimbursement
Funding
Resources
The final question on the survey asked respondents to share in text format what would assist them in implementing, sustaining, or expanding their telehealth services?
Surprisingly for staff education/training was the most requested – followed by reimbursement, then funding & resources
Resources = staffing, technical capabilities, etc.
Funding = $$$

13. QUESTIONS / DISCUSSION