1. DIAGNOSING FROM A DISTANCE aka Telehealth
Illinois Association, MSS
April 11, 2019
Presented by
Christine S. “Cris” Mobley, CPMSM, CPCS
President, C Mobley & Associates, LLC
Co-Founder/Owner, Edge-U-Cate, LLC
Colorado Springs CO
Proprietary – for educational purpose only

2. Learning Objectives Define the telehealth regulations
Identify the options for meeting these regulations
Respond to concerns and issues that the profession is having with telehealth
Describe scenarios where telehealth can be effective in treating patients
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3. Definition of Telehealth
Telehealth is the use of technology to deliver health care, health information or health education at a distance.
Telehealth can be divided into two general types of applications: real-time communication, and store-and-forward.* Real-time communication may be a patient and a nurse practitioner consulting with a specialist via a live audio/video link.
Store-and-forward refers to the transmission of digital images, as in radiology or dermatology, for a diagnosis. source: HRSA
*Also remote monitoring; e.g. e-ICU
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4. What it is today
A multi-billion-dollar industry and with nearly every major healthcare system leveraging it to transform and to re-invent healthcare.
Currently about 200 telemedicine networks, with 3,500 service sites in the US.
Nearly 1 million Americans are currently using remote cardiac monitors and in 2011, the Veterans Health Administration delivered over 300,000 remote consultations using telemedicine.
Over half of all U.S. hospitals now use some form of telemedicine.
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5. Today No real distinction between telemedicine and telehealth
“Telehealth” now commonly used to encompass all
Note: CMS does not differentiate between “telemedicine” and “teleradiology,” so credentialing rules for telemed/telerad are same
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6. Benefits Improved access – increases service to millions of patients
Cost efficiencies – reducing or containing healthcare cost
Reduced travel times
Fewer or shorter hospital stays
Shared professional staffing
Better management of chronic disease
Improved quality – studies show services provided through telehealth are as good as those given in person
Patient demand – consumers want it!
source: American Telemedicine Association
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7. A little history Started with Teleradiology Expanded to:
Tele-Radiologists were in Australia, other countries
Later, had to relocate to the U.S.
Expanded to:
E-ICU
Sub specialties that are not available in many communities
Many services offered by academic settings
CMS did not originally condone Contracts/Agreements for “proxy” credentialing and there were issues
Created dilemma for hospitals who were using (accreditors allowed it)
Legislation in 2011 gave hospitals the ability to choose
Organizations updated their telemedicine policies to comply with CMS as did the accreditors .
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8. What did we do before telehealth??
On-call physician called and waited for them to come into the hospital
E.g., radiologists for an accident
Transfer to another facility
By air
By ambulance
Outcomes could be tragic – delayed treatment/surgery
Other? (audience)
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9. Telehealth – The Accreditors:
DNV, HFAP, TJC standards address telemedicine privileges which follow CMS guidelines.
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10. Diagnosing from a Distance
Telehealth
Diagnosing from a Distance
Telemedicine (via electronic link)
LIP has either total or shared responsibility for pt care, treatment, services (i.e.; authority to write orders and/or direct responsibility for care), LIP provides official interpretative services (readings of images, tracings or specimens), all thru telemed link
Originating site (where pt is located) fully credentials internally (may use a CVO); or
Originating site uses distant site info (hospital or telemedicine entity) to privilege practitioners if distant site has CMS “deemed status” when making its privileging decision; or
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11. Telehealth 3. Originating site may choose to accept credentialing and
privileging decision from distant site when making final
privileging decision IF governing body,
through written agreement, ensures distant-site’s
credentialing/ privileging process and standards meet or
exceed CoPs (& have “deemed status”); and
Practitioner privileged for same privileges at distance site; and
Evidence of internal review of performance of practitioner
Distance site provides originating site with a current list of LIPs’ privileges. (No copies of credentialing information is necessary nor recommended.)
source – paraphrased from TJC HAS 2017
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12. Diagnosing from a Distance
Telehealth Cont’d
Diagnosing from a Distance
APPROVAL
Regardless of method used to credential, practitioner credentials must still go through MS for privilege recommendation and Board for approval. Again, in the case of “proxy” credentialing, a list is given to originating site by distance site of those providing services for approval by distance site.
No “membership” category necessary – privileges only - TBD
Can be utilized in a temporary privilege situation if it meets the definition of “pressing need.”
Remember –
Provider must be licensed in distant and originating state/s
Must do NPDB query unless assigning distance site as authorized agent; separate NPDB query must still be obtained (and de-enroll when no longer providing service)
Originating site still has duty to monitor performance (and report any issues to distant site if utilizing #3)
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13. What do you use it for?
Audience
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14. Industry Video conferencing Remote monitoring of vital signs
Cardiac, pulmonary, fetal monitoring
Mental health
Hospitalists/nocturnists
Intensive care services e.g., vent mgmt/fluid/pain mgmt., other
Many more specialties
CME credits for those in remote locations
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15. REAL CASE SCENARIO: the Facts
Northern CA – rural, critical access hospital
Access to nocurnist medicine – chronic issue
2009 brought in robot for p.m. hospitalist
Hospital admissions increased by 2% within 60 days
Nursing staff, patient satisfaction increased
Resulted in better patient care outcomes and fewer transfers
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16. Medicine Department Meeting
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17. Good news – didn’t have to credential the robot
Conclusion – expense was more than offset by increases in revenues & patient & staff satisfaction
AND…………………..
Good news – didn’t have to credential the robot
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18. Credentialing and privileging
Telehealth is NOT a separate medical specialty
Same training
Same Boards
Telehealth is NOT a medical staff category
Where is it defined in your bylaws?
Where should it be defined in your bylaws?
Telehealth IS a “methodology” for providing patient care services
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19. Decision points In-House credentialing v. credentialing by proxy
May use either depending upon factors below
Factors to consider:
Staffing
Volume
Competency (OPPD) at distance site
Timing
Recruiting individual from an accredited organization
Accredited organization must have “deemed status” to be able to credential by proxy; otherwise, originating site must credential
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20. Telehealth credentialing – Proxy efficiencies
TRADITIONAL
TELEHEALTH NEW WORLD
Signed application for MS membership
Contract – select providers
Signed release/authorization
n/a
Grant MS membership
2 year cycle
Primary source verification
Rely on contract
Query NPDB
Signed privilege delineation form
One common privilege delineation
Grant privileges
1 year annual contract review
Individual credentials file
One list for all contract providers
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21. Telehealth credentialing – Proxy efficiencies
TRADITIONAL
TELEHEALTH NEW WORLD
OPPE
Report adverse events/complaints
FPPE
Signed reappointment request
n/a
Signed privilege delineation request
Contract
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22. Telehealth credentialing - efficiencies
MEDICAL STAFF OBLIGATIONS/PREROGATIGES
Parking
n/a
ED call coverage
Dues/fees
Annual meeting attendance
Department meeting attendance
Committee Service
Vote on medical staff actions
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23. Your role Get involved in telehealth discussions
Help to determine which telehealth path to follow given the facts (see previous slides)
Know what your organization’s letter of agreement/contracts state (if using Proxy route)
Know and monitor your State’s laws
Facilitate the approval process through Medical Staff and Board approval process regardless of which path chosen
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24. Resources American Telemedicine Association
Illinois State Medical Society
The Joint Commission Medical Staff Standards, MS
HRSA
UC Davis Medical Center, Sacramento
Stanford University Hospital (see on line forms, etc)
Google it!!
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25. Questions???? Comments!!!!
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