1. Making Telehealth Work For You

2. Overview What is Telehealth? Why Telehealth Regulatory Information
Current WVU Medicine

3. What
is Telehealth?
The use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.
- American Telemedicine Association
Why invest in telehealth?
What are the applications?
How is telehealth offered?
Use Cases
Modalities
Platforms
Diagnosis and Treatment
Real-time Virtual Visits
Telephonic
Web-based
Professional Consultation
Remote Patient Monitoring
Mobile, Smart Device
Monitoring and Care Coordination
Asynchronous Store-and-Forward
Kiosk
Bluetooth-Enabled Peripheral Devices

4. Telehealth Toolbox Relevant Modalities Use Cases Investment Required
Videoconference
Professional Consultation
Diagnosis and Treatment
Education and Engagement
Ongoing monitoring & Care Coordination
Need software, secure internet access for patients
Home and hospital-based technology
Asynchronous
Store-and-Forward
Need additional bandwidth, storage space
Can replace non-urgent phone calls and visits
Remote Device
More expensive hardware investment
Used for high-risk patients in non- hospital site
Telephone
Little tech investment, requires proper staffing
Used for pre-visit triage
Patient Portal
High security needs require significant investment
Must integrate EHR
Mobile App
Minimal hardware investment for providers
Complex security and data storage issues

5. Why Telehealth? Increased access to care Improved compliance
Enhanced coordination & quality of care
More convenient access to timely treatments
Capacity expansion
Reduced transfers/readmits
Avoided unnecessary test and procedures
Reduced costs and travel for patients and providers

6. CMS Coverage Requirements
Geographic Location of Originating Site
Must be provided to an eligible beneficiary in an eligible site
Site must be located in:
A Health Professional Shortage Area outside of a Metropolitan Statistical Area
A rural census tract (even within a MSA)
A county outside of a MSA
Type of Health Provider at Distant Site
Physician
Nurse Practitioner
Physician Assistant
Nurse Midwife
Clinical Nurse Specialist
Clinical Psychology and Clinical Social Worker
Type of Institution for Originating Site
Office of a physician or practitioner
Hospital
Critical access hospitals
Rural health clinic
Federally Qualified Health Centers (FQHCs)
Skilled nursing facility
Hospital-based dialysis center
Community Mental Health Center
Are You Eligible?
Visit the HRSA “Medicare Telehealth Payment Eligibility Analyzer” website.

7. Parity Laws

8. Practicing Across State Lines
Licensing Can Be a Problem for Telehealth Programs
General State Licensure Requirements
Service Occurs in the state in which the patient is physically located, and licensure is required.
Common Exceptions
Physician-to-physician consultations
Education purposes (teaching and demonstrations)
Medical emergencies or natural disasters
Licensure by endorsement, mutual recognition, or reciprocity formal agreements by multiple state licensure boards allowing certain physician privileges without licensure

9. Current Services Tele-Behavioral Medicine
Program
Services
Sites
Reimbursement
Tele-Behavioral Medicine
Child and adolescent, adult, and addiction related services 18
Contract/Grant
Tele-Retinal
Digital retinal imaging with remote image interpretations 3
FFS
Tele-Pediatric Specialties
Sub-Specialty Pediatric services 4
Tele-Stroke/Tele-Neurology
Neurological evaluation of patients with stroke-like or other acute neurological symptoms 9
Contract
ECHO (Extension for Community Health Outcomes)
Project ECHO links expert specialist teams at an academic hub with primary care clinicians in local communities.
Varies
Grant
Tele-Maternal Fetal Medicine and Reproductive Medicine
Specialized Prenatal care and reproductive medicine consults 2

10. Current Services Continued
Program
Services
Sites
Reimbursement
Tele-Nephrology
Chronic Kidney Disease outreach services 3
FFS
Tele-NICU
Inpatient NICU consultations 1
Contract
Tele-Scribe
Scribing: Primary and Surgical Care Offices 2
Tele-HVI
Outpatient Cardiology Consults
E-visit Pilot
Urgent Care Needs asynchronously for ASO population
Cost Avoidance
Remote Home Monitoring
CHF, COPD, Uncontrolled Diabetics in at risk population 3
Cost Avoidance
Video Visits
Real-time Urgent Care Needs (at this point scheduled) 1
Cost Avoidance/New Potentials
VICU
Inpatient Critical Care Consults/Rounding
Contract

11. Tips for Success Set Organizational Objectives
Be Strategic About Technology
Consider Revenue Sources
Use Traditional Performance Metrics
Keep it Sustainable

12. Snapshot: Tele-stroke
Service Description
Hospital-based consult service available via contract to any hospital
24/7 coverage for all neurology conditions; not just stroke
iPads are used for video exams; no
expensive equipment required
Impact
9 partner hospitals
1,000+ consults since January 2016 (new tracking system)
62% of patients remained at the partner hospitals in 2018

13. Snapshot: VICU Success Story-Pilot Census Transfer Rate
High patient satisfaction

14. Snapshot: Nephrology Outreach
Direct ROI $52,513

15. Shannon McAllister, BS, MBA
Thank
You
Shannon McAllister, BS, MBA