1. What value does it bring to Pretend Hospital? Pretend Hospital Logo Caring For You

2.  Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients' health status.  Closely associated with telemedicine is the term "telehealth," which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. Pretend Hospital Caring For You

3.  CMS has identified these: ◦ Physician (MD/DO) ◦ Nurse practitioner ◦ Physician assistant ◦ Nurse midwife ◦ Clinical nurse specialist ◦ Clinical psychologist ◦ Clinical social worker ◦ Registered dietician/nutrition professional (as of October 2010)

4.  Physician/Practitioner Office  Critical Access Hospital (CAH)  Federally Qualified Health Center (FQHC)  Hospital  Rural Health Clinic  Hospital-based or CAH-based Renal Dialysis Center (including satellites)  Skilled Nursing Facility  Community Mental Health Center (as of October 2010)

5. Telehealth Services under MedicareCPT/HCPCS Codes Consultants99241-99255 Office or Other Outpatient Visits99201-99215 Psychiatrist Diagnostic Interview Examination 90801 Individual Psychotherapy90804-90809 Pharmacologic Management90862 Individual Medical Nutrition TherapyG0270, 97802, 97803 End Stage Renal Disease (ESRD) Related Services G0308, G0309, G0311, G0312, G0314, G0315, G0317, G0318 Neurobehavioral Status Exam96116 Follow-up Inpatient Telehealth Consultations G0406, G0407, G0408 Information from Center for Telehealth & e-Health Law (October 2010) www.ctel.org

6.  Medicaid ◦ 35 states have established rules for telehealth reimbursement ◦ Minnesota Medicaid  Private Pay ◦ 12 states have passed legislation requiring insurance companies to pay for services delivered by telemedicine  Contract-based Services

7.  Hospital-based services  Providers must be credentialed where the patient is located  Privileges must also be granted  This process is currently being debated in Congress

8.  Determine if there is a need for the service ◦ Do you have disparities to address? ◦ Lost your provider? ◦ What is the expected patient volume?  But, is there a demand? ◦ Are providers asking for the service? ◦ Are patients asking for the service? ◦ Are others already providing the service?

9.  In/Out Patient Specialty Services: – Dermatology – Mental Health – Cardiology – Infectious Diseases – Pediatric Services – Endocrinology – Wound Care – Pulmonology – Oncology – Trauma/ER – Stroke Care …and more

10.  Telepharmacy  TeleHome Heath (home monitoring)  Remote ICU Monitoring  Family Interactions  Case/Disease Management  Education ◦ staff, provider, family, community

11.  Organizational  Budgetary Pretend Hospital Caring For You

12.  Access to add’l care resources  Staff competency  Community perception  Service stability  Patient Experience  Peer-to-peer interactions

13.  Stretch a tight travel budget  Increase ancillary services  Service continuation/expansion  Enhance the quality of care  Market-leader

14.  Impact of Telehealth ◦ Don’t look at it in a “bubble” ◦ A tool of your entire organization ◦ Now vs. Future  It is more than hard ROI ◦ Can you afford NOT to have something

15.  Lost Market Share?  Professional isolation/burn-out  Loss of “hometown dollars”  Being viewed as “Behind the Times”  Patient Care Liability  Not providing a high quality “patient experience”

16. Pretend Hospital Caring For You

17.  Adds value  Strengthens relationships  Builds competency  Stretches budgets  Expands services

18.  Patients  Providers  Partner facilities  Payers

19.  Take a step…even a small one!  Figure out what makes sense for your organization  If not…you’ll only get further behind