Professional Documents
Culture Documents
James Coviello, MD
Regional Medical Director
UH Primary Care Institute
2
Definition of Telemedicine and Telehealth
Source: Connected Health: A Review of Technologies and Strategies to Improve Patient Care with Telemedicine and Telehealth. Health Affairs
2014
3
What is Telemedicine?
Telehealth Use Cases, Relevant Modalities, and Investment Required
Ongoing
Use Cases
4 4
Medical Organization Telemedicine Guidelines
5
State of Ohio Telemedicine Overview
6
State by State Medicaid and Private Payer Coverage
7
Federal Telemedicine Overview
• Medicare provides limited telemedicine payment coverage.
• To qualify:
– Originating Site – location of eligible Medicare beneficiary. Must be a Health
Professional Shortage Area (HPSA) located either outside of a Metropolitan
Statistical Area (MSA) or in a rural census tract; or a county outside of an MSA.
Must also be one of 8 types of health care facilities (e.g., doctor’s office, hospital,
etc.)
– Distant Site – location of an eligible provider. Must be one of 10 types of
providers (e.g., physician, nurse practitioner, clinical psychologists, registered
dieticians, etc.)
– Covered Services – limited to certain HCPCS/CPT Codes
• Most UH locations do not qualify.
• Current (114th) Congress has introduced several telemedicine-
related bills, including Medicare coverage expansion.
Source: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/telehealthsrvcsfctsht.pdf
8
THE TRAIN HAS LEFT THE STATION…..
9
External Forces Driving Telemedicine Expansion
• Consumer demand
• Cost saving efforts: Commercial and employer-based insurance,
ACO shared savings program
• Value-based care and population management incentives
• Patient access/workforce limitations
• Expanding technology capabilities
10
Consumerism in Healthcare
Source: Patients’ Satisfaction with and Preference for Telehealth Visits. Polinski JM et al, J Gen Intern Med March 2016
11
Smart Phone Medical Devices
12
Challenges and Concerns
13
HOW DID WE GET HERE?
14
Health Care Reform Evolution
IHI
CMS
TRIPLE ACA MACRA
PQRI
AIM
15
MACRA Overview
16
Commercial Insurance Payment Models
17
Delivery System and Payment Transformation
18
Potential Telemedicine Uses
19
Telehealth at UH
Direct to Consumer Video Consult Patient Access
Tele-Urgent Care Online Scheduling
Telepsychiatry
(UH Virtual Visit) (Zocdoc)
Rainbow Care Connection
Remote Second Opinion Telestroke
(Nurse Triage)
UH Patient Portal
Pediatric Specialty Consults Video Concierge
(Follow My Health)
Martii Virtual Translation
Tumor Board
Neurology
Genetic Counseling
20
Current UH Virtual and Telehealth Technologies
21
UH Virtual/Telehealth Strategies and Initiatives
22
Telehealth Programs In Development
23
Virtual/Telehealth at University Hospitals
Future State
Direct to Consumer UH Facility to UH to
or Employer UH Facility External Partner
Clinical Information
Quality Measures
Contact Information
James Coviello, MD
Primary Care Institute
James.Coviello@UHHospitals.org
216-691-3510
25
Appendix
26
State Medical Board of Ohio Position Statement
27
Practice of Telemedicine Definition – Ohio (ORC
4731.296)
• The practice of medicine in this state through the use of any
communication, including oral, written or electronic communication,
by a physician located outside this state.
28
MIPS Payment Adjustment Summary
29