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February 2018    
HTRC's monthly telehealth bulletin

Just in time for Kidney Month, Medicare coverage to expand for telehealth home dialysis

Dialysis is an expensive necessity for nearly 470,000 Americans with end-stage renal disease (ESRD), but recent improvements in telehealth technology and reimbursement have planted a seed of hope for home dialysis patients just in time for Kidney Month.

The two-year, federal spending bill signed February 9 includes funding for the CHRONIC Care Act. Among other things, the act includes Medicare reimbursement for telehealth services provided to ESRD patients in their homes or in independent dialysis centers. ESRD patients on Medicare will be eligible to receive monthly telehealth visits if they continue to see their provider for periodic, in person visits - once a month for the first three months and then only once every three months after that. Another benefit of the act is that it will allow providers to distribute free technologies to patients, including home monitoring devices and devices that enable patients to connect from home, such as tablets.
Home dialysis can be performed without telehealth, however, video consultations have potential to reduce complications and  improve patient confidence and satisfaction. Common patient fears about home dialysis include performing the treatment incorrectly, burdening family members who assist them and feeling isolated from medical oversight. Telehealth can help ease these fears by establishing a means for consistent patient-provider communication and monitoring symptoms with medical devices.

The new legislation also extends coverage to non-rural patients. Telehealth with home dialysis care can be particularly beneficial for patients who face transportation barriers like an unreliable vehicle or living in a rural area. These patients may not have access or resources to see a provider in person regularly, and telehealth can facilitate consistent patient-provider interactions to ensure they are receiving the care they need.

In an effort to reach rural and underserved veterans, the  VA had already expanded its kidney care through telehealth in recent years. Their expanded choices include primary care provider support, eConsults, remote patient monitoring devices and kidney health awareness programs.

While more research into the effectiveness of telehealth for home dialysis is needed, initial findings are encouraging. In a study published in December, researchers found that using a home hemodialysis telehealth platform was associated with a decreased risk of attrition.
Though there will still be a wait for CMS to promulgate the new rules, the clouds are beginning to part for home dialysis patients who can benefit from telehealth services.

Telehealth successes in the new federal spending bill

The two-year federal spending bill signed February 9 funds the CHRONIC Care Act, which included numerous wins for telehealth coverage. Thomas B. Ferrante and Nathaniel M. Lacktman report in Health Care Law Today that the bill will, among other perks, include:
  • Elimination of originating site restrictions for telestroke;
  • Expansion of telehealth reimbursement for home dialysis;
  • Medicare Advantage plans will be able to offer telehealth as a basic benefit; and
  • Accountable Care Organizations will be able to bill for telehealth services in patients' homes.

March 5-9
Las Vegas, Nev.

The Healthcare Information and Management Systems Society 2018 meeting will cover topics including population health; pharmacy standards and technology; emerging payment models for value-based care; consumer and patient engagement and many more. Keynote speakers in clude Eric Schmidt, the technical advisor and former chairman of the parent company of Google, Alphabet Inc.; Vice Admiral Raquel C. Bono, director of the Defense Health Agency; and basketball star and entrepreneur Magic Johnson.  The Telehealth Resource Center booth welcomes HIMSS attendees and HTRC PI Dr. Eve-Lynn Nelson participates on " A Framework to Support Measure Development for Telehealth " panel on Tuesday at 8:30 a.m.

April 29 - May 1
Chicago, Ill. 

Join healthcare professionals and leaders from an array of healthcare and technology sectors at the American Telemedicine Association to learn, innovate and network. You will return to your organization with actionable insights, long-lasting connections, and an enhanced appreciation of telehealth-and how it transforms healthcare delivery. Be sure to visit the Telehealth Resource Center booth. You have until March 30 to take  advantage of early-bird savings on registration!

ECHO schedule

Starts February 27 Kansas
HELP it Might be Autism Starts in April Kansas
Opioid Addiction Treatment
Child Behavioral Health Ongoing Kansas
Impact Asthma Ongoing Missouri
Ongoing Missouri
Healthcare Ethics Ongoing Missouri
Chronic Pain Management Ongoing Missouri
Dermatology Ongoing Missouri
Hep C Ongoing Missouri
Child Psych Ongoing Missouri
Community Health Worker
Opioid Use Disorder Ongoing Missouri
Addiction Medicine Ongoing Oklahoma
Obesity Medicine Ongoing Oklahoma
HIV/Viral Disorders Ongoing Oklahoma
Pediatric Psychiatry Starts February 27 Oklahoma
Psychiatry Ongoing Oklahoma

Rural CEO Panel at Missouri Telehealth Summit
From left: Moderator Randall Tobler, M.D.; Gary Jordan, CEO of Wright Memorial Hospital; John Bustle, M.D., CEO of Bates County Memorial Hospital; Kasey Lucas, CEO of Salem Memorial District Hospital; and Amy Ireland, CRO of Carroll County Memorial Hospital

This year's Missouri Telehealth Summit included a panel of executives from rural hospitals  to discuss some of the unique benefits and challenges of rural telehealth programs. The telehealth services at all four hospitals represented had been well  received , with few exceptions. However, challenges  with reimbursement remained. Here are a few of the highlights from the panel:

Educating the boardGary Jordan, CEO of Wright Memorial Hospital, suggested that telehealth champions consider the demographics of the board before presenting the proposal. For example, older board members might be less familiar with the technology, but they are influenced by the services telehealth can bring to the community.

Nurse support - The chief nursing officer at Bates County Memorial Hospital became an early champion of telehealth after realizing the benefit of increased access to hospitalists, said CEO John Bustle, M.D. Jordan elaborated, saying that the telehospitalist program had especially been embraced by night-shift nurses. He said these nurses tend to be the younger, less-experienced nurses who fear reprisals when they have to wake a physician. Now they work with a telehospitalist in a different time zone, whose waking hours are during their night shift. 

Special populations  - One of the executives related his experience working with a religious community that has traditionally been technology resistant. After presenting to elders in the community, they were receptive to the technology, in part because transportation to larger hospitals was a real challenge to this population. 

Payer challenges - Amy Ireland, chief revenue officer of Carroll County Memorial Hospital, said that although the telehealth program ultimately benefits the hospital financially, they still have challenges in receiving payment from private payers. Additionally, the reimbursement may be quite low compared to in person professional fees. 

Balancing costs - All of the panelists advised telehealth novices to consider increased ancillary services like pharmacy, labs and physical therapy, in any cost analysis of telehealth, rather than looking strictly at reimbursement fees. Jordan further advised that executives consider the cost-savings from physician recruitment, a challenging and expensive task that averages $70,000 per potential recruit, according to Jordan. 

For help addressing challenges in rural hospital teleheath programs, contact HTRC at 877-643-HTRC.
Project ECHO's Dr. Sanjeev Arora visits Kansas

The founder of Project ECHO, Dr. Sanjeev Arora, recently spoke on the University  of Kansas Medical Center campus, inspiring teams across the health center to consider telementoring as a way to "move knowledge instead of patients."

Arora impressed upon the audience that ECHO is not just a webinar, but rather a technology-supported, guided practice approach to build communities of practice . On this visit, Arora focused on cancer-related ECHO opportunities across the cancer care continuum - prevention, detection, diagnosis, treatment, survivorship and palliative care. During the visit, Arora asked the University of Kansas Cancer Center Director Roy Jensen, M.D., to serve on a national Project ECHO Advisory Board.  

Kansas and Missouri are notable because they are two of only three programs in the country where the ECHO program is coordinated by the telemedicine department. Rather than traditional telemedicine, in which the provider-patient ratio is 1:1, ECHO is a is a one-to-many telementoring model for providers to learn from the expert panel and from one another in order to improve patient care. Arora provided guidance to Dr. Eve-Lynn Nelson's team around HTRC's goals to advance collaborative approaches pairing Project ECHO and telemedicine to meet community-identified needs and build workforce capacity. KU Center for Telemedicine & Telehealth ECHO Project Director Carla Deckert said that after spending a few minutes with Arora people can understand why ECHO will exceed its goal of touching one billion lives by 2025 and ECHO attendance has rapidly increased
Project ECHO

Project ECHO is a program using telehealth to revolutionize medical education  and improve access to specialty care. Project ECHO, which was developed by the University of New Mexico School of Medicine, works by connecting primary care clinicians with specialist teams via videoconference. 

Each specialty area has its own ECHO, such as autism or chronic pain. ECHO teams meet regularly to collaborate with primary care providers.

Heartland Telehealth Resource Center | | 
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