December 2016

Happy Holidays!

This edition of Northeast Connections is full of exciting content! Be sure to check out the review of 2016 headlines, Medicare billing updates, regional career opportunities, and our collection of recent news. We're also thrilled to open sponsor registration for our 2017 Regional Telehealth Conference!

Our colleagues at the National Telehealth Technology Assessment Center (TTAC) are requesting your feedback on the types of telehealth technology you are using, will use, or would like to know more about. Your input is critical to help prioritize the types of resources TTAC develops in 2017.  Please consider completing this short survey.

Are you searching for telehealth grants this spring? The USDA Distance Learning and Telemedicine Grant (a popular resource to support telemedicine equipment costs) is generally released in mid to late winter. As you explore grant opportunities, join us for January's National Telehealth Webinar, Perspectives on Telehealth Funding. As always, we will share funding announcements in future newsletters as they become available. Did you catch the grants highlighted in our November Newsletter?

We hope to hear from you in 2017!


The NETRC Team
Closer to Mainstream: Telehealth in 2016
What a year! Telehealth continued to be a major focus for many healthcare organizations, policy makers, and other stakeholders throughout 2016!  We've collected a sampling of  the major headlines:

 It was no  surprise  that there were many regional policy changes in 2016 (including updated MaineCare rules, a new parity bill passed in Rhode Island, and New Hampshire joining the Interstate Medical Licensure Compact). But even more impressive was the explosive growth of telehealth programs of all types. Here are a few of the 2016 headlines featuring programs throughout the region:

It's beginning to look a lot like telehealth is going mainstream!
We look forward to sharing more of your telehealth successes in 2017.
Sponsor Registration Now Open!


NETRC will host the next Northeast Regional Telehealth Conference in Amherst, MA (UMass Hotel and Campus Center) on  May 23+24, 2017 ! T he conference will begin with hands-on afternoon workshops and an evening networking reception on May 23, followed by a full-day conference on May 24 with nationally recognized plenary speakers and a variety of breakout sessions.

Sponsor registration is now open!

Stay tuned for more information about our exciting agenda and the launch of our attendee registration.
CY 2017 Billing Updates

CMS and the Place of Service 02 Code:

The CY 2017 Physician Fee Schedule was published in November with several updates. This includes the addition of end-stage renal disease (ESRD) and advance care planning codes to the list of eligible telehealth services, as well as the creation of two new codes for critical care consultations (G0508 and G0509). 

Effective January 1, 2017, CMS has adopted a new telehealth specific Place of Service (POS) code (02). This code must be reported with the GT modifier (via interactive audio and video telecommunications systems) or the MAC will deny service. Medicare will reimburse at the Medicare Physician Fee Schedule facility rate (note: the POS code does not apply to originating sites billing a facility fee).

For additional information, review the MLN Matters Fact Sheet and be sure to check out the Center for Connected Health Policy's summary of the CY 2017 Final Fee Schedule

AMA and Modifier 95:

The 2017 AMA Codebook includes a new "Modifier 95" that signifies "synchronous telemedicine services rendered via a real-time interactive audio and video telecommunications system." NETRC is not aware of any payers who are requiring the use of Modifier 95 yet, but we will be watching to see if CMS decides to implement it in the future.
Regional Career Opportunities

Organization:  University of Vermont Health Network

Now Hiring:  Director of Telehealth Services

Location:  Burlington, VT

Description:  Directs the development and implementation of Telehealth initiatives/programs across the system. Provides analysis of existing programs and services and makes recommendations to management for alternative methods to enhance cost efficiencies, productivity, improved process performance and capital utilization in regional facilities. The Director is accountable for projects and tactics to increase the volume and geographical footprint of the Health System and Health Plan with product lines and services to establish and sustain market leadership for all the system's organizations.  This includes the development of a Telehealth strategies, business plans, follow-up on direct or indirect implementation activities, tracking and reporting progress.

Visit the University of Vermont Medical Center Jobs Site for more information.
Organization: Dartmouth-Hitchcock Connected Care Center

Now Hiring:  Telehealth Technology Manager

Location:  Lebanon, NH

Description:  Provides wide-ranging advice and expertise regarding the selection, operation and maintenance of telehealth technologies both within DH and at distant sites. Works to help roll out and expand our clinical, educational, monitoring and research initiatives towards the promotion of population health.

Visit the Dartmouth-Hitchcock Jobs Site for more information.
Additional openings include Telehealth Implementation Specialist and Teleneurology Program Mananger.

Organization: Arnot Health

Now Hiring:  Telehealth Clinical Coordinator

Location:  Bath, NY

Description:  This position functions as a liaison between participating providers engaged in Arnot Health's Telemedicine Program.  Proactively develops and implements clinical activities between regional providers, managed contracts and the Arnot Health Telemedicine program. This position ensures that high quality clinical services are delivered via telemedicine and functions as member of Case Management in providing services to the region. 

Visit the Arnot Health Jobs Site for more information.

Recent Telehealth News
Content compiled by Michael Edwards, NETRC Consultant
Telehealth Policy News

mHealth Intelligence, December 16, 2016
According to a recent survey conducted by the Federation of State Medical Boards, telemedicine was identified as the most important regulatory topic in 2016. Additional topics included opioid prescribing, the Interstate Medical Licensure Compact, and physician reentry into practice. 

21st Century Cures Act and its effect on digital health
National Law Review, December 9, 2016
The new federal legislation recently signed into law includes among its many provisions a broad regulatory exemption from FDA policies for medical software and devices that promote or monitor a healthy lifestyle and provide a supplement to clinical decision support. 
Update on telemedicine parity laws
National Law Review, December 6, 2016
This overview covers the reasons why more and more states are enacting laws or regulations that call for parity in reimbursement of medical visits carried out by telemedicine and in-person.  In some states such regulations are applied only to Medicaid, leaving market forces to determine  cost differentials for private insurance programs.

FierceHealthcare, November 30, 2016
The ECHO Act was unanimously passed by the Senate. As reviewed in this article, the bill requests the Department of Health and Human Services to analyze and report to congress about the model. The bill did become law when it was signed by the President on December 14, 2016.

OMH: New Yorkers can access remote psychiatric services
Times Union (Albany), November 21, 2016
In order to address the shortage of psychiatrists the New York State Office of Mental Health recently modified its regulations for the practice of telepsychiatry by expanding the range of sites to receive such services.  The new rules also specify provision of informed consent, assurance of confidentiality, and use of videoconferencing technology that allows remote "tilt, pan, zoom" control of the patient camera.
High-quality mHealth apps can be blended into care
AMA Wire, November 15, 2016
The American Medical Association recently provided a statement of principles for assuring security and clinical validity for the use of mHealth apps in patient health care.  The AMA calls for industry-wide action to address pervasive privacy and security concerns and legislative action to mitigate the physicians' potential risk of liability from their use or recommendation of mHealth apps.
In-depth: with diabetes prevention programs, digital programs are close to earning CMS's approval
MobiHealth News, November 4, 2016
An evidence-based diabetes prevention program that involves weekly group education classes with people at risk for diabetes has been adapted by several health systems and companies to make use of online participation and coaching apps on mobile devices.  The program of Omada Health and a few others that employ digital health strategies have been recognized by the CDC and allowed to register with the Centers for Medicare and Medicaid Services as a reimbursable provider for Medicare patients.

News on the Practice of Telemedicine

CHC of Cape Cod now offering telepsychiatry services
Cape Cod Today, December 12, 2016
Community Health Center of Cape Cod has recently developed patient access to psychiatry by telemedicine for its three clinics.  They already implement interpreting services by tele-video, and home-based remote patient monitoring, and they plan to add teleoptometry and teledermatology services in 2017.
Silver Linings: Remote rehab -- Telehealth helps seniors recover in rural areas
New Hampshire Union Leader, December 10, 2016
This story highlights innovations in remote direction of rehabilitation in homes or assisted living facilities by telehealth and points out the barrier for such programs in New Hampshire, where state law requires the presence of a physical or occupational therapist in the room with the patient.  Dr. Stephen Bartels of the Dartmouth Institute and Andrew Solomon of NETRC are quoted on the import of these challenges and others to implementing telemedicine to patients in their residence.
Telehealth projects underway
Federal Telemedicine News, December 4, 2016
The Rural Telehealth Research Center at the University of Iowa is funded by the HRSA Office of Rural Health Policy for work on several projects related to rural telehealth.  Current projects include the evaluation plan for ORHP Telehealth Network grantees in emergency telemedicine and in school-based telehealth, an initiative to create a 50-state inventory of telehealth services provided to Medicaid enrollees, and a study of telestroke adoption among hospitals in North Carolina.
Dermatology services now available via telehealth technology to UnitedHealthcare Medicaid beneficiaries in Rhode Island
Business Wire, December 1, 2016
Patients enrolled in UnitedHealthcare's Medicaid plan in Rhode Island may now receive faster diagnosis and treatment of skin disorders at their local health care facility through digital imaging and telehealth linkage with dermatologists on the Community eConsult Network.  The Thundermist Health Center was recently funded by a grant to evaluate outcomes of their participation on this network, which was developed by the Weitzman Institute in Connecticut.
Excellus pushes telemedicine as alternative to ER for minor illnesses
The Post Standard (Syracuse), November 29, 2016
Beginning Jan. 1 patients with Excellus BlueCross BlueShield in New York will be able to access telemedicine providers through the insurer's website. Excellus has teamed up with MDLIVE, a national telemedicine company, to provide this service.
Factors behind the adoption of school-based telehealth
mHealth Intelligence, November 21, 2016
This overview covers the benefits and barriers to implementing pediatric, behavioral, and dental health services to children at school facilities.  Successful programs in Texas, Georgia, New Mexico, South Carolina, Florida, California, and Missouri are profiles, the first three of which have benefited from state laws mandating Medicaid reimbursement.
Remote monitoring platform is an mHealth lifeline for New York's 'sickest children'
mHealth Intelligence, November 18, 2016
An mHealth platform is being employed by St. Mary's Healthcare System for Children in New York City for remote home monitoring of seriously ill children.  The program is reported to reduce hospitalizations and is considered a successful step toward making such  remote patient monitoring a standard of care for post-acute and home-bound populations once barriers to reimbursement and sustainability are resolved..
Boston Medical Center launching telehealth epilepsy care collaborative
Healthcare Informatics, November 18, 2016
Boston Medical Center has been awarded a three-year, $1.2 million grant from the Health Resources and Services Administration (HRSA) to expand access to care for underserved populations of children and youth with epilepsy and related disorders.  The project aims to serve by telemedicine over 1,000 children and young adults with pediatric neurology services at 13 clinical sites across the state.
For telehealth and mHealth, value-based care takes time to work out
mHealth Intelligence, November 17, 2016
This overview of a Boston conference on strategies to prepare for the transition from fee-for-service to value-based care includes highlights telehealth solutions developed by UMass Memorial Hospital, Dartmouth-Hitchcock Medical Center, and the Atrius Health System in  Massachusetts.  The presentation by NETRC's Program Director, Danielle Louder, focused on the policy landscape and other model programs in the northeast (the Powerpoint presentations and audio recordings of this and other speakers may be accessed in an archive).
Yale New Haven Hospital introduces video appointments
Yale Daily News, November 16, 2016
In October, the Yale New Haven Transplantation Center launched a program which allows physicians to conduct video visits with their patients while simultaneously having access to test results and other vital medical information made possible by integration of the service with the center's Epic EHR system.  An interview with the director of the center outlines the benefits to patients who would normally require several in-person visits a week with providers after transplant surgery.

T elemedicine Technology News

AMA, AHA, HIMSS, DHX Group form mobile health safety collaboration
MobiHealth News, December 12, 2016
The American Medical Association, The American Heart Association, HIMSS and the DHX have joined to create Xcertia, a collaborative with the mission to evaluate and improve the safety and effectiveness of mobile health apps.  Xcertia aims to create a framework to improve mHealth app development and will serve as a resource to help consumers and clinicians in their choices.
American Well taps TytoCare to incorporate connected health tools into video visits
MobiHealth News, November 30, 2016
Telemedicine provider American Well has teamed up with Israel-based medical device maker TytoCare to combine video telehealth visits with remote examinations.  With the partnership, TytoCare's examination platform will be integrated into American Well's telehealth platform, and TytoCare's customers will have access to the network of healthcare providers who use American Well's platform.
Google researchers use deep learning to detect diabetic retinopathy with upwards of 90 percent accuracy
MobiHealth News, November 29, 2016
A team of Google researchers has published a paper in the Journal of the American Medical Association showing that Google's deep learning algorithm, trained on a large data set of fundus images, can detect diabetic retinopathy with better than 90 percent accuracy.  The authors suggest that such automated grading of diabetic retinopathy has the potential to increase the efficiency and reproducibility of screening programs and thereby reduce barriers in patient access to early detection and treatment.
mHealth startups look to connect the clinical, consumer markets
mHealth Intelligence, November 11, 2016
Tyto Care recently received FDA approval for its digital stethoscope, is launching a handheld remote monitoring telehealth kit for the provider market, and is preparing a similar product for the consumer market.  The basic TytoHome model will retail at about $300, while the TytoPro package includes more peripherals, a portal for clinician-to-clinician consults, and a software package allowing for more data storage and EMR integration.
Cerner and American Well to embed telehealth capabilities into Cerner EHR
Healthcare Informatics, November 15, 2016
Cerner has announced an agreement with telehealth vendor American Well to integrate the company's telemedicine platform with Cerner's electronic health record system.  Patients will can access their health data and video visit options through Cerner's HealtheLifeSM patient engagement portal.

Health Information Technology News

Fierce Healthcare, December 6, 2016
In an effort to attract more providers to publicly run health information exchanges (HIEs), states are taking advantage of federal financial assistance that covers 90% of administrative costs.  The funding opportunities through the Medicaid Electronic Health Records Incentive Program has the potential to reverse the decline of public HIEs in favor of private programs.
Fierce Healthcare, December 5, 2016
The New York Regional Health Information Organization, which serves 300 health care organizations, has reported success in its use of a fully automated system to resolve patient identification and merge multiple medical records created for patients seen by different providers  and health care organizations.  Evidence suggests that the 50 million medical records in their system represent health data from 16 million patients, which the reconciliation system so far has resolved to 25 million identities.
Recent Telehealth Resources

Blackman K.  Telehealth and licensing interstate providers.  NCSL Legisbrief 24(25):1-2, 2016 Link

Burgess A, Coburn A. Innovations in rural health system development: service delivery advances in care coordination, emergency care, and telehealth. University of Southern Maine. Muskie School of Public Service, Maine Rural Health Research Center; November 2016 Link

Burgess A, Coburn A.  Innovations in rural health system development: Maine's behavioral health services.  Maine Rural Health Research Center, Muskie School of Public Service, November, 2016 Link

Estai M, Kruger E, Tennant M, Bunt S, Kanagasingam Y.  Challenges in the uptake of telemedicine in dentistry.  Rural Remote Health 16(4):3915, 2016 Link

Faruque LI, Wiebe N, Ehteshami-Afshar A, et al.  Effect of telemedicine on glycated hemoglobin in diabetes: a systematic review and meta-analysis of randomized trials.  Can. Med. Assoc. J.  [epub ahead of print] October, 2016 Link

Gunter R, Fernandes-Taylor S, Mahnke A, et al.   Evaluating patient usability of an image-based mobile health platform for postoperative wound monitoring.  JMIR Mhealth Uhealth 4(3):e113, 2016 Link

Hungerbuehler I, Valiengo L, Loch AA, Rössler W, Gattaz WF.  Home-based psychiatric outpatient care through videoconferencing for depression: a randomized controlled follow-up trial.  JMIR Ment. Health 3;3(3):e36, 2016 Link

Kalankesh LR, Pourasghar F, Nicholson L, Ahmadi S, Hosseini M.  Effect of telehealth interventions on hospitalization indicators: a systematic review.  Perspect. Health Inf. Manag. 13(Fall):1, 2016 Link

Langabeer JR 2nd, Gonzalez M, Alqusairi D, et al.  Telehealth-enabled emergency medical services program reduces ambulance transport to urban emergency departments.   West. J. Emerg. Med. 17(6):713-720, 2016 Link

Lund PS.  Integration of mobile health applications and devices into practice.  Report 6 of the Council on Medical Service (I-16),  American Medical Association, 2016 Link

Mackintosh N, Terblanche M, Maharaj R, et al.  Telemedicine with clinical decision support for critical care: a systematic review.  Syst. Rev. 5(1):176, 2016 Link

Ming WK, Mackillop LH, Farmer AJ, Loerup L, Bartlett K, Levy JC, Tarassenko L, Velardo C, Kenworthy Y, Hirst JE.  Telemedicine technologies for diabetes in pregnancy: a systematic review and meta-analysis.   J. Med. Internet Res. 18(11):e290, 2016 Link

Patel YM, et al.  Variation in quality of care among virtual urgent care providers.  Find Brief 42(8):1-3, 2016  Link

Wechsler LR, Demaerschalk BM, Schwamm LH, et al; American Heart Association Stroke Council; Council on Epidemiology and Prevention; and Council on Quality of Care and Outcomes Research.  Telemedicine quality and outcomes in stroke: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association.  Stroke [epub ahead of print], November 2016  Link

Uscher-Pines L, Rudin RS.  Lessons learned from the MAVEN Project pilot: Using physician volunteers to increase access to care via telehealth.  RAND Research Report, 2016 Link

Yerukhimovich A, Balebako R, Boustead AE,et al.  Can smartphones and privacy coexist?  Assessing technologies and regulations protecting personal data on Android and iOS devices.  RAND Research Report, October 2016 Link