January 2019
TELEHEALTH BEAT
HTRC's monthly telehealth bulletin
Telestroke in the spotlight on HTRC webinar series

In case you missed the most recent installment of HTRC’s webinar series, Vascular Neurologist Sabreena Slavin, M.D. presented on the latest in telestroke data. Telestroke is regularly used in rural and under-resourced hospitals to determine whether IV tPA should be administered to patients showing signs of stroke. Slavin, who regularly consults on telestroke in her clinical role in the University of Kansas Department of Neurology, related recent data comparing telestroke to in-person stroke care. The meta-analysis , published in the journal of Prehospital Emergency Care, compared outcomes of patients treated by telestroke to those treated in-person in comprehensive stroke centers. The analysis found that telestroke patients had a shorter hospital stay and a shorter onset-to-door time.
 
According to Slavin most rural hospitals are utilizing telephone consults without video enhancement as a consultation tool to determine whether or not to administer IV tPA. While telephone consultations improve care for patients by preventing long transfers to stroke centers, there are advantages to patient exams using video.
 
“I have had times where when I see [the patient] on video, my decision changes what I was about to tell them over the phone,” said Slavin during the webinar. 
 
A study published in the Telemedicine and eHealth Journal indicated improved diagnosis when comparing telestroke to telephone consultations (96 percent compared to 83 percent). While Slavin cautioned that her experience is anecdotal, she said that seeing patients by video has been more likely to help her correctly rule out the need for IV tPA, avoiding unnecessary risks for patients who don’t actually need it.

Despite the advantages of telestroke, Slavin said American Heart Association and American Stroke Association guidelines make it clear: if telestroke is not available, use the telephone. In addition to the AHA guidelines, she recommended the Kansas Initiative for Stroke Survival as a resource.
  
Please join us for our next HTRC webinar, “Telemental health: National standards and best practices” on February 5, when HTRC’s own Eve-Lynn Nelson, Ph.D. will present.

Take the biennial TTAC Survey

The  National Telehealth Technology Assessment Center (TTAC)  invites you to participate in their biennial technology survey. Your response will help determine:

  1. Telemedicine technologies that are currently being used in telemedicine programs 
  2. Telemedicine technologies that may be of interest for future implementation
  3. How TTAC can best provide relevant information and technology resources to telemedicine users

TTAC uses this information to direct assessment and outreach efforts.  
Thank you for your participation! 

EVENTS
Missouri Telehealth Summit
Jefferson City, Mo.
January 31

Virtual reality (VR) is poised to revolutionize health care. Register today for the Missouri Telehealth Summit to hear how StoryUp Studios CEO Sarah Hill is using VR to improve the lives of terminally-ill veterans. 

The summit will also feature leaders from Kaiser, Blue Cross Blue Shield and United Healthcare who will answer your tough reimbursement questions during the payer panel!

On the day before the summit, January 30, there will once again be a Telehealth 101 Workshop for those who are new to telehealth.


For additional questions, call 573-882-4349.
Join HTRC at 12 noon CST on February 5, to learn more about standards and best practices for telemental health.


Other upcoming HTRC webinars:
March 5: Teledentistry project in Kansas
April 2: ALS telehealth program in Kansas
May 7: Telehealth and the opioid crisis
TRC Webinar: Federal and state policy updates
February 21

Join the Center for Connected Health Policy (CCHP) on February 21 at 12 noon CST for an examination of recent telehealth policy changes. CCHP Executive Director Mei Kwong and Policy Associate Christine Calouro will be joined by Jonathan Neufeld, Ph.D. of gpTRAC to discuss the following:
 
  • 2019 Medicare telehealth policy changes;
  • Medicare Advantage Plans & telehealth;
  • Latest on telehealth & substance use disorder;
  • State-level policy developments; and
  • FQHCs & RHCs.
NATIONAL NEWS
New year, new CMS codes and more!

The new year brought some exciting new opportunities for telehealth reimbursement. Not only are there new codes, but there are new opportunities for virtual check-ins, store-and-forward and provider consults. Due to regulatory restrictions, these services fall outside the CMS definition of telehealth; therefore they have enacted separate provisions to cover them. The policy implications of these changes are discussed further in the Center for Connected Health Policy fact sheet.
 
Below are some of the highlights of the new, telehealth-related provisions. This list is an overview but more details are available from the CCHP analysis .

Virtual check-in
Virtual check-ins will be covered under HCPCS code G2012, Brief Communication Technology-Based Service. This will allow for virtual check-ins to evaluate whether an office visit is warranted and can be completed via a phone call or video call, but must occur in real-time. This provision only covers professionals who meet the CMS definition of  evaluation and management (E/M) service providers , which unfortunately does not include RNs or other clinical staff such as physical therapists. This code will primarily cover services that do not result in an office visit and are not part of a follow-up from a recent visit.
 
Store-and-forward
HCPCS code G2010 will cover what CMS is calling Remote Evaluation of Pre-Recorded Patient Information. This will cover what is commonly known as store-and-forward, professional evaluation of patient videos or images such as an image of a skin-lesion. Like the virtual check-in provision, this only applies to E/M providers.
 
Provider-to-provider consults
Known as Interprofessional Internet Consultation, this provision will cover provider-to-provider consultations via telephone or internet. This service can be billed through CPT codes 99452, 99451, 99446, 99447 and 99449.

Guidance for FQHCs and RHCs
CMS provided explicit guidance for FQHCs and RHCs – there will be a payment methodology for the store-and-forward and virtual check-in provisions, but not for the provider-to-provider consults.

Lifting some geographic restrictions
Geographic restrictions have been removed to allow reimbursement for treatment in homes and regional dialysis centers for end-state renal disease. Additional changes will allow treatment of acute stroke by telehealth in any hospital or mobile stroke unit.

Other new telehealth codes
Prolonged preventative services: G0513, G0514
Remote physiological monitoring: CPT codes 99453, 99454, 99457

For more information on how these new provisions can be used to expand your reach through telehealth, contact HTRC at 877-643-HTRC.
Letter urges DEA to consider changes regarding teleprescribing

The American Telemedicine Association (ATA) recently offered recommendations to the Drug Enforcement Agency (DEA) to activate a special registration for telemedicine prescribing of controlled substances. Shawna Wright, Ph.D., LP, associate director of KU Center for Telemedicine & Telehealth, collaborated in the development of the recommendations, as part of ATA's Telebehavioral Health Special Interest Group.  The letter endorsed the aim of the SUPPORT for Patients and Communities Act, to increase access to substance use disorder (SUD) treatment through activation of a special registration, but also highlighted other important uses for the registration.
 
“In writing this letter the ATA took the opportunity to inform the DEA about the wide range of disciplines, including child and adolescent psychiatry, endocrinology and emergency medicine that also rely on appropriately prescribing controlled substances,” said Wright. “Therefore, we encourage inclusion of these disciplines in the special registration provision. The limitations associated with remote prescribing of controlled substances and the Ryan Haight Act go beyond the opioid crisis and also directly impact the quality of care that patients can receive from providers for a variety of health and mental health care needs.” 
 
The letter encouraged formulation of the special registration process to be inclusive of the diverse and applicable health care issues that can be effectively treated through telemedicine. For example, current provisions restrict child and adolescent psychiatrists from prescribing stimulant medications via telemedicine to treat Attention-Deficit/Hyperactivity Disorder (ADHD), one the most prevalent child and adolescent mental health diagnoses.  Since most child psychiatrists are located in urban areas, for many rural families, telemedicine is the only option. This creates a hardship for rural families, which could be addressed through the special registration process.