Monday, February 8, 2010
$125 Billion Budget Request
Eric K. Shinseki, Secretary of the Department of Veterans Affairs appeared before the House Committee on Veterans Affairs on February 4th to discuss the President’s VA budget request for FY 2011. The President’s budget provides $125 billion in 2011 which is almost $60.3 billion in discretionary resources and nearly $64.7 billion in mandatory funding.The Secretary reported that in December 2009, the VA successfully exchanged electronic health record information in a pilot program between the VA Medical Center in San Diego and a local Kaiser Permanente hospital using the Nationwide Health Information Network. During the second quarter of 2010, DOD plans to join the pilot and there are plans to add additional Virtual Lifetime Electronic Record health community sites. The VA has $52 million available in IT funds in 2011 to continue the development and implementation of this priority.
The budget provides $51.5 million to use for medical care in 2011, which is an increase of $4 billion or 8.5 percent over the 2010 level. In 2011, the budget provides $2.6 billion to help meet the needs of veterans who have served in Iraq and Afghanistan.
The FY 2011 budget also includes funding to treat new patients resulting from the recent decision to add Parkinson’s disease, ischemic heart disease, and B-cell leukemia to the list of presumptive conditions for veterans with service in Vietnam.
The VA’s 2011 budget includes $250 million to strengthen access to healthcare for 3.2 million enrolled veterans living in rural and highly rural areas. Plans are to provide new rural health outreach and delivery initiatives and to expand the use of home-based primary care and mental health services.
The VA intends to expand the use of cutting edge telehealth technologies and would like to invest in $163 million in 2011 for home telehealth to take advantage of the latest technological advancement in healthcare delivery. The VA’s home telehealth program cares for 35,000 patients and a recent study found that patients enrolled in home telehealth programs experienced a 25 percent reduction in the average number of days hospitalized and a 19 percent reduction in hospitalizations.
According to the Secretary, the Department’s IT operations and maintenance program supports 334,000 users situated in 1,400 healthcare facilities, 57 regional offices, 158 national cemeteries around the country, plus the IT program maintains 8.5 million vital health and benefit records for veterans. The FY 2011 budget provides $3.3 billion for IT, which is the same level of funding provided in 2010.
The IT resources requested would fund IT to process education claims, to help the Financial and Logistics Integrated Technology Enterprise project replace outdated technology, further develop the paperless claims processing system, and continue to develop the VA’s EHR system for $342.2 million.
2/8/10
Federal Telemedicine News: $125 Billion Budget Request
1/29/10
Breakthrough and Telehealth's Tipping Point
If you told me last year that web-base psychotherapy would gain traction I wouldn’t have believed you. That was before I met Mark Goldenson, CEO of Breakthrough, a silicon valley based web startup that matches patient and therapist through a secure online portal. Breakthrough clients can review a therapist’s qualifications and fees, view sample video, and initiate therapy by video or phone.
In a 2.0 world marked by clouds, hives and democratized healthcare, Breakthrough is cultivating one-on-one relationships through improved access to mental health services. Everyone should be talking about this.
Goldenson made the TechCrunch 50 this past fall and maintained his continence before the likes of Tim O’Reilly, Kevin Rose and other tech luminaries. You can check out the coverage in Wired and Forbes.
The road to viable online teletherapy is littered with skeletons of those who were either ahead of the parade or didn’t have the technical support of Breakthrough. But telehealth has reached a tipping point. And Breakthrough may be there to seize the moment and tap the 2/3 of America’s 58 million with mental illness too stigmatized to seek help in person.
I’d like to say I discovered Mark Goldenson but it was he who discovered me after I delivered a lunchtime keynote on social media at this year’s American Telemedicine Association meeting in Palm Springs. He’s a pretty sharp guy. And if the fervency of his questions is any measure of his capacity to lead, Breakthrough may be worth keeping and eye on.
BreakThrough is continuing to move forward with its teletherapy model for matching psychiatric patients with specialists through streaming video connection. Most of the company's early successes have been the accolades lavished upon its CEO, Mark Goldenson, but little news has emerged about the Silicon Valley startup's experiences in the trenches. I would be particularly interested to hear about the company's experiences negotiating reimbursement with providers. More investigation seems to be in order, but its generally encouraging to see telehealth and telemedicine can play in Silicon Valley.
1/27/10
Video Conferencing saving lives in Irish Hospitals
Claire O’Connell in the Irish Times has an interesting article on how a stroke patient at the Midland Regional Hospital in Mullingar received urgent and potentially life-saving treatment on Sunday after a consultant at another hospital used the RP-7 (the “Remote Presence Robot” pictured below) to assess her remotely and prescribe clot-busting medication.
“The patient, who had a stroke just after noon, was collected by ambulance and was at the Midland Regional Hospital in Mullingar by 1.30pm. She was assessed by Prof Des O’Neill at Tallaght Hospital using the RP-7, which also allowed him to talk with her, examine her scans and discuss treatment with members of the medical team in Mullingar. The patient was on clot-busting medication by 2.40pm and her condition improved in half an hour”
Prof O’Neill commented on this first with a reminder of the short time window there is for putting suitable patients on potentially life-saving thrombolytic drugs; “The key challenge is to get people to have their clot-busting drug within three hours of a stroke.”
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Federal Telemedicine News: Grant Announcement Posted
Grant Announcement Posted
HRSA recently posted their “Small Health Care Provider Quality Improvement Grant Program” announcement seeking rural providers ready to implement quality improvement strategies. The plan is to help improve patient care and chronic disease outcomes for diabetes mellitus, and cardiovascular disease. The grant’s goal is to help rural primary care providers achieve these goals by using the Chronic Care Model along with Electronic Patient Registries (EPR).Both the EHR and EPR are electronic systems, but the EPR captures information that is population-based with data on specific conditions. This grant program does not support funding for an EHR, but healthcare providers who currently have an EHR are still eligible to participate in the program.
Some of the previous grantees have used their experience working with EPRs as a stepping stone to electronic medical records adoption. These grantees also have interests in the medical home model to help spread and sustain their quality improvement initiatives that go beyond chronic disease tracking to disease prevention. Grantees have also developed business case models to help sustain their quality improvement initiatives.
The program will provide funding during FY 2010-2012. Approximately $6,000,000 is expected to be available annually and to fund up to 60 grantees. Applicants can request up to $100,000 per year. Funding beyond the first year is dependent on the availability of funds in subsequent fiscal years.
Applicants must be a rural public or rural non-profit private entity and must not have previously received a grant for the Rural Quality Grant Program or a similar project. Examples of eligible entities include rural health clinics, critical access hospitals, small rural hospitals, and Federally Qualified Health Centers. For profit Rural Health Centers and Critical Access Hospitals may also apply.
Eligible applicants must also meet at least one of these three requirements:
• Applicants must be located in a rural area
• Applicants exist exclusively to provide services to migrant and seasonal farm workers in rural areas
• Applicant is a Tribal government where grant funded activities will be conducted within their Federally recognized Tribal areaThe application is due March 15, 2010. For more information, go to http://www.grants.gov/ or contact Elizabeth Rezaizadeh, Program Coordinator by email at erezai@hrsa.gov or call (301) 443-410.
Federal Telemedicine News: MHS IM/IT Plan Approved
MHS IM/IT Plan Approved
The Military Health System Information Management/Information Technology Strategic Plan for 2010-2015 has been approved by the Senior Military Medical Advisory Committee. Leaders from the Army, Navy, Air Force, Health Affairs, TRICARE Management Activity, Joint Staff, Joint Task Force National Capital Region Medical, and the MHS Office of the Chief Information gathered last summer for a series of workshops to develop the plan.While there have been strategic planning initiatives that have guided key priorities throughout the last ten years, this new effort by IM/IT leadership across the services, is the first formally approved plan since 1999.
The plan’s ten IM/IT goals that the Military Health Service (MHS) will focus on over the next five years are to:
• Provide rapid, affordable, secure delivery, and life cycle support for IT products and services
• Provide a comprehensive longitudinal EHR for all beneficiaries and care settings
• Implement a governance structure and process to enable effective and efficient use of resources
• Enhance enterprise intelligence through the use of enterprise tools, data, and services
• Advance the MHS personalized health agenda so that patients would have electronic access to their own records, have virtual visits, and be able to refill prescriptions online
• Advance IT interoperability using health, operational, and functional partners to create an accessible and complete virtual lifetime electronic record
• Show how the flow of funds from programming to execution can improve using better cost estimating methodologies
• Establish an innovation lifecycle management process to align IT innovation with MHS strategy
• Improve human capital management by having the right people with the right training and experience on the right job
• Develop processes, guidance, and standards to develop and integrate distributed services and applications so that time and money spent on products can be delivered rapidly and with a minimum amount of modificationIn total, the planning team drafted 13 unique action plans and 14 performance measurements to define specific activities, deliverables, and milestones. In the months ahead, the IM/IIT strategic planning team will work with the action plan teams across the MHS and then draft updates, review the IM/IT measures, and determine if and how these measures should link to the broader MHS Value Measures dashboard.
For more information, go to www.health.mil/mhscio/governance.htm.
This would be a great action plan for innovating/improving any health system, from the military to local and regional providers. Hopefully this crosses the president's desk and he adopts some of the major action items to his own health reform agenda. These are the major things that need to be addressed which will have the greatest impact on the health care industry.
11/9/09
GE Healthymagination Fund - Investment Platform
Investment Platform
The Healthymagination Fund draws on capabilities from across GE Healthcare, GE Capital and GE Global Research and has a global footprint. The investment committee is comprised of senior leaders of these groups.
Exciting new $250mm HIT investment fund launched by GE Capital offers unprecedentedly aggressive and bullish HIT private equity joint venture. Ideas abound...
10/8/09
Telemedicine: CMS definition and reimbursement guidelines
Telemedicine
For purposes of Medicaid, telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient's health. Electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment permitting two-way, real time interactive communication between the patient, and the physician or practitioner at the distant site. Telemedicine is viewed as a cost-effective alternative to the more traditional face-to-face way of providing medical care (e.g., face-to-face consultations or examinations between provider and patient) that states may choose to cover. This definition is modeled on Medicare's definition of telehealth services located at 42 CFR 410.78. Note that the Federal Medicaid statute (Title XIX of the Social Security Act) does not recognize telemedicine as a distinct service.
Distant or Hub Site means the site at which the physician or other licensed practitioner delivering the service is located at the time the service is provided via telecommunications system.
Originating or Spoke site means the location of the Medicaid patient at the time the service being furnished via a telecommunications system occurs. Telepresenters may be needed to facilitate the delivery of this service.
Asynchronous or "Store and Forward" means transferring data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation. Asynchronous or "store and forward" applications would not meet the above definition of telemedicine--see telehealth.
Reimbursement/Billing—Reimbursement for Medicaid covered services, including those with telemedicine applications, must satisfy federal requirements of efficiency, economy and quality of care. With this in mind, States are encouraged to use the flexibility inherent in federal law to create innovative payment methodologies for services that incorporate telemedicine technology. For example, States may reimburse the physician or other licensed practitioner at the distant site and reimburse a facility fee to the originating site. States can also reimburse any additional costs such as technical support, transmission charges, and equipment. These add-on costs can be incorporated into the fee-for-service rates or separately reimbursed as an administrative cost by the state. If they are separately billed and reimbursed, the costs must be linked to a covered Medicaid service. While telemedicine is not considered a distinct Medicaid service, any State wishing to cover/reimburse for telemedicine services should submit a State Plan Amendment to the Centers for Medicare and Medicaid Services for approval.
Medical Codes—States may select from a variety of HCPCS codes (T1014 and Q3014), CPT codes and modifiers (GT, U1-UD) in order to identify, track and reimburse for telemedicine services.
Telehealth (or Telemonitoring) is the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across distance.
Telehealth includes such technologies as telephones, facsimile machines, electronic mail systems, and remote patient monitoring devices which are used to collect and transmit patient data for monitoring and interpretation. While they do not meet the Medicaid definition of telemedicine they are often considered under the broad umbrella of telehealth services. Even though such technologies are not considered "telemedicine," they may nevertheless be covered and reimbursed as part of a Medicaid coverable service under section 1905(a) of the Social Security Act such as laboratory service, x-ray service or physician services.
Other Considerations:
Medicaid guidelines require all providers to practice within the scope of their state practice act. Some States have enacted legislation which requires providers using telemedicine technology across state lines to have a valid state license in the state where the patient is located. Any such requirements or restrictions placed by the State are binding under current Medicaid rules. Medicare Conditions of Participation (COPs) applicable to settings such as long-term care facilities, and hospitals may also impact reimbursement for services provided via telemedicine technology. For instance, the Medicare COPs for long-term care facilities require physician visits at set intervals. Current regulations require that the physician must be physically present in the same room as the patient during the visit. This requirement must also be met for Medicaid to pay for services provided to Medicaid eligible patients while in a Medicare or Medicaid certified facility. Similarly, federal regulations require face-to-face visits for home health, and telemedicine cannot be used as a substitute for those visits. However, a telemedicine encounter may be used as a supplement to the required face-to-face visits.
Anyone eager to make a business out of remote care and telemedicine technologies must carefully read, re-read, and ultimately memorize the one-page guidelines above if they hope to remain a sustainable investment in the current environment. In my estimation, the most valuable by-product of a Billion-dollar US Connected Health sector will be its utility as a stimulant of hyper-innovation. Without a business plan and patient care protocols/procedures that achieve 75-100% reimbursement rates from CMS, any telemedicine program is doomed to be a money-pit regardless of the altruistic motives of its proponents. The entrepreneur who will emerge best-of-breed in telemedicine will be he/she who finds the shortest path to demonstrating "Meaningful Use" in the form of real improvement in patient outcomes.
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9/19/09
AHRQ Report: Consumers Need to be Empowered in Health IT Debate
A new study out the Agency for Healthcare Research and Quality (AHRQ) suggests that by excluding consumers from the broader implementation of health information technologies, the medical community is marginalizing themselves and prolonging the time it will take to reach high levels of consumer adoption. Just another reason to add to the list of flawed approaches/perspectives on information technology among health professionals, though quite possibly the one issue that if addressed effectively could make all of the other impediments to ubiquitous adoption of highly advanced IT systems evaporate in the face of overwhelming consumer demand.
BreakThrough: Teletherapy startup gaining some mainstream popularity, but business model is very misleading
The premise underlying the business model for BreakThrough may well be sound, particularly the evidence presented supporting the positive impact of teletherapy on psychiatric patient outcomes. However, the increase in quality of treatment via telemedicine is irrelevant without a method for sustaining the provision of treatment through reimbursement of attending psychiatrists.Overview
BreakThrough connects mental health professionals with clients through secure video, phone, and web.
We have a mental health epidemic
More than 57 million Americans – one in four adults – have a diagnosed mental illness. Tens of millions more struggle with stress and relationship issues. Institutions such as hospitals, prisons, schools, companies, health plans, and veterans centers are overcrowded with patients needing help, but growing costs and shrinking budgets are decimating quality of care.
Even though seventy to eighty percent of patients with mental illness improve with treatment, patients remain woefully underserved. Two–thirds of Americans with a mental illness do not receive treatment due to cost, stigma, inconvenience, and low access, particularly in rural areas. This is despite Americans spending $121 billion on mental health and substance abuse treatment.
The solution of telemedicine
Telepsychiatry and teletherapy – mental health services delivered through secure video, phone, and web – have emerged as effective, affordable, convenient, and safe methods of treating stress and mental illness. Telemedicine has several substantial benefits:
Effectiveness:
over fifteen years of research confirm that telemedicine is as effective as in–person treatment. This is particularly true in psychiatry and clinical psychology where much of the treatment is doctor–patient communication. Click here for a list of research studies on the effectiveness of telemedicine.
Convenience:
fifty percent of therapy clients drop out after a few sessions, but research shows teletherapy can boost retention to over ninety percent. Because clients can hold sessions anywhere with phone or internet access, they are much more likely to go and stay in treatment. BreakThrough supports sessions via video, phone, email, and live chat.
Affordability:
telemedicine sessions can cost ten to fifty percent less due to reduced overhead, travel time, and staffing needs. On BreakThrough, providers set rates that are almost always more affordable than in–office visits.
Access:
research shows the fit between clients and mental health providers is essential to positive outcomes. Most people will not travel to a provider beyond fifty miles, but telemedicine lets clients work with the best licensed provider regardless of location. BreakThrough clients can find providers on a wide variety of criteria, including price, reputation, location, gender, experience, credentials, and more.
Confidentiality:
eighty percent of therapy clients worry about the stigma of treatment. To protect clients, BreakThrough requires minimal information, enabling treatment with a level of discreteness and security not possible with in–person treatment.
Peer support:
the support of friends, family, and other patients is essential to long–term recovery. BreakThrough offers forums, group sessions, and seminars to enable peers to support each other no matter where they live.
Telemedicine is legal and expanding
Telepsychiatry and teletherapy are legal and regulated by state–specific guidelines. Government and licensing boards are also rapidly evolving legislation to expand telemedicine access.
To protect providers and meet the highest levels of regulatory compliance, we currently allow providers to see clients only in states where the provider is licensed. Providers can typically apply for licensure in multiple states, either directly through state licensing boards or third–party services that streamline the application process.
Telemedicine is reimburseable
Since 2004, Medicare and the AMA have issued CPT codes to identify and reimburse telepsychiatry and teletherapy services. A list of eligible services and codes include:
CPT code descriptions can be found on the American Medical Association's CPT directory. The modifier GT may be necessary to identify that services were delivered via telemedicine. For Medicare reimbursement, clients generally must receive treatment at an eligible originating site, such as a doctor's office, hospital, nursing facility, mental health clinic, or similar facility. Private payers often do not have the same locality restrictions. More details on reimbursement are available through the American Telemedicine Association.
- Individual psychotherapy: CPT 90804 – 90809
- Consultations: CPT 99241 – 99255
- Office or other outpatient visits: CPT 99201 – 99215
- Pharmacologic management: CPT 90862
- Psychiatric diagnostic interview examination:CPT 90801
- Neurobehavioral status examination: CPT 96116
via breakthrough.com
The assertion that "Telemedicine is reimbursable" made in the final section above, while accurate technically, is misleading in that eligibility to be reimbursed and actually recouping fees for services provided are two entirely different issues. The CPT codes provided by the BreakThrough founders are a distraction from the real challenge of processing and collecting payment, which is overcoming the fact that CPT codes are very often (more often than not) ignored because of the GT modifier and the advanced standards of practice that must be met to be eligible under Medicare reimbursement policy.
Medicare mandates clearly that telemedicine services are only eligible for reimbursement when there is a two-way video transmission that allows doctor and patient to each see the other. Any health professional will tell you that private insurers will always follow Medicare's guidance when it comes to establishing standards of eligibility for reimbursement.
This is going to create a major obstacle for the well intentioned and otherwise exciting startup to achieve widespread adoption amongst mental health providers, as they are not likely to adopt therapeutic practices without demonstrable evidence that reimbursement above a significant percentage of total consults is achievable. I wish the BreakThrough team the best of luck!!
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9/18/09
National Coalition for Health Integration (NCHI): Bringing order to the chaotic health information technology through grid computing
The National Coalition for Health Integration (NCHI) initiative is an ambitious attempt to establish a truly interoperable environment for linking independent health information technology projects around the US through an open framework. With an all-star team of business and scientific directors funded entirely through private donations made by its principal founder, billionaire pharmaceutical entrepreneur Patrick Soon-Shiong, M.D., NCHI seeks to establish "virtual organizations" which combine numerous disparate health organizations across all sub-specialties and functional purposes (i.e. billing, administration, health records, etc.) without concern for traditional geographic constraints. It utilizes in an unprecedented fashion institutes of higher education and their leading academic innovators in bio-informatics and grid computing. Truly a revolutionary initiative which will undoubtedly emerge as a major foundational element of any long-term improvement in the delivery of quality care. (www.nchiconnect.org)
Posted via web from Connected Care Solutions
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6/30/09
Health Information Technology State Legislation Database
| SB 196 | (Last Update: 9/23/2008) | ||
| Sponsor: | Hagedorn | ||
| Session Year: | 2007 | ||
| Bill Type: | Senate Bill Date of Last Action: 5/24/2007 Status: Enacted | ||
| Topics: | Health Information Exchange | Study Commission/Taskforce | Telemedicine | ||
| Citation: | SB 196 | ||
| Summary: | Creates the health information technology advisory committee and establishes membership. The committee is charged with developing a long-range health information technology plan, on or before Jan. 1, 2009, for health care information technology that includes use of electronic medical records, computerized clinical support systems, computerized physician order entry, regional health information organization, data privacy and security measures; and achieves interoperability among health information technology systems. Requires the committee to pursue an interstate compact between, but not limited to, Arizona, Kansas, Montana, Oklahoma, New Mexico, North Dakota, South Dakota, Utah, and Wyoming to allow for interstate exchange of health data. Provides for telemedicine reimbursement in the state’s medical assistance programs for home health care services or home and community based services that are otherwise eligible for reimbursement. | ||
Very interesting resource for start-ups and consultancies looking to plot strategies for pursuing deals in the booming health IT sector at the state and local levels. Certain states are clearly better suited legislatively for pursuing advanced health communications projects because either they have clearly defined medicare reimbursement programs for tele-care, or incentives in place for physicians to adopt electronic medical records, or a number of other highly attractive programs that are easily found using this database!
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