Thursday, August 25, 2016
Why do many providers think an innovative way to deliver healthcare like telemedicine would align with outdated reimbursement models? Thinking out of the box in regards to getting paid for your telemedicine services is the winning mentality. Establishing these alternative revenue models and pursuing strategic partnerships are all major keys in creating telemedicine revenue. The concept of government funded fee-for-service payments (i.e. traditional reimbursement) is becoming an increasingly outdated and less than ideal payment model for 21st century healthcare. CMS is pushing for 50% of reimbursement by 2018 tied to alternative payment models (Accountable Care Organizations, bundled payment). The most successful telemedicine providers and companies understand the current healthcare payment landscape and shift their thinking from “reimbursement” to “revenue”. Though there are many creative revenue models, here we will cover three revenue models providers should consider offering as revenue streams.
Institution to Institution
Academic medical centers or even small physician groups can leverage their expertise and contract their specialty services to small rural hospitals or other institutions with specialist coverage need. These contracts can be structured to either provide peer to peer consults, direct patient care, or both. These entities could utilize a monthly rate, a hybrid payment, a special fee schedule menu or just a cafeteria list style of multi-specialty services. In the end, this is a professional services agreement and does not have any dependence on traditional Fee for Service reimbursement to drive revenue. Creating these relationships and servicing them well can become a revenue source for years to come.
Employer Workforce Offerings
Telemedicine Providers with a network of primary care providers can offer telemedicine services to an employer’s workforce via on-site kiosks or online apps. This was in the past an overlooked telemedicine setting but now gaining a lot of steam. This type of offering is becoming very attractive to self-insured employers because of the real ROI that can be realized. The benefits of reduced absenteeism, better workforce health, reduced direct care costs, and reduced overall workforce health costs are just some of the benefits. Showing a minimal 5% redirection of a workforce to use telemedicine first, instead of traditional office visits, ER or urgent care can mean big savings to employer’s bottom lines. The telemedicine provider could negotiate a variety of different compensation approaches with the employers. The compensation may be on a per-encounter fee or a base services rate, combined with a reduced per-encounter fee. Sometimes a fully capitated per employee per month payment may be negotiated. The different compensation methodologies will impact telemedicine utilization by the employers. All these factors should be considered and tailored specifically to the employer’s goals. The payments for the employee telemedicine services could be made by the employer’s self-funded plan, the employee’s third party administration, or even by the employees themselves as an out of pocket cost. The best way for telemedicine providers to obtain these types of contracts is outreach, engaging local employers on the benefits and cost savings of providing a telemedicine offering. These contracts should be the first step. Show them the benefits, the cost savings, the advantages of a healthier, present workforce, along with your dedication to making the program work. Almost always, this payment model is a new program being introduced. Take the time to educate the employer and the employees of the capabilities and limitations of the telemedicine offering. Taking these steps to encourage utilization will increase ROI in the long run.
New technology has created an explosion in demand for international telemedicine, especially in fields such as radiology and pathology that lend themselves to virtual care. It's an area that has humanitarian interest and is also a growing business for the hospitals, AMCs or physician participating in it. Not only can physicians treat patients in remote or underserved regions, but they can also tap into a market of international patients who want access to specialty care in the U.S. without getting on an airplane. A country such as China, with increased middle-class purchasing power, means more patients have the opportunity to pursue treatment from Western medical centers. That means U.S. medical centers, particularly large academic institutions, are making a concerted effort to build their brands abroad. Payment can be better than reimbursement in the U.S., as patients are either self-pay or have government health plans. Physicians can also bypass the additional licensing and paperwork they would need if they were going to expand their practices in another state. Contractual per consult or basic monthly fee arrangements can be made to provide direct care, and/or even second opinions abroad.
Telemedicine is here to stay. Our aging population, increase in chronic diseases among the population, and physician shortages are the main drivers for consumer demand of virtual health services. The old Fee-for-Service model is going the way of the typewriter, and it’s critical to position yourself for the new age payment models, to avoid being left behind the pack. IN addition, the models discussed in this article shed new light on new, disruptive ways to get paid for delivering healthcare services without getting involved with insurance companies and their paternalistic controls over the way you practice medicine. In the end, patients will enjoy more convenient access to care and better health outcomes. Providers will enjoy more secure revenue streams, and job satisfaction. Those are the key ingredients for maximum patient-provider relationships that lead to long-term, sustainable health quality.
Written by Aneel Irfan, CTL, CTC
Thursday, July 7, 2016
With most of the United States engulfed in a heat wave and summer in full swing, overexposure to sunlight can occur easily due to outdoor activities. Overexposure is an underlying cause for harmful effects on the skin, eyes, and immune system, not to mention skin cancer. Four out of five skin cases of skin cancer can be prevented experts believe, as UV damage is mostly avoidable.
Simple precautions can assist in protecting your body from overexposure while outdoors. Shade, clothing and hats provide the best protection and applying sunscreen to those parts of the body that remain exposed. Keep these simple tips in mind, especially for those with children.
- Limit your time in the midday sun
- Watch for the UV Index
- Use shade wisely
- Wear protective clothing
- Use sunscreen
Sunscreens use the measurement Sun Protection Factor (SPF) to convey the degree to which you will be protected from sunburn and UVB rays. SPF is a measure of how long you can stay in the sun without burning. The average light skinned person can stay in the sun about 15 minutes with no sun protection before they start to suffer minor sunburn. The SPF number is then multiplied by this number to determine how long the average person can stay outside.
- SPF 15:15 minutes x 15 = 225 minutes before burning (3.75 hours)
- SPF 30:15 minutes x 30 = 450 minutes before burning (7.5 hours)
- SPF 50:15 minutes x 50 = 750 minutes before burning (12.5 hours)
- SPF 100:15 minutes x 100 = 1500 minutes before burning (25 hours)
A lower SPF may protect you for short periods in the sun, but a sunscreen with higher SPF also filters more UVB rays from sunlight. Another important factor to look for in sunscreens is a broad spectrum sunscreen which protects against both UVA and UVB rays. UVA rays penetrate more deeply and are associated with long term aging of skin. UVB rays cause the immediate damage we know as sunburn.
- SPF 15 blocks about 93% of UVB rays
- SPF 30 blocks about 97% of UVB rays
- SPF 50 blocks about 98% of UVB rays
- SPF 100 blocks about 99% of UVB rays
Tuesday, May 31, 2016
Telepsychiatry is steadily growing into a robust industry. Telepsychiatry refers to a specific component of telemedicine which deals with the assessment and delivery of mental health care through telecommunications services, usually video conferencing. Insurance companies and medical providers are increasingly covering and providing psychiatry services for patients through telemedicine. Given the prevalence of Americans currently dealing with mental illness, this is a welcome development. The National Survey on Drug Use and Health reported that in 2014 18.1% of all US adults aged 18 or older had any mental illness (AMI) defined as:
· A mental, behavioral, or emotional disorder (excluding developmental and substance use disorders);
· Diagnosable currently or within the past year; and,
· Of sufficient duration to meet diagnostic criteria specified in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
Treating individuals with mental illnesses requires an enormous amount of medical resources and a dedicated number of mental health professionals. Unfortunately, in the U.S., according to the Department of Health and Human Services, there are over 4,000 mental health shortage areas. Essentially, in these regions the ratio of psychiatrist to patient exceeds 1:30,000. “Applying this formula, it would take approximately 2,800 additional psychiatrists to eliminate the current mental health HPSA designations.” Unless we see a dramatic increase of 2,800 psychiatrists tomorrow, most medical facilities and practices are unequipped to deal with the shortage of mental health care professionals. This is where telepsychiatry is beginning to play a crucial role in expanding access to care and relieving pressure on overburdened systems.
Those seeking care for mental health illnesses might be better positioned to receive care virtually, and emergency rooms can now offer virtual psychiatry sessions reducing the burden on ER staff. The growing telepsychiatry industry means broader access across the U.S., especially for U.S. veterans. Of the 1.7 million veterans who served in Iraq and Afghanistan, 300,000 (20 percent) suffer from post-traumatic stress disorder or major depression (RAND Center for Military Health Policy Research, Invisible Wounds of War, 2008). Most Veterans will not seek treatment from VA system psychiatrists or health professionals. MyOnCallDoc President and CEO, Craig Zurman, created the international telemedicine services solution provider MyOnCallDoc to help address this very need. While working with the U.S. Department of Veterans Affairs, the need for a comprehensive, affordable, and quality telepsychiatry program was overwhelmingly apparent. Now, MyOnCallDoc features a robust network of providers able to offer psychiatry services at affordable rates, bringing the care people need directly to their homes.
While telepsychiatry is a rapidly expanding industry, there are still challenges and barriers to its implementation. Most insurance companies do not have regulations in place to allow for telepsychiatry reimbursement. The number of insurance companies or employer provided health programs that offer coverage for these services is expanding, but not quickly enough. Other times, psychiatrists may only consult with patients located in the state in which the psychiatrist is licensed due to very specific licensing requirements. Training can also be an issue, simply because a psychiatrist has access to the technology does not mean they have been adequately trained to handle virtual sessions. Fortunately, the American Telemedicine Association has put together guidelines for video-based mental health services. The guidelines are comprehensive and address technical, clinical, and administrative processes.
As long as psychiatrists remain open to offering psychiatry sessions via telecommunications, patients are amenable to participating in virtual sessions, and patient outcomes continue improving, telepsychiatry stands to help provide broader access to mental health services for at-risk and vulnerable populations and reduce health care costs in the long run.
For more information, please contact MyOnCallDoc to speak with one of our psychiatrists today.
Monday, May 2, 2016
Recognizing the resounding barriers to health care for the LGBT community, MyOnCallDoc and The World Professional Association for Transgender Health (WPATH) are partnering together to establish a pilot program that will allow doctors and psychiatrists who have received specific training to address the needs of transgender individuals through telemedicine. When MyOnCallDoc began investigating the current health care environment for transgender individuals and those in the LGBT community, WPATH was the only organization actively training health care professionals in the intricacies of treating transgender patients. Through this partnership, MyOnCallDoc will be introducing an entirely new focus program called GenderCare. The MyOnCallDoc GenderCare pilot program will allow doctors from WPATH’s trained community to offer 24/7 telemedicine and telepsychiarty care to the LGBT and transgender communities. The mission of the program is to expand access to quality, affordable care for LGBT patients through telemedicine services. WPATH is also working with insurance companies to increase the number of services that are covered for a transgender patient.
MyOnCallDoc was founded on principals of inclusion and providing broader access to high-quality, affordable health care services for ALL individuals. These are the principles that continue to guide our development of new projects and programs. Most recently, we have been researching barriers to access for those within the transgender and LGBT communities. Unfortunately, the realities surrounding discriminatory practices in health care and with insurance companies for LGBT individuals can be disheartening. As transgender individuals attempt to address their mental and physical needs, they are often denied care and access to medical health professionals – even for episodic conditions. Most individuals have stated they have refrained from seeking care because of perceived discrimination or denial of care. The National Transgender Discrimination Society reported that, “health outcomes for all categories of respondents show the appalling effects of social and economic marginalization, including much higher rates of HIV infection, smoking, drug and alcohol use and suicide attempts than the general population.” It was also reported that transgender people experience over 4 times the national rate of HIV infection.
While the realities can be sobering, it is incredibly important to celebrate the small steps in legislation and standards that have been enacted recently that prohibit LGBT, gender non-conforming and DSD individuals from being denied health care services and coverage. The Affordable Care Act which “prohibits sex discrimination in hospitals and other health programs or facilities receiving federal financial assistance as well as bias based on race, national origin, age, and disability,” is a first rate example. While this covers all health programs and facilities that receive federal funding assistance, there are plenty of individuals seeking care within the LGBT community that don’t have access to any of these programs. Additionally, there are many organizations and companies working to transform the status quo and expand health care access. WPATH is committed to transgender health and formulating strategies and care that address the full spectrum of needs for those with gender identity disorders. Their vision is to, “bring together diverse professionals dedicated to developing best practices and supportive policies worldwide that promote health, research, education, respect, dignity, and equality for transgender, transsexual, and gender-variant people in all cultural settings.” WPATH has already trained over 1300 medical health providers and continues to offer a Transgender Health Certification Course. Through WPATH’s commitment to elevating transgender health care, thousands of individuals now have access to medical resources, scientific research studies, organizations, a community of like-minded individuals, and trained professional health care providers. If you have questions about Gender Care or wish to be connected to a provider, don’t hesitate to call MyOnCallDoc at 855-362-3278 or visit our website.
Organizations providing further information:
- National Center for Transgender Equality – “The National Center for Transgender Equality is the nation’s leading social justice advocacy organization winning life-saving change for transgender people.” http://www.transequality.org/know-your-rights/healthcare
- Lambda Legal – “Founded in 1973, Lambda Legal is the oldest and largest national legal organization whose mission is to achieve full recognition of the civil rights of lesbians, gay men, bisexuals, transgender people and those with HIV through impact litigation, education and public policy work.” http://www.lambdalegal.org/issues/health-care-fairness
Monday, April 11, 2016
The telemedicine industry is projected to generate over USD 48 billion by 2019 globally. This influx of investment means consumers are likely to witness an increase of innovative businesses working in this sector, trends towards greater availability of telemedicine programs on a national scale, and increased healthcare cost savings for both employers and employees. Access to telemedicine programs has the potential to impact employer provided healthcare plans in a very positive way. In the past, healthcare plans that incorporated telemedicine services were restricted by differing state legislation and regulations making it hard for employers located in multiple states to choose a telemedicine provider or service that followed each state regulation separately.
TELEMEDICINE PLAN BENEFITS
Lately, most of the news surrounding the telemedicine industry pertains to how various state legislatures have started to remove barriers to telehealth service development and develop clearer cost and implementation regulations for the industry. This is making it much easier for companies and employers to begin realizing telemedicine services as part of their standard healthcare plans or as an elective component of their traditional plans. Most recently, the state legislature in Florida passed a bill expanding coverage for Medicaid telemedicine services. The bill expands coverage for real-time, audio-visual interactive telemedicine services. Previously, telemedicine was not covered for Medicaid patients in Florida, but thanks to the efforts of the Telehealth Association of Florida and industry experts, the bill was revised to incorporate broader coverage of telemedicine services.
Even more importantly, as certain taxes and legislation that have the potential to increase the financial burden of healthcare for employers come into play, an established robust telemedicine program can help offset or reduce costs for employers and employees. For example, the “Cadillac Tax” which will apply to tax years beginning on or after January 1, 2018, imposes an excise tax of 40% on the cost of employer-sponsored health coverage that exceeds certain annual thresholds. The tax is meant to help finance the Affordable Care Act and decrease excessive healthcare spending by employers and employees. However, this can be costly for employers with employees seeking care for chronic conditions or working in high risk situations.
Taking into account evidence of quantifiable healthcare savings for both employers and employees, more convenient access to medical care and the looming “Cadillac Tax”, more and more employers are including telehealth services as an integral part of their employee healthcare models. According to Mercer’s 2015 National Survey of Employer-Sponsored Health Plans, large companies with 500 or more employees offering telemedicine services jumped from 18% to 30%. Essentially, employers are witnessing the added benefits of including telehealth services for employees including fewer instances of decreased production due to excess time spent on doctor or hospital visits, greater employee management of personal health, increased patient knowledge and clinical outcomes, and greater access to qualified medical providers.
TELEMEDICINE IMPLEMENTATION GUIDELINES
Implementation of telemedicine services as an employee healthcare benefit should be part of a comprehensive workplace health plan. Whether you want to offer employees chronic care management, mental health consultation services, or replace the need for urgent care visits, your telemedicine plan needs to take into account the needs of your employees and function accordingly. Communication is also essential to a successful implementation. If your employees don’t understand the specifics of your new standard or elective telemedicine program, they won’t be keen to utilize the service.
Examples of how you can foster a culture of broad acceptance and usage within your company:
- Send regular communications about your telemedicine program
- Have plan experts available for questions and concerns
- Make the services available to all employees and family members
- Speak about your own personal experience using telemedicine
While the telehealth services environment is rapidly expanding and states are removing barriers to access and reimbursement for telemedicine services, we understand there are still challenges to telemedicine program implementation for employers. Employers must decide whether or not to make telemedicine part of their standard healthcare plan or add it as an elective component of an existing model, choose a qualified telemedicine provider, and account for healthcare IT rules and regulations. As the evolving healthcare industry focuses on employer-sponsored telehealth services, MyOnCallDoc is available to guide you through the process of incorporating standard or elective telehealth models for telehealth and decode state and federal legislation. Don’t hesitate to reach out to us with questions, comments or requests for more information about how you can start implementing your employer-sponsored telemedicine program today.
Wednesday, March 23, 2016
It’s that time of year when a significant percentage of the population is plagued with extremely itchy and watery eyes, constant sneezing, and runny noses. You guessed it, allergy season is just around the corner. As climate change continues to impact temperatures and weather patterns around the world, researchers are noticing different trends for allergy sufferers. In particular, the allergy season has been arriving a few weeks earlier each year, according to the World Allergy Organization. This does not mean that allergy season has also been ending earlier though. For allergy sufferers, this is far from welcome news.
Air pollution, pollen, mold, and poison ivy are more prevalent due to climate change and warmer weather, which can increase risks for those with allergies. Each year, the Asthma and Allergy Foundation of America, puts together a list of the Spring Allergy Capitals in the US. The list takes into account: the pollen score of each city, rates of allergy medication use by residents, and availability of Board-certified allergists. In 2016, the AAFA estimates that Jackson, MS will be the most challenging city to live in for allergy sufferers. Also on the list are, Memphis, TN; Syracuse, NY; and Louisville, KY.
Pollen allergies pose physically challenging symptoms, as patients deal with added sinus pressure, runny noses, itchy and watery eyes, headaches, shortness of breath, repeated sneezing and excessive fatigue. Unfortunately, allergies can also take an emotional toll by causing anxiety, depression, and frustration. The allergy season is also sometimes associated with economic costs, as employees take time off to deal with aggressive allergy symptoms. It’s no wonder why those with allergies dread spring and the change of seasons.
Proper diagnosis and treatment of allergy symptoms is paramount to the effective management of allergy symptoms. However, for most Americans, proper management of allergy symptoms can mean excessive time and valuable resources wasted sitting at urgent care centers or in the doctor’s office. This allergy season, we propose a different solution; telemedicine. Our providers are available 24 hours a day, 365 days a year. The MyOnCallDoc team wants to ensure you receive timely, affordable allergy care this year. So, forget about hiring a babysitter, taking time off from work, or sitting in traffic to begin your treatment plan. Call our medical providers now and start experiencing allergy relief today.
Thursday, March 17, 2016
Telemedicine is quickly proving itself to be a driving force in the quest to provide broader access to quality healthcare for more Americans. Expansive mobile technology advances, faster connection speeds, and President Obama’s ConnectALL initiative have consequently expanded telemedicine programs through the country and brought this version of digital medicine to the forefront of many healthcare organizations. One government entity in particular, The Centers for Medicare and Medicaid Services or CMS, is recognizing the importance of testing and proving the advantages of telehealth services for Medicare and Medicaid patients.
CMS’s Innovation Center is working on developing and implementing new models for Accountable Care Organizations. One of those new models, based on experiences with Pioneer ACOs and the Medicare Shared Savings Program, the Next Generation ACO model, “sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care.” However, for MyOnCallDoc, the most innovative part of the Next Generation ACO model is the Telemedicine Waiver for participating Next Generation ACOs.
Previous Telemedicine Restrictions
Telemedicine used to be heavily restricted in many CMS ACOs and payment models. Two regulations initially put in place by CMS made telehealth unavailable to a wide segment of individuals enrolled in various ACOs. First, the Rural Health Professional Shortage Areas (HPSA) stipulation geographically limited which patients could benefit from telemedicine. The HPSAs included “HPSAs located outside of a county, outside of an MSA [metropolitan statistical area], as well as those located in rural census tracts, as determined by the Office of Rural Health Policy.” Individuals residing in these areas experienced shortages of primary care, dental care, or medical healthcare providers. This regulation seriously limited the number of patients able to utilize telemedicine approaches to ongoing healthcare services.
Second, an originating site requirement meant that patients had to travel to an authorized healthcare facility to initiate a virtual visit with a medical provider. The originating site designations where Medicare beneficiaries could receive medical services via telecommunications were:
- The office of a physician or practitioner
- Critical access hospitals (CAH)
- Rural health clinics (RHC)
- Federally qualified health centers (FQHC)
- Hospital-based or critical access hospital-based renal dialysis centers
- Skilled nursing facilities (SNF)
- Community mental health centers (CMHC).
Additionally, and even more restricting, most of those originating sites had to be located in a HSPA or non-MSA location.
MyOnCallDoc has collaborated with the CMS Seamless Care Models Group at The Center for Medicare and Medicaid Innovation Centers to increase telemedicine awareness and access. Through this collaboration, MyOnCallDoc hopes to fully illustrate and maximize the benefits of telemedicine within the Next Generation ACOs and all future ACO models. The Innovation Center at CMS is interested in testing initiatives and models that incorporate innovative approaches to healthcare without disrupting entire systems. Thus, the Telemedicine Waiver has been developed to allow for quality testing of telemedicine procedures without changing the Next Generation ACO model completely.
The Telemedicine Waiver
The Telemedicine Wavier speaks to the potential future of telemedicine as a part of a comprehensive, affordable, and effective healthcare system available to millions of Americans. The Rural Health Professional Shortage Areas regulation and the originating site requirement for the qualified use of telemedicine have been expanded within the Telemedicine Waiver. Qualified beneficiaries can now utilize telecommunications for medical services, which is a testament to the greater understanding of telehealth benefits. However, as with any new endeavor, there still exist certain limitations within the Telemedicine Waiver.
The first limitation outlines allowable originating sites for patients; however, this regulation has been expanded upon from the list of previously allowed originating sites. Now, patients can access telemedicine opportunities from their home or other designated originating sites whether or not they are located in a rural area. The second limitation within the waiver, excludes certain types of care. Patients cannot use telehealth services for:
- Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or skilled nursing facilities (SNF)
- Subsequent hospital care services
- Subsequent nursing facility care services.
While the Telehealth Waiver does not eliminate every barrier to telemedicine services within Next Generation ACOs, it places telemedicine services at the forefront of new development models and allows for the growth of telemedicine opportunities in a variety of healthcare management systems.
MyOnCallDoc and Telehealth Compliant Programs
MyOnCallDoc has spent significant time with CMS Innovation Centers discussing in detail telemedicine services, clarifying telehealth protocols, uncovering areas for improvement within particular ACO models, and developing Telehealth Compliant programs that highlight the potential benefits of incorporating strong telemedicine initiatives. We have compiled a basic overview of the programs we will have implemented, they are as follows:
- Chronic Care Management Services: Telemedicine can be used to effectively manage chronic conditions among an aging population. Medicare created the 99490 code to define how non-face-to-face patient provider interactions can facilitate the proper management of chronic conditions. As 2/3 of patients within the Medicare population experience 2 or more chronic conditions, this program can have far ranging benefits.
- Episodic or Minor Acute Care: Next Generation ACOs have the freedom to offer telemedicine to their members for the resolution of minor care needs. CMS statistics cite nearly 60% of urgent care visits could have been managed via compliant telemedicine services.
- Accurate and Complete Data Collection: Through the use of telemedicine and specially trained medical staff, a Next Generation ACO can improve the accuracy and completeness of HCCs and Risk Adjustment Factor data. This improves an ACOs ability to accurately predict expenditures and receive proper reimbursement per member.