Wednesday, March 23, 2016

It’s Allergy Season – Are You Prepared?

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

Introducing the Telemedicine Waiver for Next Generation ACOs

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
-          Hospitals
-          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. 

At MyOnCallDoc, our team is thrilled to be an integral part of the development of telemedicine initiatives for today and the future. The path to implementing telemedicine services in different healthcare management systems will be long, but practioners, administrators, patients, and government entities are beginning to recognize the benefits of incorporating strong telemedicine initiatives, as the healthcare system expands. The Telehealth Waiver for Next Generation ACOs will help provide affordable, effective healthcare services to many more Americans. Through our partnership programs, we will collect more data to inform best practices, increase the ability of ACOs to be profitable, and improve access to quality healthcare for some of the most vulnerable populations.