Tag Archives: Medicare

Why You Should Medicare about Alternative Payment Models

Early in my career, around 1995-96, I was selected by Vice President Al Gore to sit on a senatorial/congressional Sub-Committee to talk about reimbursement for “video teleconferencing for medicine.” I remember Senator John D. “Jay” Rockefeller, IV, the chair, telling us all in the first meeting that “one day, this will be the biggest thing in medicine.” After putting the first “payment plan”11280389_s legislation in motion for telemedicine, we are all still waiting for his statement to come true! Today, at last, we are a few steps closer to his famous statement…

“Simplicity is the soul of efficiency.” –Austin Freeman

If this quote is true, and I believe it is, it is not surprising that telemedicine had a slow start when it was introduced to health care. The technology itself has never been overly complicated, however navigating the ever winding web of HIPPA compliance and the insurance systems payment models stifled any growth that telemedicine was poised to show early on.

As of late, that has all started to change. Many technologies now actively address patient privacy, encryption, and secure data storage that mitigate any potential threats to the security of patient’s medical information. Many states are also now passing legislation to make sure that telemedicine services are paid by insurance companies just like in person visits would be. And the Centers for Medicare and Medicaid Services, (CMS), have put quotas into place for services that need to be billed using Alternative Payment Models (APM).

What is an APM exactly and what is the purpose of promoting them?

“All alternative payment models (APM) and payment reforms that seek to deliver better care at lower cost share a common pathway for success: providers, payers, and others in the health care system must make fundamental changes in their day-to-day operations that improve quality and reduce the cost of health care.” –CMS

The take away here is that better care at a lower cost requires “fundamental changes” in the way healthcare providers run their operations. And as we all know, change is never easy. There must be some promise of reward to drive it forward, which is why APMs are so important. They provide the pathway for change by providing stronger incentives to do so.

Telemedicine services fall squarely in the wheelhouse of APMs as they promote physician efficiency, improve access to and potential quality of care, and can be provided for a fraction of the cost of face to face visits. It is for these reasons that CMS is aiming to grow payment of services paid through APMs to 30% of all services by the end of this year (2016) and to 50% of all services by 2018. The 2018 goal also links 90% of all payments through all payment models to quality of care, not just a fee for a service.

No longer will patients be paying for “time” in front of a medical professional, but their care and the payment of it will be more directly linked to the value of the service provided. Providers will be incentivized for providing the best quality of care in the most efficient manner possible or they may not be paid at all.

The question then is not whether or not healthcare practices and facilities will be substantially affected by APMs, but rather if they are ready to provide services like telemedicine that fit the bill. With the amazing advantages in technology like those in Web RTC and several technology grant programs being offered today, there really are very few reasons that forward thinking healthcare organizations shouldn’t be ramping up their telemedicine services ASAP.

Avidex AV is revolutionizing the way healthcare facilities and doctors are delivering care. Their 20 years of experience is being leveraged to drive down the cost of care while promoting positive healthcare outcomes. Is your organization looking for a new kind of technology partner? Connect with one of our Account Executives today to learn more.

Resources:

#1: https://www.cms.gov/

#2: https://innovation.cms.gov/initiatives/Health-Care-Payment-Learning-and-Action-Network/

#3: http://blog.avidex.com/breaking-through-the-telemedicine-payment-barrier/

#4: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html

#5: http://blog.avidex.com/just-browsing-webrtc-for-healthcare/

Bob Higginbotham

About Bob Higginbotham

Bob Higginbotham, CTS-I, CTS-D, is the Avidex National Manager of Healthcare AV. Bob has spent his 30 year career in leadership positions in the AV industry including extensive design and build work in healthcare facilities. He owned and operated a successful AV business in Texas with multiple offices in several cities where he managed a staff of over 100 employees. Bob has served as a technical consultant for a major AV manufacturer, led the technical sales team for a national video conferencing provider and provided technology auditing services for several private education facilities. He has a unique working knowledge of audiovisual technology as well as multiple certifications in audio engineering, acoustics, AV design, CQT system commissioning and video transmission systems. Bob holds a BA in communications and has recently served as board chair for a large private school. He brings his years of technical knowledge and leadership experience to Avidex where he leads the national healthcare AV team. Contact Bob at bobh@avidexav.com

The Telephone ‘Bill’ You Actually Want!

Many years ago, I was asked to work with a group of Senators in Washington, DCremote monitoring to come up with an equitable bill to reimburse physicians for their time when they consult via video for a second opinion. I also sat on the committee that discussed payment from insurance companies to medical personnel when they perform a video visit over video conferencing. Although we worked hard to get these bills passed, it met with opposition from individuals who knew nothing first hand of the practice of video visits and imposed legislation to limit the payment to and for the individuals who use the service.

A new bill that has been introduced will help eliminate some of that “red tape” and allow the people using the practice to do so without limitations of borders and hoops to jump through. As you might read between the lines, people are starting to believe that technology is here to stay and that maybe it is time to loosen the reigns a bit to help those who use the service to get the most out of it.

I am not a political person by nature, but this bill will have my attention as it slowly moves through the Washington, DC cog…let me know what you think!

With all the political hype surrounding candidates visiting Iowa, New Hampshire, and South Carolina you may think it strange that I am recommending you pay attention to Tennessee and Colorado. Why?  A Tennessee Congresswoman and a Colorado Senator have sponsored bills in the House and Senate respectively that would greatly expand telehealth’s role in providing better and more convenient patient care.

It’s called the Telehealth Innovation and Improvement Act of 2015 and it’s currently under review in the Healthcare Subcommittee under Ways and Means.

How would this bill affect telehealth, especially for Medicare services?

1) It Defines Conditions- The following conditions are specifically designated as eligible for Telehealth under this bill:

  • Chronic hypertension
  • Ischemic heart diseases
  • Chronic obstructive pulmonary disease
  • Heart failure and/or heart attack
  • Osteoarthritis
  • Diabetes
  • Chronic kidney disease
  • Depression
  • Atrial fibrillation
  • Cancer
  • Asthma
  • Stroke
  • Total hip and/or knee replacement procedures
  • Parkinson’s disease

2) It Sets Parameters for Types of Remote Care- This bill goes further than previous legislation to define more remote technologies that would be eligible for payment. These include:

  • Remote monitoring technologies, including remote device management for purposes of remotely interrogating or programming a medical device outside the office of the physician specialist involved.
  •  Bi-directional audio/video technologies.
  •  Physiologic and behavioral monitoring technologies
  •  Engagement prompt technologies
  •  Store and forward technologies.
  •  Point-of-care testing technologies.

3) It Removes Restrictions on Time and Location of Rendering Services- Current restrictions on providing remote services across state lines as well as requirements for all remote care to happen in real time are being eliminated in this bill. This means a doctor in New York could remotely treat a patient in New Jersey by reviewing the patient’s remote monitoring data and then updating care instructions without needing to have a real time one on one video conversation. IT also removes the requirement for the patient to be a certain distance from the physician in order to make remote care available.

Given all of the proposed changes to telehealth policy above, it is obvious as to how this bill would not only help telehealth expand in rural areas where there is limited access to medical resources, but also in urban areas as well. It would increase physician choice by eliminating geography as a requirement for payment, and create efficiencies by utilizing technology that allows physicians to access current biometric data about a patient and their condition, even if the patient wasn’t available for a face to face call at that time. The passage of a bill of this nature could really do great things for telehealth, so let’s hope it makes it out of committee for a vote. This could be the only telephone bill that you ever actually hope to get.

Avidex AV is revolutionizing the way healthcare facilities and doctors are delivering care. Their 20 years of experience is being leveraged to drive down the cost of care while promoting positive healthcare outcomes. Is your organization looking for a new kind of technology partner? Connect with one of our Account Executives today to learn more.

Resources:

#1: https://www.congress.gov/bill/114th-congress/house-bill/4155

#2: https://www.govtrack.us/congress/bills/114/s2343

#3: https://www.govtrack.us/congress/bills/114/s2343/text

Bob Higginbotham

About Bob Higginbotham

Bob Higginbotham, CTS-I, CTS-D, is the Avidex National Manager of Healthcare AV. Bob has spent his 30 year career in leadership positions in the AV industry including extensive design and build work in healthcare facilities. He owned and operated a successful AV business in Texas with multiple offices in several cities where he managed a staff of over 100 employees. Bob has served as a technical consultant for a major AV manufacturer, led the technical sales team for a national video conferencing provider and provided technology auditing services for several private education facilities. He has a unique working knowledge of audiovisual technology as well as multiple certifications in audio engineering, acoustics, AV design, CQT system commissioning and video transmission systems. Bob holds a BA in communications and has recently served as board chair for a large private school. He brings his years of technical knowledge and leadership experience to Avidex where he leads the national healthcare AV team. Contact Bob at bobh@avidexav.com

Better Care and Cost Savings by Increasing Adoption of Telehealth Services

In today’s healthcare marketplace the ability to match the needs of patients with the resources available is difficult. This rings especially true when health care organizations aren’t able to provide the most optimal level of care due to “Technical” limitations.

Today, Medicare is having this very problem with strict limits on if and how they can use technology to deliver healthcare services. Right now, the limitations are primarily bureaucratic rather than technical because Accountable Care Organizations are limiting how healthcare providers can be reimbursed for providing technology based care to patients. However, the good news is a number of leading organizations are working together to try and change the way Medicare reimbursements are handled for Telehealth and Telemedicine Services. Check out this link from EHR Intelligence “Groups urge Medicare to widen telemedicine options for ACOs.”

The American Telemedicine Association (ATA) and a coalition of other groups that support Telehealth services have provided a letter to the department of health and human services outlining that 80% of American’s don’t have access to the type of technology based care required for approval by Medicare and this is severely limiting the delivery of patient care and driving up costs. According to these groups it is believed that better care and cost savings could be seen with the increased adoption of Telehealth services. What do you think?

At Avidex, we believe that Telehealth and Healthcare Technology can drive better patient care and outcomes. Find out how we can help your organization utilize technology by getting in touch with our team.

Bob Higginbotham

About Bob Higginbotham

Bob Higginbotham, CTS-I, CTS-D, is the Avidex National Manager of Healthcare AV. Bob has spent his 30 year career in leadership positions in the AV industry including extensive design and build work in healthcare facilities. He owned and operated a successful AV business in Texas with multiple offices in several cities where he managed a staff of over 100 employees. Bob has served as a technical consultant for a major AV manufacturer, led the technical sales team for a national video conferencing provider and provided technology auditing services for several private education facilities. He has a unique working knowledge of audiovisual technology as well as multiple certifications in audio engineering, acoustics, AV design, CQT system commissioning and video transmission systems. Bob holds a BA in communications and has recently served as board chair for a large private school. He brings his years of technical knowledge and leadership experience to Avidex where he leads the national healthcare AV team. Contact Bob at bobh@avidexav.com