Tag Archives: Obamacare

Will Obamacare be Trump’d? (and does it really matter?)

On the 20th of January, a new president took office. Barack Obama graciously exited the White House handing the keys to the inbound Donald J. Trump. President Trump was a vocal opponent of the Affordable Care Act, (ACA), and had promised to reverse it once in office. 20558323 - close up of male doctor holding tablet pc with medical appWhat ultimately happens to President Obama’s signature piece of legislation is yet to be seen. It may be revamped or it may be scrapped altogether, but when it comes to technology adoption in healthcare, does it really matter?

To answer that question we need to look at a few other pieces of legislation as well as general trends in healthcare.

The first piece of legislation that is important is the Tele-Med Act of 2015. We detailed the implications of this bill in another post about a year ago.

In general, The Tele-Med Act of 2015 may just lower existing barriers to implementing telemedicine services, especially across state lines. Now, as it is a federal bill, it really only applies to Medicare currently, but it would set a precedent for other private insurance companies to follow and open up the boundaries that may currently prohibit them from offering services in neighboring states.”

Now that piece of legislation seems to be taking it’s time getting through committees, but there is one other important thing about the bill you should know. It was introduced by a Republican and there are 27 cosponsors of that bill with equal “D”s and “R”s following their names.

The second piece of legislation that may lend some insight into what the future role of technology in healthcare may be is the ECHO Act. ECHO stand for Expanding Capacity for Health Outcomes. This act became law on December 14th 2016, and it applies to examining how the use and integration of technology-enabled collaborative learning and capacity building models can impact better health outcomes. It would pave the way for technology like video teleconferencing and distance learning to be used to actually facilitate knowledge and resource sharing between healthcare facilities to better train staff and make more efficient use of limited resources and specialists. This bill also had bipartisan support when introduced.

Despite whatever political rhetoric and posturing seems to be going on, one thing seems clear. Both sides of the aisle agree that telehealth will be a large part of the solution to our healthcare problems. It will decrease costs, increase efficiency, and create access for those that may be in underserved or rural locales where the quality of care is not currently up to par.

Even if the ACA is scrapped, the trends towards using technology to allow healthcare professionals to share information more effectively and to connect doctor’s to patients for after care, follow up visits, counseling, etc will still continue due to bipartisan bills and laws that were passed apart from the ACA. The ACA does not impact the need for us to use technology to allow patients to self-manage their own care to drive the desired outcomes. However, creating solutions that are truly engaging for patients/families will have the highest impact on reducing costs.

One idea of reform needed to make plans more affordable is that of breaking down the invisible lines between the states when it comes to providing and billing for care. It would seem that telehealth would have a strong role in this scenario if implemented as well as a way to bridge the geographic gaps.

At the end of the day, an objective look at the types of healthcare bills that are being introduced and passed, illustrate that both sides of the aisle see technology as a way to make healthcare more affordable and to create better patient outcomes. Despite what reform or repeal happens with the ACA, it doesn’t seem like the new House, Senate, or President will “trump” that trend.

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: http://blog.avidex.com/are-you-ready-the-tele-med-act-of-2015/

#2: https://www.congress.gov/bill/114th-congress/house-bill/3081/cosponsors

#3: https://www.congress.gov/bill/114th-congress/senate-bill/2873/cosponsors

#4: http://www.healthcare-informatics.com/news-item/telemedicine/senate-passes-bill-use-project-echo-nationwide-telehealth-model

Anthony Paoletti

About Anthony Paoletti

Anthony brings over 23 years of audiovisual experience and has worn nearly every "hat" in the industry; from Consultant to End User; Account Representative to Install Technician; Project Manager to Systems Engineer. Contact Anthony at apaoletti@avidexav.com

Breaking Through the Telemedicine Payment Barrier

dr A and BA tale of two doctors. 

Doctor A and Doctor B see two patients simultaneously.  Both patients have come in for a follow up visit on their recent knee surgeries.  Both doctors speak with their patients for 15 minutes, asking about the recovery, if the patient has any abnormal pain, and observing the leg for any visible redness or abnormal swelling.  Both patients are recovering well, are pain free, and look to be avoiding infection.  The doctors both advise their patients to continue on as they have been, and to come back in another month for another follow up appointment.  The patient outcome is the same in both scenarios.  Doctor A gets a check from the insurance company as usual.  Doctor B submits for payment to the insurance company as well and is denied payment.  Doctor A gets paid and Doctor B is left holding the bag saying, “Show me the money.”  The difference?  Doctor A sees his patient in person, while Doctor B sees her patient through the use of a video conferencing system.

It’s amazing to think that telemedicine has been around for nearly 40 years.  Of course, the technology used back then was markedly different than today’s high definition audio video teleconferencing systems.  Yet despite these innovative leaps in technology, one thing has remained rather constant.  The insurance companies have not paid telemedicine claims in the same way as in person visits, and sometimes, haven’t agreed to pay for them at all.  This lack of payment has been a major problem in the adoption and proliferation of telemedicine systems in general.

Today however, all that is changing at a quicker pace than ever before.

There are two main reasons that the tide is shifting in favor of telemedicine, creating what Forbes called a “perfect storm” for the rapid adoption of telemedicine as a viable way to reduce health care costs and better leverage the limited resources of our physicians’ time.

Federal Regulation

To start, the Affordable Care Act, or ACA, is redefining the way we evaluate medical care.  It is moving our insurance payer model from a “fee for service model” to one based on patient outcomes.  According to Shahid Shah, CEO of Netspective, also known as “The Healthcare IT Guy”, the idea is not the services that the provider performs and gets fees paid for; instead it is the outcome that the services provide that is of significance.” It is this focus on outcomes that means “Physicians will get paid for emails and phone visits in the same way they get paid for in-person visits…”

Besides the ACA, the Medicaid program is also creating opportunities for telemedicine to proliferate as well by defining care standards for “the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment.” They in turn are encouraging states “to use the flexibility inherent in federal law to create innovative payment methodologies for services that incorporate telemedicine technology.”

State Legislation

Given the efficiencies of telemedicine, the need for health care reform, and the directives of federal programs like Medicaid above, the states have indeed been leveraging their power as well to change the way insurance companies are approaching payments.

In fact, currently 27 states now have laws in place to assure that telehealth is treated similarly to in person visits from a payment perspective.  The three latest states to pass this legislation were Indiana, Minnesota, and Nevada.  There are currently 8 other states in the process of this type of legislation as well.  Given those bills are passed with equal fervor, it seems 35 states and Washington DC will all have some type of telemedicine legislation in effect by the end of the year.  Of course not all states are implementing this equally, so the American Telemedicine Association has created a resource center to help educate us on the differences.

It has been shown through several studies that Americans are ready and willing to start to leverage telemedicine to take control of their health.  Unfortunately, despite the patient’s desire to take advantage of these services and their innate cost efficiencies, Telehealth has been undervalued for many years…because the reimbursement climate for telehealth was not favourable.” However today, through the exercise of governmental reforms on the state and federal levels, we have finally broken through the telemedicine payment barrier.

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: http://www.handsontelehealth.com/past-issues/139-healthcare-reform-how-telehealth-and-telemedicine-fit-in

#2: http://www.forbes.com/sites/brucejapsen/2014/12/09/with-aca-telemedicine-in-perfect-storm-for-coverage/#3

#3: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Telemedicine.html

#4: http://www.americantelemed.org/news-landing/2015/05/27/milestone-most-states-now-have-telehealth-parity-laws#.VXfD3PlVikq

#5: http://www.americantelemed.org/policy/state-policy-resource-center/#.VXfD2PlVikr

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 New House Call- Telehealth is Bringing the Doctor Back Home

woman video chat with DrWatch any movie set in the late 19th or early twentieth century where someone has taken ill and inevitably, a doctor will arrive at the patient’s home, black bag in hand, and sit next to them in their own bed to take a look. In fact, this is the origin of the term “bedside manner”.

In the 1930’s house calls were standard practice for physicians. Approximately 40 percent of doctor patient visits happened in the patient’s home. By 1950, this had decreased to 10 percent, and by 1980, to about only 1 percent. –American Academy of Family Physicians

In a way, some of this shift to medical care at a dedicated facility outside of the home makes sense. A physician at an emergency room (ER) for example may need access to a CAT scan machine, an MRI machine, a cardiology lab, or a lab for blood work. It is hard to imagine all of this being taken to the patient’s home in that traditional little, black doctor’s bag. The propagation of the modern day insurance system also played a part in the reduction of house calls by physicians due to their policy for reimbursement on these type of visits.

The house calls, for all intents and purposes, are gone. However, the march of technology and the need to better allocate the limited resources of a physician’s time, while reducing the cost of medical care are bringing back the house call in an innovative new way.

Enter Telehealth.

Telehealth as a concept has been around for some time, but it seems that the introduction of new technology alone is not enough to tip the scales. You need an accompanying change in the attitudes and acceptance of the technology by the patients themselves. You also need acceptance of the technology by both the medical community, as well as by the medical insurance system to assure payment. For the last few years, these needed changes had been slow to materialize, however today the pendulum has begun to swing in favor of telehealth.

A recent Harris Poll showed that 66% of people surveyed are open to visiting with their doctor over video. The appeal of convenience and shorter wait times were strong drivers of this willingness. Another interesting revelation in the poll was that for “middle of the night” care, 21% of respondents indicated they would choose a video visit. This may on the surface seem low, but when you consider the fact that 17% said they would call a 24 hour nurse line, and an additional 5% indicated they would use an online symptom checker, the result is that 43% of the respondents chose methods that did not require seeing a doctor in person. That means telehealth in some form has now reached the same level of preference as a visit to the ER, (44% chose this method), when it comes to middle of the night care.

For obtaining prescriptions, an overwhelming 70% of respondents said they would prefer a video visit with the doctor. Prescription refills, birth control, antibiotics, and prescriptions for chronic illness are all situations that align well with online consultations.

Doctors Matter

Another telling finding in the Harris Poll on telehealth was that doctors still matter. Just because patients are willing to meet with a doctor over video doesn’t mean that they are willing to meet with any doctor available. In fact, 88% of those polled wanted the ability to choose their online doctor just as they would their primary care physician (PCP). 7% of respondents said they would be willing to switch PCPs to get video visits, which indicates that adding telehealth services would not dramatically attract new patients to a practice, but would create opportunities to retain more existing patients, especially younger patients who would be more likely to leave.

Doctors do indeed matter, and not just in a patient’s choice of physician, but also in the doctor’s choice to use telemedicine in their practice. As stated above, doctors do not currently face a mass exodus if they choose not to employ telehealth. However, doctors who have made the leap have found they can offer the same quality of care and positive patient outcomes when they utilize HD video for patient visits.

“The first thing I do when I treat a patient is I look at their face,” said Dr. Peter Antall, President and Medical Director of the Online Care Group, which provides telehealth services. “A person’s facial expressions and body language give me an understanding for their overall well-being that could be missed over the phone. Beyond that, video gives me an opportunity to see skin rashes or tonsils – important signs when making a diagnosis. With the HD-quality video, I can assess the patient closely and provide a diagnosis that will produce the best possible outcome.”

This aligns well with the Federation of State Medical Boards’ policy recommendations of utilizing both high quality audio and video in telehealth.

Cost of Care

The survey shows that 62% of patients expect telehealth visits to cost less than an in person visits. This is a reasonable assumption, and has proven to be true in reality. Studies have shown that “telehealth visit saves about $100 or more compared to the estimated cost for in-person care.”  Given these savings, it seems odd that insurance companies have been slow to embrace reimbursements for these visits.  Today however, 22 states now have laws requiring that telehealth visits be paid in the same way as traditional office visits, and the Affordable Care Act also has rules in place that will continue to pave the way for increased technology in healthcare.

With consumer attitudes on telehealth dramatically shifting, insurance policies rapidly changing to allow for telehealth reimbursements, telehealth’s innate cost advantages, and the growing acceptance of telehealth in the medical community based on realized positive outcomes, it is no surprise that telehealth is poised to revolutionize healthcare.  It all adds up to one thing.

The house call…is back!

 

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: http://www.aafp.org/afp/2011/0415/p925.html

#2: http://www.fiercehealthit.com/story/patients-increasingly-open-video-doctor-visits/2015-01-23

#3: http://cdn2.hubspot.net/hub/214366/file-2374840622-pdf/TelehealthConsumerSurvey_eBook_NDF_Electronic_Version_(2).pdf\

#4: http://www.fiercehealthit.com/story/new-york-enacts-telehealth-parity-law/2015-01-12

 

Joel Harris

About Joel Harris

Joel Harris brings invaluable insight to the Avidex team in his role as CEO, with years of experience leading national technology, healthcare and business organizations. You can reach Joel at jharris@avidexav.com

Telemedicine: A $428 Million Silver Bullet?

TV as a Dr cartoonWhen I was a small child watching Saturday morning cartoons on our 300-pound console television set in my living room, I imagined what the year 2015 might bring while watching the Jetson’s. I looked forward to the flying car that came out of a briefcase, “Rosey” the robot maid and the talking interactive TV set with Mr. Spacely yammering at George all the time. What I haven’t seen so far in 2015 is the flying car…”Rosey” is called a “Rumba” (okay, kind of a stretch but somewhat a help in the maid department,) and that talking TV…video conferencing at its finest!  Here is how that talking box is making health care a bit easier to swallow with all these new laws going into effect.

Our US hospitals will be fined an estimated $428 million by the federal government in 2015. It is all a part of the Affordable Care Act (ACA) called the Hospital Readmissions Reduction Program (HRRP). An alarming 2,610 of our 3,369 US hospitals, (over 77%), will be fined under the HRRP in 2015.

The stated goal of the HRRP is to reduce the number of unnecessary hospital readmissions and increase quality of care while reducing the overall cost. Others, like Dr. Peter Pronovost, director at Johns Hopkins Medicine, refer to the HRRP as “a mechanism to reduce payment rather than improve quality.”

Many hospitals just can’t afford to do that follow up in a traditional manner under the current cost and pay structure. The Wall Street Journal states that “small and financially struggling hospitals lack the resources to effectively manage their discharged patients at home. Attempting to reduce readmissions could create greater financial difficulties for them.” Many worry that the HRRP’s requirement for reduced admissions actually flies in the face of the best medical science and jeopardizes the health of patients.” That would be a disastrous unintended consequence and one everyone wants to avoid.

There is a silver lining on the readmissions cloud however. Telemedicine.

Technology is reducing the cost of home-based follow up care to proactively reduce readmissions. Progressive health care systems like the Mayo Clinic are working hard to develop and define telemedicine best practices and policies. These efforts have saved the Mayo Clinic an estimated $35,000 to $75,000 a year in fines so far.

It seems that the embrace of new video conferencing and connected sensor technologies in our modern hospitals may just be the answer to the HRRP’s call to action and an affordable way for hospitals to reduce readmissions.

Telemedicine reduces readmissions.

Despite some claims that only 25% of readmissions are unavoidable, one study on readmissions of patients with congestive heart failure showed that using telemedicine cut readmissions in those cases by 38-44%.

Telemedicine investments have positive ROI.

The Pennsylvania hospital system Geisinger Health Plan tracked 541 patients using the telemedicine system for 4 years. The net result? A return on investment of $3.30 for every dollar spent on the program.

Telemedicine can relate real-time data.

A telemedicine system can do more than allow real-time, face-to-face interaction between a patient and their care team. A telemedicine system can also utilize internet connected sensors to relate everything form heart rate, to blood pressure, blood sugar, and weight to help the care team respond to warning signs in a timely manner.

In fact, for telemedicine to be a viable option and one that can be covered for reimbursement, the Department of Health and Human Services requires that “you must use an interactive audio and video telecommunications system that permits real-time communication between you, at the distant site, and the beneficiary, at the originating site.”

Given all this, it seems a wise investment in telemedicine today may be the answer to providing better care, reducing readmissions, and ultimately avoiding costly fines in the future.

For more than 20 years Avidex AV has provided innovative technologies that drive business outcomes for our clients. Is your organization looking for a new kind of technology partner? Connect with one of our Account Executives today to learn more.

Resources:

#1: http://healthblog.ncpa.org/400-additional-hospitals-face-obamacare-readmission-penalties-totaling-428-million-in-fiscal-2015/

#2: https://www.healthcatalyst.com/healthcare-data-warehouse-hospital-readmissions-reduction

#3: http://healthblog.ncpa.org/medicare-advantage-telemonitoring-cuts-hospital-readmissions-44-percent-roi-3-30-per-dollar/

#4: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/telehealthsrvcsfctsht.pdf

#5: http://www.wsj.com/articles/SB10001424127887323741004578418993777612184

#6: http://www.mayoclinic.org/healthy-living/consumer-health/in-depth/telehealth/art-20044878

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 Wait is Over- Technology and the Continuum of Care

vectorstock_2226919Imagine you aren’t feeling well.  You call your doctor to get an appointment.  You are lucky and are able to get an appointment within a week due to a cancellation.  You have to schedule a couple hours off of work to travel to the doctor’s office and conduct the appointment.  A week later you leave work and get to the doctor’s office at the scheduled time.  It takes 30 minutes for you to be called back to an examination room by the nurse.  He conducts a brief precursory check of your vitals and then says the doctor will be with you shortly.  Another 20 minutes pass and the doctor comes into the room.  She asks a few questions and you answer.  After about 11 minutes she gives you a prescription and sends you on your way.  You return to work late and are greeted by a stern glance from your boss.  Hopefully the pills do the trick, because there is no way you want to do this again any time soon.

The story above details the typical American experience in seeing the doctor and is the reason why there is a major problem in America today.

People are voluntarily delaying essential healthcare.

A great number of people find getting healthcare difficult based on the time it takes to see a doctor.  In fact, 33% of people report some type of problem in seeing their Primary Care Physician (PCP) and nearly 25% report issues with getting time away from work for doctor’s appointments. “I have to wait too long” even made the list of 5 Reasons People Don’t Like Their Doctor.

The result is an undue burden on the urgent care and emergency room systems, with 55% of those visits not being urgent or emergencies. Studies also show that 46% of the time these visits could have been handled by a PCP.

The American Medical Association goes on to state that an estimated 70% of all doctor’s visits could in fact be handled…over the telephone.

A hurdle to that however is that few patients are confident that the telephone is effective in diagnosis of their medical needs. However, when asked about video-conferencing, the majority of patients are at least somewhat likely to meet that way. Over 36 million Americans have utilized some type of telemedicine service because of the convenience and time savings. So how does telemedicine help solve some of these problems?

Physicians are tasked with seeing more patients.

It’s the sad truth. One of the most limited resources in the healthcare system is a physician’s time. Physicians are being tasked with seeing more patients. The net result is that the average time a patient spends with a doctor during a visit is 11 minutes, and the patient usually only gets 4 of those minutes to talk. The average telemedicine appointment last 15 minutes or more, and does not require the patient to spend additional time traveling to the doctor’s office or waiting in the waiting room.

Telemedicine is more convenient.

Over 25% of people report trouble getting time off of work to see a doctor. That is because if you include travel to and from the doctor’s office and the time spent waiting to actually see the doctor, that 11 minutes of face time may easily take up 90 minutes of a patient’s day. It may be difficult to get 90 minutes off of work, especially if repeat visits are required. However, taking a 15 minute break to have a video conference with a physician at your desk or on your phone is very easy.

Continuum of Care

In today’s world of bits and bytes, medical charts have gone from analog paper to digital electronic health records (EHRs). EHRs make telemedicine even more feasible, as any physician can access the digital records given they have the proper permissions. EHRs are also stored and protected according to federal HIPPA guidelines to assure privacy. This allows a patients records to easily be passed form a physician to a specialist or accessed for follow up appointments or questions after an initial appointment.

The idea of telemedicine has been around for some time, however it is poised to accelerate in acceptance today. The continued consumer acceptance of videoconferencing, increased access to teleconferencing applications through computers, tablets, and phones, as well as the federal emphasis on the privacy of EHRs and continued support of telemedicine programs in the Affordable Care Act (ACA) are all strong indicators that telemedicine is indeed a major component of the future of healthcare.

For more than 20 years Avidex AV has provided innovative technologies that drive business outcomes for our clients. Is your organization looking for a new kind of technology partner? Connect with one of our Account Executives today to learn more.

 

Resources:

#1: http://www.huffingtonpost.com/richard-c-senelick-md/5-reasons-people-dont-lik_b_779950.html?

#2: http://www.ncpa.org/sub/dpd/index.php?Article_ID=24196

#3: http://www.corpsyn.com/knowledgecenter/articles/telemedicine.html#.VRlUmfnF9vk

#4: http://www.healthitoutcomes.com/doc/patients-accepting-of-telehealth-0001

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