Tele-ing it like it is: We've got a lot to learn

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James M. Berklan
James M. Berklan

On its face, this process seems so simple, especially given technology advances lately. Kids do it, even grandmas and grandpas are doing it.

So why can't the U.S. medical community do it? Why can't they communicate better and more often from afar?

I went looking for some education Wednesday, and, boy, did I get just that. I'm just not so sure I learned what I thought I would.

As many of you know, the last session of McKnight's Online Expo on Wednesday was “Telehealth and Reimbursement: What you need to know for the near term.” Presenter Emily H. Wein valiantly gave an outstanding presentation despite suffering at home from the flu. I, in the meantime, struggled to keep up with the volume of information she presented.

This is more a reflection on my shortcomings than the skill of Wein's delivery. She set the table wonderfully for Expo attendees. (I encourage you to check out the hour-long event after the Expo closes this afternoon if you haven't already. All sessions will be archived for at least six months at www.mcknights.com/Expo2018. You just have to sign in — all free — to get access.)

One of the first things I learned was there's telemedicine and then there's telehealth, the latter of which does not always involve clinical services. No, we're not talking just some physician in a distant big city talking to you on some Skype-like (or Facetime-like) set-up.

There's synchronous, asynchronous, Remote Patient Monitoring (RPM), mHealth, eHealth, ePrescribing and more. Some involve video connections; some mean mobile medical devices are in play; some mean mobile communications are the key. Maybe there's a doctor involved, maybe there isn't.

This is a wide web, and it can have broad implications for resource-strapped long-term care providers. On one hand, it can bring physicians “in house,” when there aren't any for miles around (think rural facilities, or even a suburban one on a weekend).

However, this type of healthcare could struggle dealing with a fragile patient population, which often has special mental health considerations.

By the time Wein finished her presentation, however, we had learned the potential value of telehealth and all its implications, from better remote patient monitoring to self-care education, tele-mental health and more.

The big sticking point to much of this, or course, is payment. Medicare will pay for some kinds of healthcare information transmissions but not others. It also partially depends on where the healthcare professional is, or in some cases where the patient is. The details to keep track of are many and varied.

This year, Medicare covers approximately 48 services, using 97 codes, Wein told us. It looks so simple written here.

The good news is telehealth dovetails nicely with the “Triple Aim” goals of increasing access, increasing quality and decreasing costs. It could work well with value-based payment models.

The federal budget passed Feb. 9 appears to encourage more telehealth use, listing certain accommodations for Medicare Advantage plans, accountable care organizations, and Telestroke coverage, among others.

Last year — on May 19, in fact — the Congressional Telehealth Caucus was formed. The founding members were Reps. Diane Black (R-TN), Gregg Harper (R-MA), Mike Thompson (D-CA) and Peter Welch (D-VT). You might not always achieve great progress, but you've arrived when you get your own caucus created.

One of the main things coming out of Wein's presentation was that telehealth takes great care and planning to get it right. It has to fit into a strategic plan. As a provider, you must understand the technological needs, capabilities and implications.

Insurance and liability considerations must be taken into account. And if you can get commercial insurance into the picture, all the better because it's the most flexible payer out there, Wein noted. You better also be on your toes about coverage and payment parity. They're not the same thing.

Staff and supporting contractors must be ready and able to execute. Practically speaking, as a long-term care leader, you must aim to incorporate telehealth into existing workflows, not just add it on somewhere.

It's clear: Before one telehealths, must tele-prepare very well.

Follow Editor James M. Berklan @JimBerklan.


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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.

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