[email protected] IMPLICATIONS FOR COST, QUALITY, AND ACCESS TO HEALTHCARE SHANNON C. SCOTT, DO HEALTH POLICY FELLOWSHIP 2012-2013 OSTEOPATHIC.

[email protected] IMPLICATIONS FOR COST, QUALITY, AND

ACCESS TO HEALTHCARE

SHANNON C. SCOTT, DOHEALTH POLICY FELLOWSHIP 2012-2013

OSTEOPATHIC FAMILY PHYSICIAN

Patient Access

The public wants access to e-health technology and the ability to communicate with their physicians via email.

2012 Harris Interactive Poll (n= 2,311)

E-Health Challenges

• Cost of health information technology (HIT)• Work load changes• Reimbursement• State licensing requirements• Quality of care issues• Safety and security of transmitted

information

What is E-Health?

• Over 50 different definitions– Creates health policy confusion

• Umbrella Term– Telemedicine– Telehealth– E-mail

• Synchronous (real-time) video, audio• Asynchronous (delayed-time) e-mail, text msg

Electronic Health Records By 2012, 72% of physicians have an EHR• 7% use email to communicate with

patients

EHR Costs:• Implementation and maintenance• Meaningful Use incentive programs

assist but do not reimburse. • As high as $80,000 over four years per

provider

Meaningful Use Stage 2 - Jan 2014• Requires “providers to use secure

e-mail with patients” to qualify for incentive payments

Reimbursement of E-health

• Limited in both private and federal programs

• In some states Medicaid pays for Telemedicine

• Private payer CPT 99444 exists– Many limitations to use of code

• Cost of health IT ≠ reimbursement

State Medical Licensing Issues

• Policies differ among states regarding e-health• Full license required to practice electronically– Limited to the state where the patient lives

• Unintended consequences– Expensive and time consuming to obtain multiple

state licenses– Decreased access to care– Proposal of national medical license

Security

• Increased physician and patient risk when using e-health on unencrypted sites.

• Un-secure Messages – Manipulated– Forwarded– Read by unintended recipients– Contain protected health information (PHI)

Three Pilot Projects

Group Health Cooperative

• 2003• “Shared Health Record”• Online medical records• Secure email messaging• 235,000 (54%) of eligible

adults accessed services• 1,055 physicians

engaged• 23% of their encounters

now occur via secure messaging

• Replaced 27% of office visits and 66% of telephone calls

Kaiser Permanente Experience

• 2004-2010• “Suite” online services• 2.3 million (64%)

members enrolled by 2010

• 7,000 physicians had received over 5.8 million secure messages

• 35,423 patients who used secure messaging had a reduction in office visits and an increase in health quality outcomes

Virtuwell/ HealthPartners Minnesota and Wisconsin

• 2010• Online health care

service• Medicare coverage• Accessed by 40,000

patients• Visits screened by nurse

practitioners via protocol

• $88 savings per visit• In-person office visits

were displaced by 90%• 94% patients satisfied

Pilot Project Feedback

• Critical to the success of each program included attention to provider work flow, reimbursement, and organization of the information transmitted electronically.

Access

Quality

Cost

Recommendations: Payment Reform• Traditional fee-for-service will not

support e-health. • Develop e-health business models for

private insurers.• Overhaul federal e-health incentive

programs.– The MU program designed to run

through 2016 should be lengthened instead of assessing penalties.

Recommendations: State Medical Licensing

• Develop uniform licensure rules among all states. • State medical licensing boards retain control of all

licensing fees and disciplinary regulation.• Integrate all medical licensure into a national database.

• Establish clear definitions among electronic health subsystems for policy making groups.

• Prevent telemedicine or e-health from being singled out as a medical specialty or granted special license.

Recommendations: Security

• Secure confidential information through a patient portal. – Adhere to HIPPA and AMA medico-legal guidelines.

• National policy making groups collaborate regarding security.

• Educate physicians through CME on E-health best practices.– Recommend clear practice policies regarding:

• Message response times• The amount of information transmitted electronically• Types of conditions treated with e-health technology

Well-designed e-health systems have the potential to increase physician efficiency, patient engagement, and

health outcomes.

The full potential of e-health is yet to be understood; virtually every patient could be

touched by this innovation.

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American College of Physicians. (2008). Center for Practice Improvement and Innovation: Communicating with Patients Electronically (Via Telephone, Email, & Web Sites). Accessed May, 2013, from: http://www.acponline.org/running_practice/technology/comm_electronic.pdf

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Bibliography, cont.Federation of State Medical Boards. (2012). Telemedicine Overview Board-by-Board Approach. Accessed June 2013, from Federation of State Medical Boards: http://www.fsmb.org/pdf/grpol_telemedicine_licensure.pdf

Courneya, P., et al. HealthPartner's ONline Clinic For Simple Conditions Delivers Savings of $88 Per Episode and High Patient Approval. Health Affairs, 2013; 32(2), 385-392.

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Federation of State Medical Boards. (2011). Telemedicine Conference: Balancing Access, Safety and Quality in a New Era of Telemedicine. Washington DC: Federation of State Medical Boards. Accessed June, 2013 from: http://www.fsmb.org/pdf/pub-symposium-telemed.pdf

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