HHS Telemedicine Hack Hack_Office Hours 2_vf1... · 2020. 8. 12. · Saving Lives. Protecting Americans. 4 “HHS Telemedicine Hack” Data Use • Project ECHO® collects registration,

HHS Telemedicine Hack

Week 4: Office Hours #2

August 12, 2020

2Saving Lives. Protecting Americans.

Welcome to Telemedicine (TM) Hack!

• 10-week learning community to accelerate telemedicine implementation for ambulatory care providers

• Peer-to-peer learning

Case studies and discussion boards

Modeled after CMS-led learning collaboratives (e.g., Transforming Clinical Practice Initiative)

• Inclusive and diverse

All ambulatory care providers invited to participate

• Designed as 10-week sprint

Urgency due to public health need

Optimize telemedicine readiness in anticipation of fall COVID-19 surge

GOAL: At least 90% of participants will have conducted and billed 1 or more

video-based telemedicine visits by September 30, 2020

3Saving Lives. Protecting Americans.

“HHS Telemedicine Hack” Curriculum

Session #1: Telemedicine– Where Do I Start?

July 22nd, 12-1PM ET

Session #2: Workflows & Documentation

August 5th, 12-1PM ET

Session #3: Overview of Telehealth Billing & Reimbursement Policies

August 19th, 12-1PM ET

Session #4: Clinical Best Practices & the Art of the Tele-Physical Exam

September 2nd, 12-1PM ET

Session #5: The New Normal– Making Telemedicine Part of Your Permanent Practice

September 16th, 12-1PM ET

You are here

Office Hours # 1July 29th, 12-1PM ET

Office Hours # 2August 12th, 12-1PM ET

Office Hours # 3August 26th, 12-1PM ET

Office Hours # 4September 9th, 12-1PM ET

Office Hours # 5September 23rd, 12-1PM ET

GOALAt least 90% of participants will have conducted and billed 1 or more video-based telemedicine visits by

September 30, 2020

4Saving Lives. Protecting Americans.

“HHS Telemedicine Hack” Data Use

• Project ECHO® collects registration, participation, questions/answers, chat comments, and poll responses for this program

and shares this data with HHS/ASPR. Your individual data will be kept confidential. These data may be used for reports,

maps, communications, surveys, quality assurance, evaluation, research, and to inform new initiatives

5Saving Lives. Protecting Americans.

Logistics

• Use Q&A function on Zoom for questions and comments for speakers

• Use Chat function on Zoom for technical/logistical issues

• This session is being recorded. Your attendance is consent to be recorded.

• CME/Continuing Professional Development (CPD) credits—Link is in today’s Project ECHO email announcement and will also

be placed in the Chat at end of session.

6Saving Lives. Protecting Americans.

How to Ask Questions on TM Hack

• Please be as specific as possible—More details, the better!

• Information that will help facilitate answering your question include:

Specific state where the patient is located

Where the telehealth interaction is taking place

Where the provider is located

Type of provider (e.g., hospital, FQHC, solo practitioner, nurse, PT/OT)

For billing/reimbursement issues, please include if you are asking about Medicare, Medicaid, or private payer

• Please post additional questions to the TRAIN discussion boards

TRC staff will review discussion boards periodically; Answers available to entire TM Hack community

7Saving Lives. Protecting Americans.

Today’s Agenda

• Case #1: Three’s Company: Adding More People and Value to Virtual Visits– Kyle Knierim, UCHealth, Denver, CO (10 min)

Q&A Follow-up (5 min)

• Ask Our Panelists Your Workflow Questions (35 min) – Moderated by Dr. Christian Ramers. Panelists are:

David Dansereau, MSPT — Member Expert, Digital Medicine Society

Tollie Elliott, Sr., MD — Chief Medical Officer, Mary’s Center

Kyle Knierim, MD — Associate Director of Practice Transformation, UCHealth

Dara Koppelman, RN, MHSA — Chief Nursing Officer, Mary’s Center

Elizabeth Krupinski, PhD, FSPIE, FSIIM, FATA, FAIMBE — Co-Director, Southwest Telehealth Resource Center

Fay MacDonnell — Senior Workflow Engineer, OCHIN and California Telehealth Resource Center

Tabassum Salam, MD, MBA, FACP — VP, Medical Education, American College of Physicians

John Scott, MD, MSc, FIDSA — Medical Director of Digital Health, UW Medicine

Eric Shah, MD, MBA— Director, Gastrointestinal Motility, Esophageal, and Swallowing Disorders Center, Dartmouth-Hitchcock Health

Leah Shoval, BSN, RN, IBCLC — Director of Care Coordination, Mary’s Center

Two TRC staff—Rebecca Picasso (California TRC) and Andrew Solomon (Northeast TRC)—will answer questions in Q&A box that are not posed to the panel.

Three’s CompanyTelehealth Experience at the University of Colorado Department of Family Medicine

Kyle Knierim, MD

Associate Director Practice Innovation Program @ CU

August 12, 2020

University of Colorado DFM Clinics

5 Clinics Spread Across Denver Metro Area• CU School of Medicine clinics affiliated with

UCHealth, a nonprofit network of hospitals, provider groups and facilities in Colorado, Nebraska and Wyoming

• All NCQA Level 3 recognized, CPC+• Integrated Care Team• Faculty Physicians: 62• NP: 4, PA: 2• FM Residents: 18• RN’s, tele-psychiatry, embedded psychology, clinical

pharmacists, SW, care managers, QI coaches at each site, tele-legal coming this fall.

• MA: 2.5 MA:1 provider (ideal state)

• Platforms: Epic EHR; Vidyo integration; Doximityvideo and phone as backup

Virtual Care Maintained Patient Access and Primary Care Volume During Pandemic

>99% of all visits were in person in October 2019 >73% of all

visits were Virtual in April 2020

59 61 71 96 69

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12106

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3615

6657

7371

12165

958910194

11004

9692

8398

7215

8353

986010238

Oct Nov Dec Jan Feb Mar Apr May Jun Jul

2019 2020

Virtual Visits In Person Visits Total Visits

Timeline of DFM Clinic’s Virtual Visit Expansion

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Oct Nov Dec Jan Feb Mar Apr

2019 2020

DA

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Patient Line Schedules First Virtual Visits (3/18)

Residents & BH fully remote, faculty “Crop Rotations” Begin (3/20)

Pilots of fully remote primary care sessions (Dec 2019)

DFM Virtual Visit Champions Start (10/1)

Prework (Before Sept 2019) • Local Technical Training• Initial equipment purchases• Vidyo-Epic integrations• Early adopters pilot virtual visits

Online Scheduling of Virtual Visits via MHC (4/9)

DFM virtual visit training developed (Jan 2020)

Relatively well prepared by February

26%29%

39%

49%54%

99% 100%

13% 13% 13% 13% 13%

0% 0% 0% 0% 0%0%

10%

20%

30%

40%

50%

60%

70%

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100%

OCT NOV DEC JAN FEB MAR APR

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Medical Providers BH Providers GME • DFM focused attention to Virtual Visits began in October 2019

• 54% of medical providers in DFM clinics had experience with virtual visits by February 2020

• 99% of all 75 medical, behavioral health and GME providers had done virtual visits within 2 weeks of COVID disruptions

Common scenarios with 3+ people

1. 3+ participants for the whole visit• “In room” scribing• Interpreter services• Support for patients with disabilities• Extra family members or caregivers

2. The Warm Handoff • Tele-psychiatry co-consults• On-demand Behavioral Health• Clinical pharmacy

3. Supervising Trainees • Family Medicine residents• Psychology interns and externs

4. Virtual group visits• Advance Care Planning• Centering Pregnancy• Group counseling using Health and Behavior codes

Common scenarios with 3+ people

1. 3+ participants for the whole visit• “In room” scribing• Interpreter services• Support for patients with disabilities• Extra family members or caregivers

2. The Warm Handoff • Tele-psychiatry co-consults• On-demand Behavioral Health• Clinical pharmacy

3. Supervising Trainees • Family Medicine residents• Psychology interns and externs

4. Virtual group visits• Advance Care Planning• Centering Pregnancy• Group counseling using Health and Behavior codes

The Basics Elements

1. Pick telehealth platforms that allow for 5+ users to join simultaneously

2. Make Access Consistent and Easy

• Preferred: EHR + Portal Integration

• Link to virtual room automatically generated for certain visit types

• Care team enters room using link accessed in EHR on their computer or mobile app

• Patients access link from their secure patient portal account

• Back up: Stand alone Platform

• Virtual room created on the fly using Doximity

• Link is sent to both patient and care team via text

• Special (rare) cases:

• HIPAA-compliant versions of MS Teams or Zoom used for large group virtual visits

3. Prepare, practice, tweak, repeat.

Approach Pros Cons

EHR + Patient Portal Integration

• One login for care teams• Synchronized e-Checkin with consents,

insurance verification, co-pay collection, etc.• More time to share link• Promotes use of portal for its other features

(self-scheduling, med refills, results, etc.)

• Extra steps = more chances for things to go wrong (email address, portal account, proxy access for caregivers/parents, navigation, Vidyo bugs, etc.)

Stand alone Platform

• Patient: Simple. Just need a smartphone and click on a link.

• Provider: Create virtual room in <30 sec., share with others quickly.

• Nice back up before resorting to phone-only visit.

• Consents and other compliance items handled separately.

• Outside of normal EHR workflows

Details on Specific Scenarios - Interpreters

Ideal

• Contracted with 3rd party interpretation company; interpreters given EHR access

• Interpreter scheduled to join virtual room at the same time as the patient

• Currently set up for two common languages: American Sign Language and Spanish, expansion underway to other languages

Work Arounds

• Securely send virtual room link to interpreter on the fly (best/hardest)

• Provider & patient on video, interpreter on speaker phone (clunky)

• 3-way telephone call without video (easiest)

Details on Specific Scenarios – Warm Handoff with Behavioral Health Provider (BHP)

Ideal

• BH team creates on-demand schedule giving a BHP few, if any, scheduled visits. Staff and medical providers reminded of on-demand BHP prior to each session.

• Medical provider explains rationale for engaging BHP, sends secure chat to BHP giving brief sketch of the patient’s needs.

• BHP joins room, medical provider introduces BHP and either stays for co-visit or leaves room to see next patient

Work Arounds

• BHP tied up at the moment: BHP replies in chat and communicates a time to call patient later in the day. Medical provider informs patient of the plan.

• No BHP scheduled at the time (night, weekend, etc): provider puts in referral and patient schedules a 1:1 visit with BHP at a future date.

Common scenarios with 3+ people

1. 3+ participants for the whole visit• “In room” scribing• Interpreter services• Support for patients with disabilities• Extra family members or caregivers

2. The Warm Handoff • Tele-psychiatry co-consults• On-demand Behavioral Health• Clinical pharmacy

3. Supervising Trainees • Family Medicine residents• Psychology interns and externs

4. Virtual group visits• Advance Care Planning• Centering Pregnancy• Group counseling using Health and Behavior codes

My telemedicine lifehack is . . .

Over-prepare your team.

[email protected]

21Saving Lives. Protecting Americans.

Your Telemedicine Questions,

Answered

Please submit your questions through the Q&A box

22Saving Lives. Protecting Americans.

TRAIN is Your One-Stop Shop for TM Hack Resources

• Visit www.train.org

Login if you have an account, or create an account if you don’t have one

• To access discussion boards, slides, and recordings

Click on “Your Profile” (under Your Name on the top right) to access the “Manage Groups” screen

Enter “TMHACK” under “Join by Group Code”

Save your profile and then click the Discussions tab

Click here for a TRAIN User Guide with step-by-step instructions

• Other TRAIN benefits

HHS training certificate, if you complete 8/10 TM Hack sessions

Access to other trainings, including COVID-19 resources

23Saving Lives. Protecting Americans.

TRAIN Discussion Boards

• Discussion Boards (n=11)

8 topical boards

Getting Started in Telemedicine (Week 1)

Workflows & Integration (Week 3)

Regulations, Compliance, and Documentation (Weeks 3 & 5)

Billing Policy, Coding, and Reimbursements (Week 5)

Scaling Up & Sustainability (Week 9)

Equitable Access

Miscellaneous

Technology

Specialty Connect

Slides, Recordings, and Session Materials

Telehealth Resource Centers (TRCs)

24Saving Lives. Protecting Americans.

TM Hack Updates

• TRC Picks—Frequently Used Telehealth Resources

• Midpoint survey

To be conducted after next week’s session

Healthcare providers and non-healthcare providers will both be able to complete survey

• Save-the-Date—“Bonus Hack” on Tele-behavioral health (Thu, Sept 3, Noon-1 PM ET)

Separate invite and registration from main TM Hack series

25Saving Lives. Protecting Americans.

Billing and Reimbursement

• #1 “pressing need” of TM Hack registrants (~20%)

• Next week’s session (Week 5—“Overview of Telehealth Billing and Reimbursement Policies”)

Many factors impact what is reimbursed and how to bill for services provided

This session will provide an overview of some of those factors and how they impact telehealth billing and

reimbursement policies for Medicare, Medicaid and commercial payers in the time of COVID-19

• Week 6—Office Hours #3

26Saving Lives. Protecting Americans.

“HHS Telemedicine Hack” Curriculum

Session #1: Telemedicine– Where Do I Start?

July 22nd, 12-1PM ET

Session #2: Workflows & Documentation

August 5th, 12-1PM ET

Session #3: Overview of Telehealth Billing & Reimbursement Policies

August 19th, 12-1PM ET

Session #4: Clinical Best Practices & the Art of the Tele-Physical Exam

September 2nd, 12-1PM ET

Session #5: The New Normal– Making Telemedicine Part of Your Permanent Practice

September 16th, 12-1PM ET

You are here

Office Hours # 1July 29th, 12-1PM ET

Office Hours # 2August 12th, 12-1PM ET

Office Hours # 3August 26th, 12-1PM ET

Office Hours # 4September 9th, 12-1PM ET

Office Hours # 5September 23rd, 12-1PM ET

GOALAt least 90% of participants will have conducted and billed 1 or more video-based telemedicine visits by

September 30, 2020

27Saving Lives. Protecting Americans.

See One, Do One, Teach One

[email protected]

(Use this email to

reach TM Hack

organizers directly)

28Saving Lives. Protecting Americans.

TRC Picks—Frequently Used Telehealth Resources

• Telehealth COVID-19 Policies—Federal and State

• State Medicaid Telehealth Policies

• How to Select Technology–TTAC Tool Kits

• What to Expect in a Telehealth Visit (for patients)

• Telehealth Implementation Checklist

• FDA Medical Devices Fact Sheet