mom, maternity, & monitoring

Mom, Maternity, & MonitoringPerinatal Telemedicine

DEXTER M. PAGE, MD, FACOGATLANTA PERINATAL ASSOCIATES

PAGEMED, LLC

OBJECTIVESWhy there is a need?Challenges AdvantagesPossibilitiesPerinatal assessmentScope of service

Why a NEED – DisparitiesAPA experience

Access QualityGeographyContinuityMorbidityPreventionAwareness

Why Bother?

Infant mortality rates 10% higher

Rural child death rate (ages 1-14) 29% higher

Poverty rate 58% higher

Percent of population living in poverty is higher

Percent of the population that is uninsured is higher

Receiving inadequate prenatal care (<or =4 physician visits) 47% higher

Cancer death rate 33% higher

Deaths from motor vehicle accidents 68% higher

Educational levels < ninth grade are two times higher

Why Bother?

“Cure” Growing Needs

Inadequate Prenatal care late or infrequent

Rural neglect minimizing the travel physician back-up/support

Stopgap - Provider shortagesEncourage partnershipsEscalating costsIncreasing demand for care

Quality Deficiencies

Experts - 200 MFM graduates nationally

2/year in GA

Marginalized care does not = managed care

Outdated tools

Infant Mortality Rate Critical measure of access to healthcare services

Georgia ranks 48th in the nationRate in rural counties is 11.4/1,000Infant mortality rates are 10% higherRate in 10.1/1,000 in urban countiesRural child death rate (ages 1-14) is 29%

higherWithout adequate medical infrastructure 33%

higher infant mortality

GOALS Decrease the Disparity in Infant Mortality

Objective 1: Decrease African American infant mortality rate

Objective 2: Increase first trimester initiation of prenatal care among African American women

Objective 3: Decrease the percent of Low Birth Weight (LBW), Very Low Birth Weight (VLBW) African American

Baseline of 15.5 to 13.0 per thousand live births by 5/31/14

Baseline of 85.2% in 2004-2006 to 87.0% by 5/31/14

Baseline to LBW = 10.3% and VLBW = 2.5 % of live births by 5/31/14.

Balancing the Scales

Long appt wait times

Limited resourcesOutdatedPatient anxietyConsolidationRegionalization

ConveniencePatient-friendlyTechnologyReal-time resultsCost-saving

measuresProvider efficiencyAccuracyTimeliness Patient compliance

Rural Healthcare Core problems facing rural health care providers

Declining population

High percentage of the elderly

Poorer health status indicators

Retaining medical and administrative staff

Maintaining sufficient inpatient occupancy and outpatient volume to cover costs

Inability to achieve economies of scale

Difficulty securing capital to renovate old physical structures and to replace outdated medical equipment

High percentage of Medicare/Medicaid and indigent/CHARITY

Rural Healthcare Core problems facing rural health care providers

Lack of planningInability to adaptProblems can be traced to Medicare and

other third party payment practices, including managed care

Result Providers’ inability to shift costsChanges in reimbursement have decreased

LOSShift resulted in more outpatient treatment

Rural Healthcare Core problems facing rural health care providers

ChallengesLead a horse to water….

InfrastructureNot a real “Trekkie”Cost of equipmentRegulatory concernsReimbursement issuesLack of standardizationReimbursementCredentialing of ProvidersHigh administrative costInteractive video

PerinatologistDefinition of a Subspecialist in MFM Is a subspecialist in obstetrics and gynecologyBy virtue of additional education

cares forprovides consultationwomen with complications of pregnancy

Requires advanced knowledge of complications of pregnancyObstetricalMedicalSurgical

The effects on both the mother and the fetusRequires expertise in the most current approaches to

diagnosis and treatment of women with complicated pregnanciespractice in a setting in which such modalities are available.

Perinatal ServicesH&PCounselingGeneticImagingLab interpretationShare infoManage the Risks, AND Transfer liability

Active Assessments

Fetal well-beingPTLCervical compromiseGlucose monitoringFetal developmentFetal arrhythmia

Advantages

Face to faceAccurateCoordinate proper referralsManage, Diagnose Image, MonitorPatient/Provider satisfactionDecreased LOS Reduced anxietyIncreased compliance

Telemedicine AdvantagesProviding immediate access to specialty consultation

Retaining the patient at the rural community hospital

Reducing delays in providing acute careMaintaining continuity of care with the patient’s

primary care physicianProviding effective continuing medical education

(distance learning)Expanding medical capability as well as the ability to

supervise non-physician healthcare personnelDecreasing healthcare costs.

Telemedicine Advantages

Providers want to reside in/near metropolitan areasRemove the feel of isolation from the medical

communityMost of the population in the rural areas are

Medicare/Medicaid recipients and/or are uninsuredThere are fewer opportunities for on-call coverage and

time offRural docs work longer hours for same $$ urban MDsState-of-the-art equipment and technologies are often

unavailablePatient referrals and transportation in emergency

cases may be difficult

Requirementslive or interactive;

Service provided through the use of camera, video, or audio conference equipment on a real-time basis

store-and-forwardtransferring information by sound, images, or images

on videotapemust be provided through the transference of

digital images between locationsallow quality consultation to referring provider

obtain information analyze report back diagnosis and management

Challenges

Perception AcceptanceComplianceLack of understandingBuy-inReimbursementDocumentation

Pregnancy complications

Prenatal diagnosisAmniocentesis CVS

PTL concernsRPLMultiplesFetal anomalies

Pregnancy complications

Maternal medical conditions

Teratogenic concerns

Counseling

Procedures

2nd opinion

Build relationships

help local providers detect and manage maternal and fetal

complications congenital anomalies, oligohydramnios or polyhydramnios, maternal medical disorders

diabetes, hypertension autoimmune disorders

Build Relationships

HospitalsCommunity centersOB/GYNFamiliesReferrals

Telemedicine Services

Ultrasound Level I, Complete: Interpretation (Store & Forward) CPT: 76801, 76802,

76805, 76810 Level II, Detailed Complete: Interpretation (Store & Forward) CPT: 76811,

76812 Transvaginal Ultrasound: Interpretation (Store & Forward) CPT: 76817 Follow-Up (Single item or AFI): Interpretation (Store & Forward) CPT:

76816 Limited Ultrasound: Interpretation (Store & Forward) CPT: 76815 Nuchal Translucency: Physician to co-sign with certified sonographer

CPT: 76813 Real time/online participation of Perinatologist for all ultrasounds can be

scheduled in advance. CPT 76811, 76812, 76817 For all ultrasounds, the remote site will bill for the technical/facility

component, and the referral site will bill for the professional component.

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