Davia Smith

-David Craig, MD

Welcome to the second half of our series on MACRA! We’re going to spend this whole post on what MACRA means for telehealth, so if you need to catch up on the basics of what the new law is and what it means for Medicare reimbursement in general, please check out part one first and then meet me back here.

If you’re already up to speed on MACRA 101, though, and you’re ready for a nitty-gritty deep-dive on what the new legislation might mean for telehealth and especially for telehealth reimbursement, then let’s get started.

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–Springs Memorial Hospital

(October 6, 2016) —Springs Memorial Hospital will soon launch a critical care telemedicine program to enhance care for patients in the intensive and critical care units (ICU and CCU) of the hospital. This new service will build upon the quality patient care now delivered by hospitalists, pulmonologists, specialists and nurses in the Springs Memorial ICU and CCU.

On October 11, 2016 at 1:30 p.m., the hospital will Go Live with this extra layer of care in which highly trained intensivist physicians and critical care specialists support care 24 hours a day, 7 days a week using telecommunication and other technologies. With this new service, Springs will enhance patient safety while also meeting a best practice standard to have intensivist physicians monitoring ICU patients around the clock.

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–Healthcare IT News

Democratic Presidential Candidate Hillary Clinton posted her plans for mental health care on August 29 with a focus on harnessing information technologies to bolster care coordination.

Clinton said she would adjust payment systems in Medicare, Medicaid, and under the Public Health Service Act to allow for reimbursement of telepsychiatry and other telehealth services delivered through primary care and hospital settings.

“We’ve got to break through and break down the stigma and shame,” Clinton said. “We’ve got to make clear that mental health is not a personal failing. Right now it’s our country which is failing people with mental health issues.”

Her plan also calls for increasing research into brain and behavioral science, including work on PTSD traumatic brain injury; developing new links with private and nonprofit sectors; and brain and behavioral science research based on open data. Clinton also promised to direct federal agencies to study suicide and how to prevent it. Her plan also calls for training law enforcement officers to recognize and relate with people who have a mental illness.

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—Submitted by Jim Allen, MPH, MSW, LMSW

Palmetto Care Connections was recently awarded $158,224 by the US Department of Agriculture Distance Learning & Telemedicine Grant Program.  The Medical University of South Carolina (MUSC) Center for Telehealth pledged a 100 percent cash match of $158,224 for a total amount of $316,448.  In addition MUSC pledged an in-kind match of $12,000 to assist with project implementation. Low Country Health Care System will provide primary health care services to school children in Allendale and Barnwell Counties.

This project seeks to establish school-based telehealth availability in three underserved counties, Allendale, Bamberg, and Barnwell, in South Carolina.  School-based clinics have been shown to increase health access to rural children, decreased emergency room visits, decrease absenteeism, improve chronic disease management and improve academic performance.  The application of telehealth allows the services to be delivered in rural areas and smaller schools without the sustainability barriers otherwise necessitating large, urban schools.   Acute sick care and chronic disease management is delivered in the school setting via a telehealth connection between the healthcare provider and the school nurse.  Telehealth equipment incorporates real-time video conferencing with examination capabilities.  Importantly, the model to be employed with this effort emphasizes the use of local providers as telehealth providers or care coordinating entities. Anticipated benefits include reduced emergency room visits, reduced missed work days for parents, increased access to healthcare for children, decreased absenteeism and tardiness for students, and educational achievement.

The MUSC Center for Telehealth has budgeted to expand its school-based telehealth program to a total of 40 schools. The following school districts are currently participating in the program: Charleston County School District, Williamsburg County School District, Sumter School District, and one school in Bamberg School District 1.  Allendale County School District, Bamberg School District 2, and the three Barnwell County School Districts are out of the designated catchment area for their expansion plan. This grant will enable the school-based telehealth program to expand to a total of 19 schools in Allendale County School District, Bamberg School Districts 1 & 2, and Barnwell County School Districts 19, 29 & 45.

For the school districts in the three counties, we will have three providers that will be able to offer services to all 19 schools.  Participating hub sites include Low Country Health Care System, MUSC and Allendale County Hospital. There will be 6,474 school-aged children eligible to benefit from this program by increasing access to high-quality health care. Equipment for end users (schools) will include Avizia 300 carts with a horus scope (exam camera and otoscope), and the Think Lab Stethoscope which will be used in the nurse’s offices. Equipment for the hub sites (primary care providers) includes a laptop with Jabber licensure, and high-quality head phones. For more information about this innovative program, please contact Trayce Shanks, RN, Telehealth Liaison, at [email protected] or Elana Wells, MPH, Program Manager, MUSC School-Based Health Center for Telehealth, at [email protected].

–The Post and Courier, Derrek Asberry

“The Medical University of South Carolina and the state Department of Corrections are teaming up to provide telehealth services to inmates in four South Carolina prisons.

Using the service, a doctor in Charleston can consult with the care team at a prison any time of day via video conferencing equipment. Then, the doctor can remotely prescribe medications, treatments and procedures that prison officials can implement for the inmate.”

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–mHealth Intelligence

Today’s healthcare ecosystem is filled with references to and examples of telemedicine and telehealth – in some cases, the two terms are used interchangeably. Whether they mean the same thing is a topic of considerable debate.

In general terms, telemedicine is considered the clinical application of technology, while telehealth encompasses a broader, consumer-facing approach – “a collection of means or methods, not a speci­fic clinical service, to enhance care delivery and education,” according to the federal network of telehealth resource centers.

“While ‘telemedicine’ has been more commonly used in the past, ‘telehealth’ is a more universal term for the current broad array of applications in the ­field,” the TRC network states in its online resource guide. “Its use crosses most health service disciplines, including dentistry, counseling, physical therapy and home health, and many other domains. Further, telehealth practice has expanded beyond traditional diagnostic and monitoring activities to include consumer and professional education. Note that while a connection exists between health information technology (HIT), health information exchange (HIE) and telehealth, neither HIE nor HIT are considered to be telehealth.”

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–Greenville Online

Greenville Health System patients with minor ailments will soon be able to access a remote health care provider using technology instead of going to the doctor.

With SmartExams, established patients contact a service and provide their symptoms while a nurse practitioner or physician assistant calls them back to discuss a diagnosis and treatment plan.

SmartExams, which launches April 4, is one of several telehealth services popping up around the country in response to consumers who are looking for more convenient care in their busy lives and as the physician shortage makes it increasingly difficult to get a timely appointment with a doctor.

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