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Televisits June 5, 2021 Charit Fares, MD System Medical Director – Virtual Hospital Medicine

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Televisits June 5, 2021 Charit Fares, MD System Medical Director – Virtual Hospital Medicine Gulf States Hospital Medicine Conference Televisits June 5, 2021 Charit Fares, MD System Medical Director – Virtual Hospital Medicine 1 Agenda • History of Telemedicine & Definitions • Modalities of Telehealth • Covid-19 Transformation • Tele-hospital medicine • The Verdict • Challenges • Hybrid Model • Plan for Future Implementation • Future Goals 2 Telemedicine Timeline & History 1924 “Teledactyl” – Dr. 2014 Gernsback 1970’s eVisit launched. envisioned a tool • The federal government 1999 Created a platform with robotic funded a range of telemed Medicare began that allowed fingers & a programs. reimbursing for providers to securely projected video • NASA tested video for telehealth services. videochat with feed to examine telemed. patients anywhere, patient from afar. anytime. 1876 1950’s 1989 Telephone is • Medical personnel 2000’s 2020 • First patient Invented. 1897 introduced 1993 • Videochat Projected to a successfully article in the examinations with Creation of the (Skype) programs $34 billion defibrillated by Lancet talked close-circuit TV American and apps industry. telephone. about utilizing link to conduct Telemedicine developed. Medicare • Web expands the telephone psychiatric Association (ATA) • Telemed is used expands access. telemed. to avoid office consults. to stimulate • First visits. business in the international industry. telemed project commenced. 3 Similarities • Used interchangeably by the WHO and ATA (American Telemedicine Association) • Two-way, real time interaction between patient and provider at a distant site that includes audio and visual Telemedicine equipment. • They both describe the use of telecom technology to vs support: Telehealth • Clinical Health Care • Health Related Education • Health Administration Similar, but Different Differences • Telemedicine • Refers to provision of clinical services remotely • Telehealth • Clinical plus non-clinical services, e.g provider training, CME, and administrative meetings 4 Interchangeable Terminology Telehealth Enhancing ✓ Health Care ✓ Public Health ✓ Health Education Telemedicine 5 Modalities of Telehealth 6 But…… •Despite the rise of telestroke and telepsychiatry in the 1960s with closed circuit television, telemedicine still saw a slow growth although it was flexible, and technology was rapidly advancing 7 March 2020 1 Impetus for Change • Covid-19 → Tremendous burden on the US healthcare infrastructure • Social distancing and stay at home mandates provided a greater opportunity for telehealth → rebirth of telehealth • Numerous patients had their first virtual visit during the pandemic • During Q1 of 2020, there was a 154% increase in virtual visits compared to the same period in 2019 • PCP, specialist, new specialists, telepsychiatry, telestroke, teleradiology, and ER 9 Telehospital Medicine Telenocturnists No day telehospital Day programs were Programs were well medicine programs outpatient and established nationally inpatient consults nationally (telestroke, telepsychiatry, eICU) HM Adoption CMS wavers and Nationally HIPAA leniencies 10 Lack of Access to Quality Care Timeliness of Care Concern Cost Savings Hospital Medicine Capacity Management Staffing Shortages Provider Burnout Solution Public Health Emergencies 11 ATA Statement Studies have consistently shown that the quality of healthcare services delivered via telemedicine is as good as that provided by traditional in-person consultations. 12 Business Case for Action Business Outcomes • Better management of HM provider capacity during high-census and disaster response, as well as optimizing a provider float pool • Decreased costs for Hospital Medicine through flexible staffing solutions • Updated workflows to maximize efficiency and patient experience • Improved throughput management by decreased length of stay and a more efficient discharge process Human Objectives • Improved patient experience • Opportunities for multidisciplinary rounding • Decreased burnout • Protect all staff from unnecessary infectious risk 13 Impact of Doing Nothing • Lack of response options for emergencies/crisis where telemedicine is vital for success • Continued inefficiencies with throughput and staffing resulting in loss of revenue and increased expenses • Missed opportunity to coordinate key players for an effective and safe patient discharge 14 15 EMR Development 16 EMR Development 17 Virtual Inpatient Workflow The following Tele-presenter Provider calls Consult placed day, virtual to assist with telemedicine by in-patient provider works patient virtual Virtual provider with tele-presenter device via provider to visit to verify reviews consult to determine time Vidyo to virtual hospital patient for visit and conduct virtual medicine understands confirm device to visit call plan of care** **If patient starts to decompensate, the virtual provider will follow site Rapid Response/Code Blue process. Virtual provider hands-off to on-site provider. 18 Physical Exam • Document what you see • Utilize vitals from monitors • Patient assistance • Nursing / Telepresenter assistance 19 Clinical Guidance COVID Criteria: Exclusion Criteria: • < or = to 4L of O2 • High Risk of Clinical Deterioration • Improving fever curve • MEWS score >5 • Able to interact with audiovisual technology Potential Patients: • Preferably English speaking for now (until we have a • Pancreatitis; RANSON <3, BISAP ≤2 better means of how to involve the translation services) • Alcohol or other drug withdrawal conditions; CIWA score <8 General Med Criteria: • PE / DVT low to intermediate risk; PESI score of 0 or 1 • Medically ready to discharge but with existing discharge • MDR infections on contact precautions barriers • Waiting for surgery or other procedures and stable 20 Virtual Hospital Medicine Program (VHM)) Ochsner Main Campus Ochsner Baptist Ochsner Kenner Ochsner St. Charles Parish Ochsner Northshore Ochsner Westbank Ochsner Hancock → Tele- nocturnist program Ochsner Medical Center Iberville → Tele-observation Program 21 Transcend Geographical Barriers 22 VHM Daytime Program Encounters (April - June 2020) Hospital Medicine Tele-Service Encounters April May June TOTALS TELE VISITS Total Visits* 573 730 428 1731 # Re-admits -- -- -- 2 # Dropped before discharge 5 2 2 9 TELE NOTES avg per patient 7.3 5.8 4.3 5.8 min per patient 1 1 1 1 max per patient 22 25 32 26 23 VHM Daytime Program Encounters (February -April 2021) 24 VHM Iberville Virtual Observation Volume (Jan - April 2021) Monthly Consult Volume 3 2 2 2 2 Jan Feb Mar 1 1 Apr 0 Ochsner - Iberville 25 The Verdict What Patients Say What Providers Say Offloading Stress Quality of life / New and valve reduction burnout innovative Time savings Faster Cost savings Convenience of Exciting career and convenience working remotely opportunity Safety Better access 26 Telemed Challenges Requires Technology Some Feel It’s Sometimes Requires a & Cybersecurity Impersonal Telepresenter Reimbursement Regulatory Barriers 27 Reimbursement - Increased Scrutiny • Medicare Payment Advisory Commission (MedPAC) • Quality of telehealth services • Is it improving health and safety • Quality of hybrid model • Access, rural communities, disabled, minorities • Increased cost to Medicare • Increase potential for fraud and waste • Are providers using it to reap reimbursement than they should not • The Government Accountability Office (GAO) states the full effect of the CMS wavers on telehealth coverage is not fully well known at this point and more studies are needed 28 Reimbursement • Telehealth Modernization Act introduced in the Senate in February 2021 • Extends certain flexibilities during the initial public health emergency (PHE) • Originating site (patient site) and distant site (provider location) • All types of providers to utilize telehealth • Payment parity for primary care and chronic diseases in several states 29 Reimbursement Telehealth will remain a permanent fixture after the PHE CMS to permanently expand more than 60 services that will be added to the Medicare telehealth list Reimbursed at the same rate as in-person CMS previously limited telehealth to rural areas designated as Health Professional Shortage Areas (HPSAs) 30 Reimbursement - Sustainability • Review current compliance plans • Coding and billing procedures • Provider education • Services are not billable • Moonlighting and Locums mitigation 31 Cybersecurity • Not an IT issue • It’s an organization issue • Risk and reputation • Increased patient expectation to use telehealth • Increased HIPAA regulations and enforcement • Be prepared. Be resilient. 32 Robots Will Not Replace Us • Will not replace in-person providers • Not appropriate for every patient • Not a career preference for providers 33 Hybrid Concept • Blend of in-person and virtual interactions weaved into the fabric of how we deliver care and create new pathways In-person Virtual Hybrid Medicine 34 What Telemedicine Is… Adjunct Augment Support 35 Plan of Action for the Future • What problem(s) are we trying to solve? • What patient outcomes need improving? • What revenue opportunity can we impact? • Stay well-informed and be data driven • Focus in on business strategy then the technology will be found • Engage leadership and key stakeholders early 36 Solution in the Changing Healthcare Landscape • Shift from Fee-For-Service to Value-Based Care in an environment of growing physician shortages compounded by increased patient needs and acuity • Better quality of care yet more cost effective Telemedicine 37 Future Goals METRICS DEVELOP / DEFINE ROBUST CLINICAL TECHNOLOGY LANGUAGE
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