The TeleHealthe - Promoting TeleHealth through Information
Reimbursement for TeleHealth exists and is expanding constantly. Situations exist where traditional face to face medicine is simply not possible. Bringing speciality care to rural areas, delivering care to the homebound and providing post-care follow up can be greatly enhanced using TeleHealth solutions.
Due to the necessity of securing TeleHealth encounters, the growth of TeleMedicine has been slow. Voice and video chat software is readily accessible on the internet, however it rarely complies with the requirements for protected health information, rendering them invalid for TeleHealth applications. Proprietary systems are expensive, though many are vulnerable to compromise and intrusion. WebRTC changes all of that, since it requires no proprietary software or hardware, and inherently is immune from intrusion, eavesdropping or compromise. This makes WebRTC very attractive for TeleHealth solutions.
The Centers for Medicare and Medicaid Services in the US reimburses many services delivered via TeleHealth. As with any federally reimbursable service, eligibility requirements exist, but many services are reimbursable under medicare. The CMS in November of 2014 decided that medicare payments for TeleHealth services would increase by 0.8%, at the same time they debated cutting payments for other services.
The reimbursement strategy includes requirements for both approved "originating sites' (where the service originated from ) and approved "distant site practitioners" (who can deliver reimbursable services).
Generally, originating sites are:
Critical Access Hospitals
Rural Health Clinics (RHC)
Federally Qualified Health Centers (FQHC)
Hospital-based or CAH-based Renal
Dialysis Centers (including satellites
Skilled Nursing Facilities (SNF)
Community Mental Health Centers (CMHC)
Nurse practitioners (NP)
Physician assistants (PA)
Clinical nurse specialists (CNS)
Services that are reimbursable include::
Office or other outpatient visits
Psychiatric diagnostic interview examination
End-Stage Renal Disease (ESRD)-related services
Individual medical nutrition therapy
Neurobehavioral status examination
Follow-up inpatient telehealth consultations
A wide variety of services are covered in the States and fees are rising.
This makes TeleHealth an attractive option to improve healthcare delivery!
Edition #2, 24 June 2015
TeleHealth and the ambulatory surgical patient
In the the Journal of Telemedicine and Telecare (ref 1), the authors were able to realize both time and travel benefits for a group of pediatric surgical patients. In this study, the distance to the hospital was 330km, a substantial distance for the recently postoperative patient. Further, we can assume that often the same patient would not be able to operate a vehicle and many would need assistance to travel. The question then becomes is TeleHealth safe and will it be well received by the patient? A September 2013 study in JAMA Surgery (ref 2), looked at both complication rate and acceptance, for a group of 141 postoperative patients, who elected for TeleHealth in lieu of a visit to the clinic. This study showed that a Telehealth visit by an allied health professional can be safely and effectively used for postoperative care. There were no complications that resulted from the substitution of telehealth for a clinic visit, in this study. In this study, TeleHealth was performed via telephone. Therefore we do not know what impact, if any, the addition of video would have.
Areas for further study:
We wonder about the impact video would have on postoperative wound care. Patients often have wound care questions and anxieties, and uncommonly (thankfully) complications. Traditionally, providers must rely on telephone descriptions to determine the seriousness of the problem. Would HD visualization have an impact? Currently, this is unknown. However, mounting evidence does exist in the dermatology literature, to support further investigation in the use of TeleHealth in postoperative wound care.
In summary, there is evidence based literature demonstrating the benefits of TeleHealth in the surgical patient. The literature does not suggest that this methodology induces complications and it was well received in trials. Studies clearly demonstrate time savings and travel savings. This becomes very poignant for those at great distance, those for whom travel becomes honorous and those where travel is impossible. We certainly feel that additional studies are warranted, and attractive study possibilities truly exist.
Subjects requiring further investigation:
- Home Hospice
- The Elderly and those with disabilities and major barriers to travel
- Wound care
- Rural speciality care
2)JAMA Surg. 2013;148(9):823-827. doi:10.1001/jamasurg.2013.2672
Custom development for Better Patient Care
We have been very busy at SysNetx working with our customers and improving our service. We have learned that making our service more flexible allows us to serve our clients better. This seems intuitive, though we often must adjust our workflow, to conform with the workflow of our software.
At SysNetx, we wanted to improve upon that convention, so we have spent the last few months learning how to better serve our public.
Software as a service (SaaS explained) can be greatly improved if it can integrate with the customers native platform (website, intranet, DB, etc...).
SysNetx embraces this concept, and has developed an API to facilitate integration with our clients infrastructure. This service allows secure calls to be made from the customer to our platform, and in a seamless manner integrate both services for a better user experience. This is really nothing more than the classic "Two heads are better than one" wisdom. Your medical practice, your EMR system and your customer relationship management system (CRM) can all be easily integrated with SysNetx, for an improved experience. Our engineers and clinicians will work with your IT team to develop a cost-effective, secure and reliable integration that remains relevant for years to come. You get the same great SysNetx services, the same highly secure platform, and seamless integration with your system(s).
Features that our API delivers for you:
- Secure, seamless integration with your EMR, EHR, CRM, Website and more....
- "White Labeled" for your practice, company, institution, etc...
- Simplicity in upgrades, updates and maintenance
- Enormous flexibility to build the right solution for your workflow
SysNetx custom solutions deliver the great SysNetx service, Your Way!