Targeted Opportunities For Telemedicine In Medicare Programs

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Targeted Opportunities For Telemedicine In
Medicare Programs

• James M. Jorling
• Powers Pyles Sutter Verville, P.C.
• Washington, D.C.
• 202/349-4257
• james.jorling_at_ppsv.com

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Targeted Opportunities ForTelemedicine In
Medicare Programs

• Medicare Services Using Tele-Health/Remote
  Services
• Tele-health Within Traditional Part B Medicare
• Services
• An Example Independent Diagnostic Testing
  Facilities (IDTF)
• Non-Traditional Medicare Services
• Disease Management Services An Emerging
  Opportunity

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Targeted Opportunities ForTelemedicine In
Medicare Programs

• What are Independent Diagnostic Testing
  Facilities?
• Independent of a Physicians office or Hospital
• Provide and bill for diagnostic tests (not
  clinical laboratories) rather than physician
  services (such as evaluation and management)
• Provide diagnostic tests to patient referred by a
  physician
• An IDTF must
• Have at least one supervising physician who
  oversees the facility and the tests
• Have qualified non-physician clinicians
• Be enrolled with Medicare as Supplier
• May be a fixed location or mobile entity

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Medicare Spending For Services Provided by IDTFs
(2002)
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Targeted Opportunities ForTelemedicine In
Medicare Programs

• Cardiac Monitoring Services An Example
• Types of services covered by Medicare and most
  commercial payors cardiac holter monitors,
  cardiac event monitors, pacemaker monitors, ICD
  monitors, INR monitors.
• Physician office ECGs do not capture events
• Symptoms and health rhythms need to be captured
  when patient is at home or work
• Atrial fibrillation is responsible for 15-20
  percent of all strokes
• Example Paroxysmal atrial fibrillation and
  flutter accounts for 416,000 hospitalizations
  each year
• Risk increases dramatically for patients over 60
• Early detection far reduces morbidity and
  mortality

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Targeted Opportunities ForTelemedicine In
Medicare Programs

• Remote Monitoring Using Cardiac Event Monitors
• Patient presents asymptomatically to physician
• Physician hooks-up patient to event monitor
• Monitor is worn for 30 days and IDTF facility
  monitors events 24 hours 7 days per week (Round
  the Clock)
• Data transmitted to facility is evaluated by
  technician and then sent to ordering physician
  for interpretation
• Out of normal range situations require
  immediate action

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Targeted Opportunities ForTelemedicine In
Medicare Programs

• Independent Diagnostic Testing Facility Services
• Provide device to patient through physician
• Receive data transmission from patient
• Facility may be located in Virginia and patient
  in California
• Analyze ECG and provide report to physician
• Aberrant ECG results in immediate action
• Bill Medicare for the technical component of
  service

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Targeted Opportunities ForTelemedicine In
Medicare Programs

• Independent Diagnostic Testing Facility Issues
• Recognition of Value of Remote 24/7 Technology
• Medicare reimbursement and IDTF requirements

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Targeted Opportunities ForTelemedicine In
Medicare Programs

• Disease Management Background
• Disease management program have expanded since
  mid-1990s
• HMOs used DM programs to manage chronic illness
• Employers/Health Insurers now include DM programs
• Medicare has encouraged the development of these
  programs
• Since late 1990s, CMS initiated a number of
  demonstrations
• Last year, Medicare Health Support Pilot

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Targeted Opportunities ForTelemedicine In
Medicare Programs

• Disease Management Market
• The potential market for DM services is said to
  be as high as 4 billion for commercial (25
  million participants) and 10-12 billion for
  government payors (20 million participants).
• 2002 600 Million Revenue
• Greater than 50 of Medicare beneficiaries have
  one or more chronic conditions

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Targeted Opportunities ForTelemedicine In
Medicare Programs

• What is Disease Management?
• Disease Management is a system of coordinated
  healthcare interventions and communications for
  populations with conditions in which patient
  self-care efforts are significant.
• Disease management
• supports the physician or practitioner/patient
  relationship and plan of care,
• emphasizes prevention of exacerbations and
  complications utilizing evidence-based practice
  guidelines and patient empowerment strategies,
  and
• evaluates clinical, humanistic, and economic
  outcomes on an going basis with the goal of
  improving overall health.
• Disease Management Association of America

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Targeted Opportunities ForTelemedicine In
Medicare Programs

• What is Disease Management? (Continued)
• Disease Management Components include
• Population Identification processes
• Evidence-based practice guidelines
• Collaborative practice models to include
  physician and support-service providers
• Patient self-management education (may include
  primary prevention, behavior modification
  programs, and compliance/surveillance)
• Process and outcomes measurement, evaluation, and
  management
• Routine reporting/feedback loop (may include
  communication with patient, physician, health
  plan and ancillary providers, and practice
  profiling)
• Full Service Disease Management Programs must
  include all 6 components. Programs consisting of
  fewer components are Disease Management Support
  Services
• Disease Management Association of America

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Targeted Opportunities ForTelemedicine In
Medicare Programs

• Medicare Disease Management Programs
• Congress and CMS mandates that most Medicare
  Advantage Plans have Chronic Care Improvement
  Programs
• All Part D Plans must have Medication Therapy
  Management Programs
• Medicare Health Support (formerly CCI) Pilot
  Program that may be expanded

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Targeted Opportunities ForTelemedicine In
Medicare Programs

• Existing Medicare DM Demonstrations
• Medicare Coordinated Care Demonstration
• ESRD Disease Management Demonstration
• Medicare BIPA Disease Management Demonstration
• Upcoming Medicare DM Demonstrations
• Medicare Health Care Quality Demonstration

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Targeted Opportunities ForTelemedicine In
Medicare Programs

• Disease Management Benefits/Issues
• Disease Management is an area of interest for
  policymakers, why?
• The potential for DM to save Medicare money while
  also providing services that enhance the health
  of beneficiaries
• Commercial Payors use of DM Program
• Increasing value of Health Information Technology

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Targeted Opportunities ForTelemedicine In
Medicare Programs

• Disease Management Challenges
• Proof of cost savings
• CBO Scoring
• Studies
• Health Care Provider Resistance
• Outcomes Measurement What should the standard
  be?
• Regulation of Disease Management Programs

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Targeted Opportunities ForTelemedicine In
Medicare Programs

• The Future for IDTF and Disease Management in
  Telemedicine
• IDTFs seem ideal to provide a tele-health
  services (like diagnostic information) in near
  real time to patients and their physicians.
• Disease management relies in many cases on remote
  centers providing services to participants who
  have chronic disease in order to assist the
  patient and provider by enhancing the quality of
  health care the person receives and hopefully
  providing some cost savings to the payor.