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CMS released proposed rulemaking for electronic health record incentive program  ("meaningful use") stage 3 to begin by 2018 -- available at https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-06685.pdf.  This proposal is open for public comment until May 20.

The proposal includes "Objective 6: Coordination of Care through Patient Engagement."  Three measures are proposed for the communication continuum between providers, patients, and the patient's authorized representatives through the use of view, download, and transmit functionality, including patient-generated health data (such as '''remote patient monitoring data''').  The related proposed measure would be that patient-generated health data or data from a non-clinical setting is incorporated into the certified EHR technology for more than 15% of all unique patients seen by the eligible professional or discharged by the eligible hospital inpatient or emergency department during the EHR reporting period.
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The Centers for Medicare and Medicaid Services just announced the most portentous development for Medicare telehealth in 15 years.  For a new payment innovation “CMS will make available to qualified Next Generation ACOs awaiver of the requirement that beneficiaries be located in a rural area and at a specified type of originating sitein order to be eligible to receive telehealth services” (bold added). 

Regarding telehealth, a Next Generation accountable care organization applicant will be asked to--

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Hello everyone, my name is Dr. Gene Herrmann and I am the Director of Mental Health for the GEO Group.  We operate prisons and detention facilities throughout the world.  We are looking for companies to provide telemental health services within our facilities.  We are primarily looking for psychiatrists at this time and also companies that are considered to be physician owned in order to be in compliance with the Corporate Practice of Medicine Act which applies in many states.  The law requires physicians to work for companies which are physician owned.  The company that I work for, GEO Group, is not physician owned. Please contact me if you wish to find out more information.  Thank you.  

   
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What does telemedicine have to do with willpower? It’s a fair question, and as it turns out has some important answers. Everybody has willpower, but it’s not unlimited. We’re able to do things that seem beyond our reach or we don’t want to do by willing ourselves to do them. We’re all familiar with the idea of applying willpower to overcome something dramatically unpleasant or challenging, however most of the time willpower is at least as important for being able to do routine everyday things like following a diet, or taking medicine. In short, we’re pretty good at bursts of willpower, but it’s difficult to sustain – and that’s where telemedicine can help.

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21st Century Cures Act can be important to telemedicine. SIG thoughts on changes in furtherance of telemedicine can be presented as a constituant. Please advise and I will 

RAPS Explainer http://www.raps.org/Regulatory-Focus/21st-Century-Cures-Act/ . The Act can simplify many aspects of healthcare regulation. I will be going on the  the Hill  in May and will again see Congressman Pitts who chairs the Health Subcommittee of Energy and Commerce. Companies interested in telemedicine including the largest employer in Pitts district, my firm and many employees of my clients and of other associations which I represent  live in Pitts' district. All  can help  improve and support  the Act. 

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ATA has been working with an important bi-partisan coalition that has a goal to bring “21st Century Cures” to the United States.  In comments submitted yesterday to the House Energy and Commerce Committee, ATA recommended that Congress take immediate action to improve coverage for telehealth services under Medicare payment innovations in a number of areas from fee-for-services to the accountable care organization and bundled payment programs. The comments were in response to a draft proposal on telehealth prepared by a workgroup of eight members of the House and Energy Commerce Committee.

The Committee just released its almost 400 page draft bill (http://energycommerce.house.gov/sites/republicans.energycommerce.house.gov/files/114/Analysis/Cures/20150127-Cures-Discussion-Document.pdf) with telehealth addressed on pages 291-299 directing the Centers for Medicare and Medicaid Services to implement a methodology for Medicare to cover telehealth without a net increase in spending. Of immediate benefit would be a provision to fully cover telehealth for purposes of all related Medicare demonstrations and models.  More information on “21

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For 2015, the list of procedure codes covered for Medicare telehealth services is (by CPT or HCPCS codes)--
90791 - 90792: Psychiatric diagnostic interview examination
90832 – 90834 and 90836 – 90838: Individual psychotherapy
90845: Psychoanalysis
90846 - 90847: Family psychotherapy
90951 - 90952, 90954 - 90955, 90957 - 90958, and 90960 - 90961: End-Stage Renal Disease-related services included in the monthly capitation payment
96116: Neurobehavioral status examination
96150 – 96154: Individual and group health and behavior assessment and intervention
97802 – 97804 and G0270: Individual and group medical nutrition therapy
99201 – 99215: Office or other outpatient visits
99231 – 99233: Subsequent hospital care services, with the limitation of 1 telehealth visit every 3 days
99307 – 99310: Subsequent nursing facility care services, with the limitation of 1 telehealth visit every 30 days
99354 - 99355: Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service
99406 - 99407 and G0436 - G0437: Smoking cessation services
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ATA gratefully acknowledges that after three years, the Centers for Medicare and Medicaid Services (CMS) finally answered ATA’s petitions and may soon allow Accountable Care Organizations (ACOs) to use telehealth to keep their patients healthy.

In proposed rulemaking
, CMS indicated an openness to cover telehealth services under the payment innovation of Medicare’s ACOs.

For several years, ATA has urged the Secretary of Health and Human Services to waive certain restrictions on ACOs use of telemedicine, thereby expanding telehealth coverage to the 80% of Medicare beneficiaries who reside in metropolitan areas, and also to all beneficiaries who receive treatment their homes (or in locations other than one of the previously designated types of health facilities).

CMS is currently seeking public comment on the proposed rule (available at http://www.gpo.gov/fdsys/pkg/FR-2014-12-08/pdf/2014-28388.pdf

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We  are ready to start a pilot study in SNF, targeting patients with 2 or more chronic conditions, using  remote monitoring( pulse ox, BP, HR, EtCO2, noninvasive cardiac monitoring( CO, CI, PVR).

Need suggestions on what type of data, should we collect, to make a strong case for physicians and  for the payers as well.

Please send me your ideas. Thank you.

Dragos Zanchi

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Calling all telemedicine & telehealth service provider companies!

The Arizona Telemedicine Program has just rolled out a directory specifically aimed at healthcare administrators who are looking for medical specialty providers to help expand their offerings to their patients/clients and create better healthcare outcomes in their communities. The directory was created to advance telehealth partnerships.

If your company employs medical and clinical professionals and provides services such as telestroke, telepsychiatry, or teledermatology, to clients such as healthcare systems, schools, or employers, then this directory is for you.

The directory is at http://telemedicine.arizona.edu/servicedirectory. Because the directory is a public service, there is no charge associated with listing your company. Go to https://www.surveymonkey.com/s/ATPTTSPD to join the directory.

The survey is detailed in order to provide enough information for directory users to find their best fit. The directory is searchable by state, services offered, customer type, and company name so decision-makers from hospitals, clinics, schools, correctional facilities, nursing homes, employers, insurers and other entities can easily find what they need.
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Late this afternoon, the Centers for Medicare and Medicaid Services issued an almost 1200-page rulemaking about 2015 Medicare payment to physicians and practitioners.

For telehealth, 7 new procedure codes will be covered for—

  • annual wellness visits (HCPCS codes G0438 and G0439)
  • psychotherapy services (CPT codes 90845, 90846, and 90847)
  • prolonged services in the office (CPT codes 99354 and 99355)

The originating site facility fee will be $24.83.

Also, Medicare will begin paying physicians for chronic care management using a new procedure code, CPT code 99490.

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In what could be an opportunity for advancing telemedicine use, the CMS Innovation Center just announced a new funding initiative to support clinicians in sharing, adapting and further developing comprehensive quality improvement strategies, which are expected to lead to greater improvements in patient health and reduction in health care costs.

CMS will award cooperative agreement funding for 2 network systems

  • The Practice Transformation Networks are peer-based learning networks designed to coach, mentor and assist clinicians in developing core competencies specific to practice transformation. This approach allows clinician practices to become actively engaged in the transformation and ensures collaboration among a broad community of practices that creates, promotes, and sustains learning and improvement across the health care system.
  • The Support and Alignment Networks will provide a system for workforce development utilizing national and regional professional associations and public-private partnerships that are currently working in practice transformation efforts. Utilizing existing and emerging tools (e.g., continuing medical education, maintenance of certification, core competency development) these networks will help ensure sustainability of these efforts. These will especially support the recruitment of clinician practices serving small, rural and medically underserved communities and play an active role in the alignment of new learning.
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We are starting our telehealth program with our hospital as the main hub.  We will be associate with rural hospitals to provided neuro consults in the ER and inpatient settings.  Does anyone have information on how they cover the consent to treat that patient that is in the rural hospitals.
Thankyou
Catherine.hungate@sih.net
618-942-2171ext 36623
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WASHINGTON – Monday, September 8, 2014 - The American Telemedicine Association (ATA) today released two critical state policy reports which identify gaps in coverage and reimbursement, and in physician practice standards and licensure. These first-of-their-kind reports identify and compare state policies on a report card, assigning each state grades ranging from A-to-F based on telemedicine reimbursement and physician practice standards. ATA has captured the complex policy landscape of 50 states with differing telemedicine policies, and translated the data into an easy-to-use format. “We hope these reports serve a dual purpose: to showcase the states that are doing an excellent job when it comes to telemedicine, and to serve as a wake-up call to those who are failing to extend quality and affordable care to the residents of their state,” said Jonathan Linkous, CEO of ATA. “We hope that states will respond by streamlining policies to improve medical practice rules, licensure, healthcare quality, and reduce costs through accelerated telemedicine adoption.” 50 State Telemedicine Gaps Analysis – Coverage & Reimbursement The first report reviewed and compared telemedicine coverage and
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Over 200 counties have had some portion of their county lose eligibility for the Federal Communication Commission's Rural Health Care (RHC) Program definition of "rural area" has not changed, but the designation of rural census tracts was routinely updated based on the 2010 census and other new data. 

For information about these changes, please see http://www.usac.org/rhc/tools/news/default.aspx#1072

The Eligible Rural Areas Search website is at http://www.usac.org/rhc/telecommunications/tools/Rural/search/search.asp.

The next webinar about the RHC program will be September 18 (register at https://attendee.gotowebinar.com/register/1150473249088342529).









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During today's webcast, This Month in Telemedicine, I used PowerPoint slides to compare the incremental Medicare provisions of major telehealth bills pending in Congress.  The slides were based on a one-pager you can get at

http://www.americantelemed.org/docs/default-source/policy/menu-of-short-term-options-for-medicare-telehealth-improvements.pdf?sfvrsn=4.

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Less than One Week to Save on Fall Forum Registration:

 The early-bird deadline to register for the ATA Fall Forum (Sept. 6-9, Palm Desert, Calif.) is this Friday, August 8! We invite you to register today at the member, early-bird rate and join your colleagues for two full days of program related to telehealth in chronic care, a half-day forum focused on telemedicine opportunities in China, and golf and tennis outings at the magnificent JW Marriott Desert Springs Resort and Spa.  In addition, several round table discussions will cover hot-topic areas and a state-of-the-art trade show will feature the leading technologies for chronic care management. Register and find more info at www.ATAFallForum.org

 ATA Applauds Bill on Medicare Telemedicine Improvement:

 Last week, Reps. Mike Thompson (D-CA), Gregg Harper (R-MS), and Peter Welch (D-VT) introduced H.R. 5380, the Medicare Telehealth Parity Act of 2014, which improves telemedicine coverage in Medicare. H.R. 5380 creates a phased approach over four years to expand coverage of telemedicine-provided services and remove arbitrary barriers that limit access to services for Medicare beneficiaries. Included in these provisions are the gradual removal of geographic restrictions to patient care, and the addition of coverage for healthcare services that take place in other locations such as the home and walk-in retail health clinics. Read more here:

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Less than Two Weeks to Save on Fall Forum Registration:

 The early-bird deadline to register for the ATA Fall Forum (Sept. 6-9, Palm Desert, Calif.) is next Friday, August 8! We invite you to register today at the member, early-bird rate and join your colleagues for two full days of program related to telehealth in chronic care, a half-day forum focused on telemedicine opportunities in China, and golf and tennis outings at the magnificent JW Marriott Desert Springs Resort and Spa.  In addition, several roundtable discussions will cover hot-topic areas including:

-  Internal Awareness and Adoption

-  Telehealth and Network Deployment

-  Business Models and Sustainability

-  State Policy

-  Surgical Telementoring

-   and a Telemedicine Service Provider Forum

More info at www.ATAFallForum.org

 
Online, Direct to Consumer Patient Consultations Becoming Mainstream:

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Join us tomorrow from 2 - 3 p.m. EDT as ATA CEO Jonathan Linkous and Senior Policy Director Gary Capistrant cover breaking telemedicine policy and industry developments during a live webcast of This Month in Telemedicine. Post your questions in the comments field below and tune in for the answers live tomorrow! 

Access the webcast here
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