Urologic Telehealth: Substitution or Expansion? Covid-19 and Beyond ?

Providers have had to adapt to using telehealth during a crisis, to. allow for distancing and improving office efficiency.   Most health insurers adapted quickly to the emergency needs.  I have not seen any reports regarding the rates of denials for telehealth as yet.  Will this carry forward after the emergency orders for distancing ?

Health insurers in the past have been reticent to offer telehealth visits as it has not been established whether telehealth increased health spending, or if it was offset by fewer in person visit. 

In a poster by 

Juan Andino, MD 

Michigan Medicine Department of Urology Ann Arbor, MI 

 While insurance companies are increasingly providing coverage for telehealth services, such as video visits, and healthcare providers are increasingly utilizing these modes of healthcare delivery, the impact of video visits on cost and quality is largely unknown. One important question is whether a video visit can serve as a substitute for in-person care or whether the use of video visits will lead to additional downstream in-person visits (i.e., expansion of healthcare utilization). 

Methods: We reviewed 141 consecutive, established patient video visits completed with four urologists at our institution. We then randomly sampled 141 established patient clinic visits to serve as our comparison group. After evaluating baseline demographics of the patients in the two groups, we determined whether video visits served as a substitute for in-person care or as an expansion of healthcare services, by comparing the number of additional visits (i.e., revisits) that occurred within 30 days of each type of encounter. 

Results: There was no difference in revisit rates after video visits (4%, n=6) compared to clinic visits (6%, n=9; p=0.42). Patients that were seen via video visits tended to be younger (54.9 vs 62.7 years, p<0.001). Differences in the distance from the hospital (72 vs 64.5 miles, p=0.65) and median income ($51,402 vs $53,239, p=0.46) were not statistically significant. The most common diagnoses evaluated through video visit encounters were urolithiasis (38%), kidney or upper tract malignancy (18%), followed by elevated PSA (10%), prostate cancer (7%), and voiding issues (7%). 

Conclusions: Video visits served as a substitute for traditional clinic visits and were used by patients with a broad range of urologic conditions. These findings suggest that the expansion of synchronous telemedicine coverage by private payers may not necessarily increase the utilization of healthcare services. 

This study was in a very limited cohort for one specialty, and may not reflect the overall effect of telehealth visits.  It was also performed during an acute crisis of a pandemic outbreak of a novel coronavirus.

POSTER

https://www.eventscribe.com/2020/AUA2020/fsPopup.asp?Mode=presInfo&PresentationID=723913

Guidance to HIPAA Compliant Communication

We all use messaging, SMS, Facebook messenger, Chat rooms and more.  Some even use video conferencing.  During the Covid-19 pandemic it became an essential means for education, telehealth for medical as well as remote work from home to insure social distancing to 'flatten the curve"

The Health Care Providers Guide to HIPAA compliant messaging with patients

How patient-centered communication can help deliver better personalized care

Research increasingly shows that patient satisfaction is strongly linked to communication between healthcare providers and their patients. A global study conducted by FICO found that 80% of people would like to use their mobile phones to interact with healthcare providers. Doctors, nurses and administrators also see the clear benefits of asynchronous communication from their smartphones: It’s easy, convenient and effective.

But for healthcare organizations to give both patients and providers the communication channel they want, they need a messaging and chat solution that is both easy to use and HIPAA compliant. Therefore, it’s essential that healthcare organizations find a communication solution that is already HIPAA compliant to prevent these PHI breaches before they occur.

In this guide you will learn:

• How to balance the risks and benefits of HIPAA compliant SMS

• The role of HITECH in patient communication

• How to choose a HIPAA-compliant communication channel that best fits your needs

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Telepsychiatry and the Coronavirus Disease 2019 Pandemic—Current and Future Outcomes of the Rapid Virtualization of Psychiatric Care | Global Health | JAMA Psychiatry | JAMA Network

The coronavirus disease 2019 (COVID-19) pandemic is a seminal event that is precipitating radical transformative change to our society and health care systems. Social distancing, isolation, and deployment of suppression and mitigation strategies are directly influencing the morbidity and mortality rates of the pandemic.¹ Remote communication technologies are being broadly deployed in all spheres of medicine to support these strategies while still delivering effective health care. Telepsychiatry, in the form of videoconferencing and other technologies, was uniquely positioned to push the field of psychiatry to the forefront of these efforts. Prior to the pandemic, telepsychiatry had built a strong scientific foundation and real-world evidence base, demonstrating its effectiveness across a range of psychiatric treatments, populations, and settings.^2-5 Although previously leveraged temporarily in disaster response,⁶ telepsychiatry’s use in the COeither expanding or initiating direct clinician-home to patient-home services, and partially or fully virtualizing administrative operations. Implementation has occurred at a pace never experienced in telemedicine, with many large organizations fully virtualizing in a matter of days. Historically, full implementation of telepsychiatry, especially in large organizations, could take months to years. Rapid virtualization has shown that clinicians, patients, and systems can quickly adapt to telepsychiatry, although not without challenges and lessons learned. Previous barriers including regulatory constraints, system inertia, and general resistance to telepsychiatry have disappeared, at least temporarily; technical innovations abound as clinicians and organizations work to best configure telepsychiatry to current clinical needs and environments.

Historically, telepsychiatry has experienced a substantial evolutionary period with the expansion of the internet and the use of other  technologies and peripheral devices that are ubiquitous to consumers and based largely on commercial uses and applications. Currently, in response to the COVID-19 emergency, there has been an unprecedented revolution in the telehealth landscape with the lifting of federal and state regulatory barriers to telemedicine and telepsychiatry. Such changes include the suspension of the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which placed restrictions on controlled substance prescription via videoconferencing, previously inadequately addressed despite years of advocacy for change by the telemedicine community. Rules around Medicare and Medicaid reimbursement, such as Medicare location requirements, have loosened to support and encourage videoconferencing and telephone-based services. Many states are creating COVID-19–specific exceptions no longer requiring psychiatrists and other mental health clinicians’ licensure in the state where a patient is physically located during a video session. These actions have been incredibly favorable and enabling for telepsychiatry and have been requested for years by the field.

The surge in use of telehealth has not been limited to psychiatry, and is being used in most primary care practice.  Medicare and private payors have added appropriate CPT billing codes and allow for reimbursement. Reimbursement was an issue for providers, and previous restrictions in terms of distances for providers from patients were limiting factors in the use of telehealth.

The SARS-Covid-19 pandemic swiftly overran previous restrictions both by increasing efficiency of providers and allowing social distancing.

Telepsychiatry and the Coronavirus Disease 2019 Pandemic—Current and Future Outcomes of the Rapid Virtualization of Psychiatric Care | Global Health | JAMA Psychiatry | JAMA Network

Population Health Enters a New Era

Health Information Exchanges will allow for the extraction of information for public health. 

The analytics company says the technology expertise of MAeHC, whose CEO Micky Tripathi will join Arcadia's leadership team, will help it expand its interoperability offerings for population health management

Micky Tripathi 

Just as it's doing with nearly every facet of society around the world, the COVID-19 crisis will radically transform approaches with patient engagement and pop health. From telemedicine and remote patient monitoring to AI and advanced analytics, healthcare was already in the midst of big changes in how it manages the health of patient populations. Now, in a new era where the pandemic is upending old assumptions, the stakes are even higher. This month, we look at how approaches to treating COVID-19 and other illnesses are shifting in this new era.

Arcadia, which specializes in technologies focused on population health management and value-based care, announced Thursday that it has acquired selected assets of the Massachusetts eHealth Collaborative.

WHY IT MATTERS

The acquisition includes technology assets and some customer accounts of MAeHC, a nonprofit services firm that helps healthcare providers with technology and analytics to manage the demands of quality improvement and value-based care.

Burlington, Massachusetts-based Arcadia says MAeHC's long track record with data warehousing, analytics services, and implementation support will be an asset as the company expands its offerings for health systems looking to drive clinical and operational improvements.

Interoperability is a particular area of expertise for MAeHC, which has led or contributed to many major interoperability and standards projects and partnerships over the past decade, such as HL7's FHIR spec and the Argonaut Project, an industry collaborative to speed its adoption across the industry. 

"The COVID-19 pandemic has demonstrated the important role that population health management plays in ensuring healthcare organizations have accurate, up-to-date patient information to guide decision-making," said Tripathi.

"Over the last few weeks, we've seen how absolutely critical it is for all of us in value-based care, interoperability, and population health management to pivot at a moment's notice," he said. We are excited about joining our strong teams of experienced industry professionals who are building the future of interoperability and healthcare data exchange."

Analytics & Reporting

New analytics tool for data 

The application allows healthcare providers to easily access and understand comprehensive data in their patients’ profiles, identify gaps in care, and see how they rank in quality measures.  For today’s healthcare professionals, ensuring visibility into their patient panel, measuring patient outcomes, and providing proof that they have accurately met quality performance measures are major concerns. Many single electronic medical record (EMR) systems do not contain all of the historical or community medical information necessary to see a complete picture of a patient’s needs.

When a patient sees another doctor or is admitted to the hospital, that visit or event may not be shared with their full care team, which leaves providers with informational gaps that hinder their ability to identify and quickly rectify emerging issues.

MyData combines HIE data and provider data to deliver insights to participants in responsive, user-friendly dashboards and reports. This makes information easier to access, interpret, and track.  MyData’s community health dashboards leverage HealtheConnections’ clinical and data quality knowledge for three primary medical concerns: hypertension, diabetes, and high hospital utilization. These registries based upon contributed community data help providers get the most complete picture of their patient panel.

Population Health Improvement

The merger of health information exchanges and a route for extracting information for such diseases as hypertension, diabetes, and other chronic diseases.  The Covid19 pandemic emphasizes the importance for prevention and future of Covid 19 transmission.

Arcadia acquires assets of Massachusetts eHealth Collaborative | Healthcare IT News: