Telenutrition- u Where are we going? u Why this direction? u What - PDF document

Starting Our Telenutrition Journey u Who’s idea is this anyway? u When do we leave? Telenutrition- u Where are we going? u Why this direction? u What equipment will we need? A New Frontier u Who’s picking up the tab? u Why haven’t we left yet? u How are we getting there? ROBIN AUFDENKAMPE, MS, RDN, CD u Are we there yet? APRIL 2015 Who’s idea? When do we leave? Mary Ann Hodorowicz, MBA, RD, LDN, CDE Joanne Shears, MS, RD, LN Ø Presented in 2012 Called for: Ø more research � more publications �

Published Research on Telenutrition The Direction? Telehealth Peer Reviewed Journals & Academic Journals (EBSCO) The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health- related education, public health and health administration. Telehealth will 2012 2015 include both the use of interactive, specialized equipment , for such purposes as: Ø Tele-medicine = 5,167 Ø Tele-medicine = 7,423 Ø Tele-pharmacy = 24 Ø Tele-pharmacy = 36 Ø health promotion Ø Tele-nutrition = 0 Ø Tele-nutrition = 1 Ø disease prevention Ø diagnosis, consultation therapy Ø nutrition intervention /plan of care Ø non-interactive (or passive) communications - over the Internet, video-conferencing, email or fax lines, and other methods of distance communication for broad-based nutrition information . Academy of Nutrition and Dietetics A Direction of Progress Our Direction? Telenutrition The interactive use, by a RD or RDN, of electronic information and telecommunications technologies to implement the Nutrition Care Process: Ø Nutrition assessment Ø Nutrition diagnosis Ø Nutrition intervention/plan of care Ø Nutrition monitoring and evaluation - with patients or clients at a remote location, within the provision of their state licensure as applicable. Academy of Nutrition and Dietetics

Potential Revenue & Documented Productivity How are we getting there? Based on 10 outpatient dietitians in pediatric clinics. Telenutrition Services Each RDN spends ~2 hours per week communicating with patients via phone or email. 20 hrs/wk 80 hr/m 320 – 15 min. increments Ø Face to Face audio visual medium x 4 wks/m x 4 -15 min. x $25.00 Ø Phone calls 80 hrs/m 320 – 15 min. $8,000 per month Ø E-mail Transition “No show” and “Cancellation” appointment time. Ø Video learning modules 5 app/wk 20 app/m 80 – 15 min. increments ments X 4 wk/m x 4 – 15 min x $25.00 Ø Tele-buddy monitoring systems 20 app/m 80 -15 min $2,000 per month Ø Mobile applications 100 hrs/m in documented productivity. ~$120,000 per year in potential revenue. Methods of Telenutrition I Controlled Environment Real-time communication = Synchronous Ø The primary method of Telenutrition Ø Consists of practitioner and patient present at the same time , but in different locations. Ø Requires two sites: Ø “originating site” - location of the patient Ø Whenever possible utilize a designated Telehealth space. Ø “distance - site” - location of practitioner Ø Ensure adequate lighting and sound. Ø Live , interaction video conferencing Ø Remove all clutter. requires high quality , reliable , and secure Ø Check in your rearview mirror. telecommunications.

HIPAA Security: Technology For Telenutrition Sets national standards for the security of electronic protected health information Compliant Software Ø Vsee Ø Secure Video Broadband Encrypted Business grade Ø Vidyo Internet internet videoconferencing connection Ø Hipaachat - reliable to prevent Ø Talk to an Expert rate of data interception transmission Non-Compliant Software Ø Skype Ø FaceTime HIPAA Considerations Methods of Telenutrition II Store and Forward = Asynchronous u Encryption : for securing the chat sessions and the voice and video phone calls for the safe transmission of ePHI . Ø Transmission of digital images for u Wire Tap : the need for a platform that can prevent wire tapping. diagnosis or assessment, u Business Associate Agreement (BAA): an agreement with providers ment with providers commonly used in radiology and that you used for your ePHI is a requirement of HIPAA. IPAA. dermatology. Ø Forms of education u HIPAA Requirements : u Provide archives of chats. Ø Prepared learning modules u Provide audit trails of usage. Ø Interactive education modules u Provide notifications in case of a breach. Ø Prerecorded teaching videos u Provide administrative emergency access to previous chat histories. ous chat histories.

Who are my travel buddies? Travel Equipment & Supplies? Stakeholder Ø Gap Analysis System wide Project team Ø Strategic Plan Ø Current Telehealth Ø Project Sponsor administrators Ø Project Owner Ø Compliance Ø MD Champion Ø Coders & Finance Ø Facility ITS Ø Complexity Analysis Ø Business Case Case Ø Schedulers Ø Information Technology Services Ø Patient Education Services Ø Communications/Marketing Rules of the Road - New CMS Provisions Licensure Provision Ø Permit hospitals and CAHs to implement new credentialing and privileging Ø RDs or RDNs in states without licensure laws must be credentialed process for physicians and practitioners providing telehealth services. and privileged by the traditional route, by each hospital in which they practice. Ø Removal of unnecessary barriers to telehealth may enable patients to Ø Practitioners providing patient care services in other states must be receive medically necessary interventions in a more timely manner. licensed and/or meet other applicable standards that are required by state or local laws in both the state where the practitioner is e prac ion ioner is located and the state where the patient is located. ed. Ø Enhanced patient follow-up in the management of chronic disease conditions. Ø Provide more flexibility to small hospitals and CAHs in rural areas and regions with limited supply of primary care and specialized providers.

Authorized Distant Site Practitioners Authorized Originating Sites Ø Physicians Ø Physician or practitioner offices Ø Physician assistants Ø Hospitals Ø Nurse practitioners Ø Critical Access Hospitals Ø Nurse midwives Ø Rural Health Clinics Ø Clinical nurse specialist Ø Federally Qualified Health Centers Ø Renal Dialysis Centers (Hospital or CAH-based) Ø Clinical nurse anesthetists Ø Skilled Nursing Facilities Ø Clinical psychologist Ø Community Mental Health Center Ø Clinical social workers Ø Check with commercial payers Ø Registered dietitians or nutrition professionals. ionals. Verify Locations? Who’s picking up the tab? Ø Medicare reimburses for Telehealth services when the originating site (where the patient is) is in a Health Professional Shortage Area (HPSA) or in a county that is outside of any Metropolitan Statistical Area (MSA). Area (MSA). Ø Patient location matters Ø It’s not the distance from the provider Ø Healthcare provider shortage area Ø Population of an area Ø Location Finder Ø http://datawarehouse.hrsa.gov/telehealthAdvisor/telehealthEligibility.aspx

CPT Codes Billing Reimbursement Ø CPT codes are owned and Ø CMS uses CPT codes & written by The American creates their own codes Ø Just because you have a CPT code doesn’t Medical Association mean you’re going to get reimbursed . Ø G codes Ø Physicians are providing a Ø Modifiers service and need a Ø If you bill an insurance company or CMS Ø Restrictions corresponding code for and you are not reimbursed you must bill billing. Ø Clarifiers the patient. Ø New codes are approved Ø Medicaid is the exception. by Ø Demonstrated improved Ø Medicare will only pay for "face-to- face,” outcomes interactive video consultation services Ø Lobbying where the patient is present. Ø Government mandate Medical Nutrition Therapy Codes CPT Code Modifiers Ø Telehealth Modifiers - valid when billed with Face to Face Telephone Email only Super-bill Interaction Interaction HCPCS codes • 99372 - Provider • 97802 -Nutrition • 98966 - • 98969 – Online does not submit Assessment assessment and • (5 - minutes) Ø GT – synchronous interactive audio and video CPT the bill: clients management can submit for service provided • 97803 - Nutrition • 98967 - reimbursement by a qualified Follow-up • (11 - 20 minutes) non-physician Ø GQ – asynchronous telecommunication system - transmission health care of data • 97804 - Group professional, • 98968 - Medical Nutrition internet or • (21- 30 minutes) Ø Alaska and Hawaii are the only two states approved for Therapy electronic communications. asynchronous telecommunication reimbursement . Ø Q3014 - code filed by originating site. Healthcare Common Procedure Coding System (HCPCS)