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OIG’s November Plan on Opioid Prescribing and Telemedicine

Following the previous two work plan publications this year, OIG has come up with another strategy where it will be updating its work plan on a monthly basis. In November, the four plans are;

• OIG will be evaluating the prescriptions for opioids to Medicaid. Their observation was that Medicaid beneficiaries mostly the disabled are more vulnerable to abuse of opioids since they tend to suffer from conditions that require pain relief. OIG will be examining the issue by considering both the prescriber and the beneficiary side. The prescriber may include doctor or pharmacy. The study aims to come up with a baseline of beneficiaries receiving extreme amounts of opioids and identify the prescribers who are giving excessive or too much of opioids to recipients.
• OIG wants to study if Medical payments made for services provided through telecommunication systems fulfilled the requirements of Medicaid. The OIG will determine if all the telehealth services that may be delivered through audios and videos and any services that beneficiaries get through interactive transmissions are all paid for in the required manner.
• The Medicaid Managed Care Organizations (MCOs) will be examined by the OIG to check if it is using Medicaid funds to offer proper care to the Medicaid MCO enrollees. These are funds that MCOs receive inform of capitation payments which come from over 40 percent of federal Medicaid expenditures. The OIG aims to ensure that the capitation rates are set appropriately so that they can provide adequate services to the beneficiaries.
• OIG will be determining the way hospitals are billing for severe malnutrition. The condition is common among the elderly especially those who are seriously ill. Malnutrition can be as a result of inadequate treatment, treatment of a different disease, negligence or general worsening of the patient’s health. Hospitals are expected to bill for the treatment of this condition based on how serious the state is, which can be mild, moderate and severe. Severe malnutrition is a significant complication and increases Medicare reimbursement. OIG will be reviewing the precision of the claims to Medicare for the treatment of acute malnutrition.

There exists a potential to reshape the health system by use of telemedicine. The modern society has allowed consumers to access almost everything online which includes healthcare. Telemedicine is a comprehensive type of healthcare. It can be used to enhance the treatment of emergency care patients through its convenience, increased efficiency, and accessibility.

The various incidents where telemedicine comes in handy, especially to patients requiring urgent care include load balancing, satellite, and hub and spoke models. These services are provided by both the government and non-profit oriented organizations who offer some online healthcare facilities for those seeking to expand their telemedicine program.

Telemedicine is both safe and effective for the evaluation of any manageable conditions in the urgent care environment. Furthermore, there exists growing evidence that affirms the audio and video-based intervention for the different acute conditions that manifest in the pediatric care. For example, using telemedicine can make the diagnosis of common severe illnesses much more comfortable than before. Also, patients with trust issues would feel more comfortable being diagnosed online rather than in-person.

The evaluation and consequent treatment of urinary tract infection and sinusitis have also been enhanced using tele-visits where most physicians purpose to offer prescribed antibiotics to their online patients. These means that telemedicine is not any different from one on one diagnosis. There also exists no difference in the number of patients that may be required to make a follow-up to their treatment either online or in-person. These imply that there is a consistency in patients’ satisfaction with telemedicine attributable to the convenience provided as well as the reduced cost of medication.

The urgent care patients can, however, be given the option to either be treated at home or through telemedicine. Alternatively, patients in need of physical emergency rooms are also given the opportunity to choose from one on one treatment or receiving treatment through telemedicine. Indeed the introduction and use of telemedicine for emergency care have helped reduce the average time and money spent on medication.

Virtual medical consultations, or telemedicine, are soon going to be offered by Aetna and Apple. With CVS joining in as well, telemedicine is facing a large increase in consumer awareness. Although telemedicine has been around for years, getting the information to customers has been difficult. Now that fortune 500 companies are promoting the service, virtual medical consultations are set to become more normal.

The chief executive of Aetna, Mark Bertolini detailed the plan to incorporate glucose level readings. With technology becoming such an intricate part of everyday life, it is no surprise that medical services are being digitalized as well. Patients having the ability to help themselves at their fingertips is a step towards healthier lives for many. With the ability to connect apps to Bluetooth to get instant readings coupled with a lower cost of healthcare.

Along with lowering the cost of healthcare, patients are now able to be more independent. The technology being introduced has the ability to monitor the patient from home. This means that the CVS, Aetna, and Apple medical merger could allow people to go home and not remain stuck in a clinic or hospital. There is no set in stone apps or technological specifics being mentioned thus far, but this is progression in America’s healthcare system.

This plan sets out to ensure the patient has the independence that they want, while also remaining affordable. A large issue with America’s healthcare system is the amount of money it takes to have any medical procedure or test. Doing it remotely, from home, eliminates some of those costs that traditional medicine incurs.

Telemedicine sets to make leaps and bounds within healthcare. Gaining exposure so that patients can utilize the service has been an obstacle, but that is changing quickly. Providing people with a less expensive, easy access way to medical treatment is groundbreaking.

Diabetes is a growing epidemic, brought on by unhealthy choices, and demanding medical care unlike any disease before. Telemedicine, allowing physicians to remotely monitor patients with diabetic retinopathy, can help meet that growing demand.

Noted physician Dr. Zimmer-Galler has stated that the DR telemedicine programs have been quite helpful to treat patients. They are highly effective, but because of the anticipated rise of diabetes cases in the next 15 years, they may not be enough. Her concern is that there will not be appropriate or adequate resources to properly evaluate and treat the rate of diabetic patients.

The lack of resources to properly treat diabetic patients isn’t the only concern Dr. Dimmer-Galler and other physicians have, however. The question of the validity of telemedicine practices is another. Presently, the American Telemedicine Asociation has 4 different levels of standard validity, starting with the presence of limited of minimal DR; presence of vision-threatening DR; the ability for providers to make clim=nical recommendations, and the Early Treatment DR Study photograph star=ndard (the highest level).

This validation is how telemedicine is judged to be a standard of care – currently, DR is determined by an in-person evaluation. Each DR treatment program, including telemedicine, must be evaluated to see how well it works, based on the “gold standard” of ETDRS photographs.

Telemedical treatment of diabetic retinopathy is expected to become more common in clinical practice. This should include primary-care automated image analysis using Nonmydriatic fundus cameras. With these, the images will be able to be transferred to readings centers for viewing, and then returned to the primary care physicians for diagnosis.

There is a concern that the rate of upgradeable images may affect telemedical treatment of DR. Currently, the minimum acceptable value for upgradeable images is 5%. There is no way with the current level of telemedicine, however, to diagnose diabetic macular edema (DME), which will require office visits. As the technology of telehealthcare improves, though, this may also be a viable option for remote diagnosis.

As it stands, telemedicine cannot be fully relied upon to treat DR or DME, although the technological improvement is increasing.

The Centers for Medicare and Medicaid announced on Thursday the final rule for Medicare Physician Fees in 2018. Part of the numerous changes and payment increases is the decision of CMS to pay for a greater number of individual telemedical services. As technological capabilities increase, as well as demands on physician’s time, telehealth is increasingly a viable alternative to traditional office visits. Many of the approved telemedicine codes include instances concerning lung cancer, health risk assessments, psychotherapy, chronic care management and interactive complexity.

According to the press release provided with the document, access to telemedicine for those living in rural areas will strengthen the care available to them. In addition, the changes to Medicare telehealth coverage will make it easier for these providers to bill Medicare.

This is part of the process to modernize Medicare payments and promote innovations that enhance patient care. In addition, changes to patient monitoring via virtual treatment is also in the process of being finalized.

Morgan Reed, the Connected Health Initiative Executive Director, is very supportive of the efforts from CMS to encourage physicians to embrace remote patient treatment and monitoring. He praises the new rules from CMS as an important, yet necessary step forward to a more connected healthcare system in America. With approval for many types of telemedical treatment, connected health technologies are now accessible to those utilizing Medicaid and Medicare services. Until now, participants in those health care plans have been effectively locked out from telehealthcare.

Prior to the 2018 changes, CMS rules essentially discouraged doctors from considering newer technologies to treat Medicare and Medicaid patients. Working in conjunction with the Connected Helth Initiative Adsivory Board, the newly updated rules make telehealth and other new technologies more accessible to both doctors and patients alike.

Speaking for the American Hospital Association, Executive Vice president Tom Nickels confirms support for the CMS agency’s policies. While the support is present, this association encourages a more expansive approach to telehealth coverage available.

Telemedicine is basically the application of technology to provide health care, especially to people in the remote locations. The doctor and the patient can use either a smartphone or a computer to meet outside of the exam room.

Telemedicine seems to be taking over the health sector and improving lives all across the nation. Delaware, for instance, is placed in a better position of becoming the leader in this latest practice in health care. The technology is soon becoming available even to those who cannot afford some of this equipment.

But in reality, telemedicine has been around for quite some time, previously referred to as telehealth. What could be possibly new is the just the fact that doctors now recognize that ordinary patients now have more access to communication devices like computers and smartphones, unlike in the past.

Telemedicine has greatly helped patients with critical health conditions like Parkinson’s, who are impressed by the idea of not having to visit the physicians regularly to have a series of tests. With this new technology, they can now be tracked at home. Autism patients are also not left behind; they can arrange to meet their doctors at a place of their own choosing.

Delaware, under the legislative leadership of Rep. Byron Short and Senator Hall-Long, passed a law in 2015 that created a system seeking to balance the patient’s safety and access. But more importantly, this law created payment congruence for many insurers in Delaware, which implies that there is not a disincentive for medical practitioners to apply it for attending to their patients.

But all is not well, yet. A federal system called Medicare, for instance, is still unable to cover telemedicine in Delaware. A number of employer plans under ERISA, which is another federal law also does not match the law of Delaware by parity paying for the telemedicine services. In fact, quite a number resolve to use direct-to-consumer service, without noticing the gaps they are creating in continuity care.

But despite all that, physicians should continue to embrace telemedicine and not shy away from it.

Washington’s endless and circular debates over health insurance cannot give a true reflection of reforms in health-care. But the recent progress in telemedicine law that New Jersey has made indicates a great progress in this sector.

Washington’s health-care debate is mainly characterized by varying health insurance visions; affordable care going up against Republican repeal-and-replace; all against single payer. This is far from the type of care such systems of insurance should purchase.

This fight of insurance has been denoted by two main factors; who pays how much and for what services, and who is considered first when it comes to claiming bulks of medical resources largely fixed quantities. This, in the end, ensures that each system comes up with losers and winners.

In the last summer, New Jersey Governor Chris Christie signed the Senate Bill 291 into law, and this elevated the state of New Jersey to a more telemedicine-friendly state. In certain instances, patients will have an opportunity to get prescriptions without having to visit the doctor physically. The law has gotten rid of the need of a telepresenter, who is a basically a health-care assistant who stays with the patient as the electronic communications with a physician goes on.

As a way of satisfying the concerns of the providers in terms of efficacy and safety, the law clearly defined telemedicine to exclude emails, simple phone calls, faxes, as well as texts. Relationships must be very substantial including the transfers of the medical records of the patient to the teleproviders and video conferences. According to this new law, the patients should not worry about undergoing an in-person examination before having a consultation with a teleprovider.

There are also certain possibilities that some components of this law by the state of New Jersey could discourage telemedicine. This is because it foists massive reporting requirements as well as record keeping. Teleproviders are also required to review some medical records before they meet their patients. The patient’s gender, age, and ethnicity to the state must also be reported by the providers.

In summary, this law is likely to enable New Jersey to provide valuable services and present a wider variety of choices for the patients.

The healthcare system has improved a lot in the last decade due to recent advances in network and wireless technologies that are connected with recent advances in ubiquitous and nanotechnologies computing systems. Telemedicine is used to describe the use of telecommunication technology in diagnosing health conditions, treatment, as well as taking care of patients.

This is aimed at offering expert-based healthcare especially to remote locations that are understaffed through the use of improved communication and telecommunication technologies. Telemedicine allows health services to be undertaken using an electronic network, something that has changed the healthcare sector.

There are three main categories of telemedicine; teleconsultation, telementoring, and telemonitoring.

Teleconsultation

This is one of the most widely known categories of telemedicine. It basically refers to the online visit where a consultation between the doctor and patient take place. It can be done through the use of videoconferencing technology or by simply storing a particular picture and forwarding it to the healthcare provider for further interpretations.

Telementoring

This is a situation where one medical practitioner gets mentorship from another, who could be more specialized to find ways of helping a patient. A good example is a doctor who has an autism patient in a rural location and is looking for help in managing that particular patient. The best thing to do is to connect to an established health institution who will have one of their mentors provide assistance online. That is telementoring.

Telemonitoring

This is a case where a doctor receives data from a patient at home while connected to a certain biosensor. It can be done by an electronic scale, a vital-sign monitor, a glucometer or any other any device that can effectively monitor bio-parameter. The doctor will then use the results they have obtained from the test to start administering treatment or prescribe drugs to the patient. This form of telemedicine allows a patient to be easily monitored from home, without having to travel to the health facility.

These are the three major categories of telemedicine.

A large number of established firms in the United States are turning to telemedicine services, launching workplace health centers and pursuing other ultramodern means to provide and pay for healthcare. However, according to recent surveys, there are no possible chances of physical provider visits and other technologies in telemedicine taking over the role of clinical laboratories when it comes to offering the kind of data needed for diagnosing and treating a disease.

But instead, anatomic pathology groups and laboratories are expected to witness changes in the manner in which samples are obtained from patients through the use of telemedicine. As access to telemedicine continues to improve, the laboratories are also expected to see changes on how test results from medical labs are reported.

What Might Happen In 2018

A survey done in May 2017 by the National Business Group on Health revealed that in 2018, 96% of averagely large companies and businesses would avail telehealth services in the states where it is permitted. Telemedicine technology has been divided into three distinct categories; provider-to-provider, remote patient monitoring; and the last one is patient-to-patient.

Using The Current Retail Setups To Promote Telemedicine To Patients

The only tool that can be used to enable consumers to leverage the options of telemedicine that are available to them is the use of small marketing. Providing just a video or telephone visits is not sufficient. An integrated delivery system should be excluded from the playbooks of the retailers.

A practical illustration is how retail giants like Walmart integrate the store experience and online shopping by providing side-to-side options that promote in-store pickup and the delivery of a product. That is the same way telemedicine options are supposed to be offered, in a manner that feels seamless and integrated to the consumer. Offering a simple link to a virtual visit to the network of the healthcare’s webpage for urgent care is one means of doing this.

Telehealth Could Increase Healthcare Spending

Whereas health plans have narrowed into telehealth as a means of driving down healthcare costs, practical visits to healthcare providers might not in any way reduce spending even if the health care access is improved.

What is Telemedicine?

Any type of medical monitoring involving a clinical diagnosis that is delivered with technology can fit within the scope of telemedicine.

For many healthcare practitioners, telemedicine is part of the future of the medical industry. Video conferences allow doctors, medical staff, and patients to efficiently and accurately transmit necessary information. This includes x-ray data, films, photos and remote patient monitoring.

Telemedicine is rapidly becoming the standard for diagnosing minute health issues, such as colds, flu, and infections, as well as handling patients with more serious long-term health conditions.

Telemedicine in Healthcare

According to the American Telemedicine Association, telemedicine is now being used in the majority of hospitals. In 2016, the number of telemedicine consultations was around 20 million. At the current pace, by 2020 there will be around 160 million. In fact, around one-third of all employer groups already factor telemedicine into their group planning.

Telemedicine has allowed physicians to now practice medicine across multiple states, should they meet the eligibility qualifications. The legal regulations have already been passed within the United States.

What Does this Mean?

As telemedicine practice standards, regulations and requirements are put into effect, doctors can now establish patient-physician relationships without in-person meetings. This is a huge step in the healthcare industry, as the issue of patient mobility had not been properly addressed in the past. Additionally, insurance companies are maneuvering to usher in telemedicine into their blanket of covered medical procedures and practices.

Legally speaking, telemedicine will have the same level of liability as face to face meetings with your physician. The standards of care with telemedicine consultations and diagnoses are held to the same level as any other doctor’s appointment. Although this is still a policy that isn’t cut and dry across all states in the U.S.

Of course, telemedicine is a relatively new form of practice, and the methods used are not foolproof. Miscommunication can occur, and diagnoses can go awry when the physician is examining a patient via video conference and not in person. Any malfunctions or problems arising from equipment could cause an error of judgment, or otherwise, mask signs of disease that could easily be noticed with an in-person appointment.

In regards to medical malpractice and telemedicine, we are still working out the issues.

None the less, these issues will be addressed in due time. Telemedicine is an emerging field, one that will ultimately be perfected as it makes a path in the future of healthcare.