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Welcome to the March 2016 issue of the Washington Rural Health Association e-Newsletter. Inside this issue you will find news and information from the new 2015-2016 President and board of directors, members, and community partners from across the state of Washington.
If you would like to submit your own story, please click here.
The WRHA e-newsletter is a publication of Washington Rural Health Association, a not-for-profit association composed of individual and organization members who share a common interest in rural health. This e-newsletter seeks to disseminate news and information of interest to rural health professionals and stakeholders to help establish a state and national network of rural health care advocates.
WRHA Members
WRHA members include administrators, educators, students, researchers, government agencies and workers, physicians, hospitals, clinics, migrant and community clinics, public health departments, insurers, professional associations and educational institutions. If you are interested in joining or renewing your membership with WRHA click here.
**Please note: Effective 9/30/15, transition of the WRHA management included a new PO Box address and phone number. This contact information has been updated in several locations on our website, as well as directly on the internal invoices created when renewing a membership or sponsorship. Please ensure your internal AP systems have the correct address for mailing payments to the WRHA. Thank you for updating your records!!
Health care services have traditionally been conducted through face-to-face exchange of information between provider and patient, but advanced technology has changed how, when, and where patient care can be delivered. For example, many patients prefer to communicate with their provider online, patient portals allow patients immediate access to their medical information, and providers can collaborate about patients via telemedicine, which has become a cost-effective alternative to face-to-face patient services.
The term “telemedicine” refers to the remote diagnosis and treatment of patients by means of telecommunications technology. For Medicare payment to occur, interactive audio and video telecommunications must be used, permitting real-time communication between the distant site physician/practitioner and the Medicare beneficiary. Commercial payers are beginning to follow Medicare payment guidelines and are also creating innovative ways of paying for health care services outside the scope of a traditional face-to-face encounter. You will need to review your payer contracts for the specific payment policies related to telehealth services.
To ensure Medicare coverage, however, a telehealth service must be: • On the list of covered Medicare telehealth services (see below). • Furnished via an interactive telecommunications system. • Furnished by a physician or other authorized practitioner. • Furnished to an eligible telehealth individual. • Furnished to an individual receiving the service in a telehealth originating site and participating in the telehealth visit. When all of the above conditions are met, Medicare pays a facility fee to the originating site (the location of the Medicare beneficiary at the time the service is being furnished) and a separate payment to the distant site practitioner (at the site where the physician or practitioner providing the professional service is located at the time the service is provided).
Medicare beneficiaries are eligible for telehealth services only if the originating site is located in a rural Health Professional Shortage Area (HPSA) located either outside of a Metropolitan Statistical Area (MSA) or in a rural census tract or in a county outside of a MSA. Entities that participate in a federal telemedicine demonstration project approved by (or receiving funding from) the Secretary of the Department of Health and Human Services qualify as originating sites regardless of geographic location. Each calendar year, the eligibility of an originating site is established based on the status of the geographic area as of December 31 of the prior calendar year; eligibility continues for the full calendar year.
Medicare eligible telehealth services include (see the complete list at the link at the end of this article): • Office or other outpatient services. • Outpatient mental health services. • Health and behavior assessment/intervention. • Outpatient substance abuse services. • Transitional care management services: o CPT 99495 & 99496 • Complex chronic care services for patients with multiple chronic conditions under certain conditions: o CPT 99487 & 99489 • Prolonged service inpatient procedures: o CPT 99356 & 99357 • ESRD-related services for home dialysis: o CPT 90963 – 90966
The above services may be billed (subject to state law) if they are performed at the “distant site” by a physician, nurse practitioner (NP), physician assistant (PA), certified nurse midwife (CNM), clinical nurse specialist (CNS), clinical psychologist (CP), clinical social worker (CSW), CRNA, or a registered dietician or nutritional professional.
The opportunity for telemedicine services is growing rapidly, faster than reimbursement at this point. For example, some new innovative ways that telemedicine is being used include remote patient monitoring for population management and remote intensive care monitoring through eICU programs (e.g., early warning signs of sepsis). With the right tools and technology, many other opportunities will be created for remote patient care services.
There are many benefits to providing services via telemedicine. It mitigates access barriers related to distance, increases efficiency of tertiary centers, keeps health care dollars in local communities, and likely reduces health care costs. In addition, it can improve overall quality of care by: • Allowing patients to be seen more quickly and in a location they can get to, particularly for specialty care. • Improving communication among providers. • Educating both the consultant and primary care provider. • Increasing satisfaction for the patient and the provider. • Increasing local perception of quality of care.
Coding and Documentation for Telehealth Services
The originating site (where the patient is) should report the HCPCS code Q3014 (telehealth originating site facility fee) under type of service 9 (other items or services) in the place of service 11 (office). This facility fee is a separately billable Part B service. For the professional service (at the distant site), the CPT code for the specific service provided would be reported, appended by the GT modifier (via interactive audio and video telecommunications system).
Strategies for Successful Implementation In order to ensure an efficient implementation in your organization, be sure to: • Obtain institutional and administrative support for telemedicine services. • Integrate with existing infrastructure for documentation/coding/billing processes. • Start with low hanging fruit services where opportunity exists to address specific patient needs that are not currently being met. • Identify the outcomes you wish to measure and develop a system to do so. • Develop (and share) quality metrics, demonstrating the “win-win” for both sides. • Partner with policymakers and support further enhancements to reimbursement for telemedicine services.
INHS Health Training offers a Paramedic Program at their training facility in Spokane. At completion, students will receive certification as a Paramedic in the State of Washington and the National Registry of EMTs. The program follows the U.S. Department of Transportation Paramedic National Standard guidelines. Students are expected from throughout the Pacific Northwest and nationally. Other classes taught at the training facility by INHS include professional medical education classes for EMS providers and health care workers including continuing education courses and certification courses (EMT, EMR and Advanced EMT).
Lowell Hensley of Electric City, Wash., more than 85 miles from Spokane, was out to dinner with his wife and friends when he felt chest pains. After returning home, the pain worsened and he and his wife headed to the nearest emergency room, located in Grand Coulee. "The doctor ran some tests and said I had a heart attack," Lowell says. "He told me they were calling Northwest MedStar; they would be there in 20 minutes and take me to Providence [Sacred Heart and Medical Center] in Spokane." Minutes later, Lowell was loaded into a NW MedStar helicopter and flown to Spokane for medical care. "I enjoyed talking to the [MedStar] crew," Lowell says about the flight. "They took good care of me. I had the headset on, so I got to hear what was going on the whole time." After Lowell received two stents for the blockage in his heart, he returned home in just a few days-thankful to be members of NW MedStar with the assurance the critical care transport costs left after insurance would be covered. "I remember when we signed up a few years ago," he adds. "I would have bet you money we would never have to use it. And now, people I know signed up after my experience. They know how important it is." Membership is never a factor in being transported by NW MedStar; it can simply provide peace of mind by covering out-of-pocket costs insurance doesn't. "I'm 79," Lowell says, "and when you're my age you can have problems like stroke or heart attack. It makes me feel good to have NW MedStar close by." "I want to commend MedStar on how quickly they got me to Sacred Heart," he says about his experience "I'm very happy we have them in our area-I think they save a lot of lives."
To learn more about how to become a part of the NW MedStar Membership Program, please visit: www.nwmedstar.org/Membership/.
Submitted By: Jodi Perlmutter 2016 Conference Chair and CEO of Western Washington Area Health Education Center
The 2016 Northwest Rural Health Conference, Taking Charge of Change
Over 450 people attended The Northwest Rural Health Conference this year. According to the conference management company this is an all-time high for the conference! The number of vendors who exhibited exceeded all expectations and sponsorship funding grew with the addition of a $10,000 benefactor sponsor category.
This year the conference went through transformation. The planning of the conference fell right in line with the theme of the Conference, "Taking Charge of Change". What did we change?
• Change in the conference location. The conference location has been static for over 26 years. The new location allowed for more vendors, had adjacent upgraded lodging and an upgraded conference center space. There were many positive comments about the change in venue from participants, such as: 1. Better adjacent hotel accommodations 2. Bigger space for the exhibitors 3. Significantly more staff support from the Convention Center compared to the previous conference site.
• Change in the conference vendor management
• Combining the Rural Health Clinic Association Conference with the Northwest Rural Health Conference and an EMS section 1. Overall feedback related to this change was positive 2. The Rural Health Clinic Association has some additional ideas for better integration for next year. 3. Adding the EMS section to the first day seemed well received 4. The Critical Access Hospital section was more focused on Washington State.
The evaluations from the program demonstrated that the speakers were well received, inspirational, relevant and engaging. I want to thank the planning committee, the sponsors, the major stakeholders, and WSU Conference Services. Planning is underway for next year’s conference. The conference chair for 2017 is Lindy Vincent. Lindy is the new FLEX Coordinator at the Department of Health, Rural Health section. Lindy comes to the Department with national conference planning experience and will be a great asset to next year’s conference.
Shriners Hospital for Children, Spokane is pleased to introduce Dr. Glen Baird, M.D. as its new chief of staff. Joining the Spokane Shriners Hospital staff in 1999, he served as assistant chief of staff for over nine years. Dr. Baird succeeds Dr. Paul Caskey who retired as chief in 2015 after over a decade in the position. Dr. Baird, one of the board certified, fellowship trained pediatric orthopaedic surgeons at the Spokane Shriners Hospital, is also one of a select group of Ponseti Method (a treatment for Club Foot) preferred providers in the United States. This designation stems from having had one-on-one training with Dr. Ignacio Ponseti who developed this non-operative method of treating Club Foot. Dr. Baird is also the Medical Advisor for the Movement Analysis Laboratory, which uses state-of-the-art technology that captures 3D images of patients as they move which assists in diagnosis and treatment decisions for children with neuromusculoskeletal conditions. The Spokane hospital's laboratory is one of only 8 fully accredited labs in the nation and the only one in the Inland Northwest. Dr. Baird received his medical degree from Utah School of Medicine, completed his orthopaedic surgery residency at the University of Wisconsin followed by a fellowship in pediatric orthopaedics at the Los Angeles Children's Hospital. He specializes in club foot treatment, sports medicine, and general orthopaedic surgery. Dr. Baird holds teaching appointments for the University of Washington School of Medicine as a courtesy clinical instructor and for Pacific Northwest University of Health Sciences as an adjunct assistant professor.
Thank you to all who submitted nominations for the 2016 Annual WRHA Awards, we appreciate your input and feedback of excellent suggestions about rural health supporters in Washington state. Congratulations to the following for their awards:
Winner of the Outstanding Contribution to Rural Health Award is Thomas Martin. Mr. Martin was nominated by Tyson Lacy, CEO and Timothy O'Connell, CFO at Lincoln County Hospital District No. 3.
Winner of the Dr. John Anderson Memorial Award for Outstanding Rural Health Practitioner Award is Dr. William Hurley. Dr. Hurley was nominated by Renee Jensen, CEO at Summit Pacific Medical Center.
Winner of the Mary Selecky Friend of Rural Health Award is Jeff Mero. Mr. Mero was nominated by Ben Lindekugel and Beionka Moore both of the AWPHD.
Please see the full page of details and list of all past winners on our website here.
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