Presentation on theme: "IMPLICATIONS FOR COST, QUALITY, AND ACCESS TO HEALTHCARE SHANNON C. SCOTT, DO HEALTH POLICY FELLOWSHIP 2012-2013 OSTEOPATHIC."— Presentation transcript:
E-HEALTH@YOURPROVIDER.COM IMPLICATIONS FOR COST, QUALITY, AND ACCESS TO HEALTHCARE SHANNON C. SCOTT, DO HEALTH POLICY FELLOWSHIP 2012-2013 OSTEOPATHIC FAMILY PHYSICIAN
Patient Access The public wants access to e-health technology and the ability to communicate with their physicians via email. 2012 Harris Interactive Poll (n= 2,311)
E-Health Challenges Cost of health information technology (HIT) Work load changes Reimbursement State licensing requirements Quality of care issues Safety and security of transmitted information
What is E-Health? Over 50 different definitions – Creates health policy confusion Umbrella Term – Telemedicine – Telehealth – E-mail Synchronous (real-time) video, audio Asynchronous (delayed-time) e-mail, text msg
Electronic Health Records By 2012, 72% of physicians have an EHR 7% use email to communicate with patients EHR Costs: Implementation and maintenance Meaningful Use incentive programs assist but do not reimburse. As high as $80,000 over four years per provider Meaningful Use Stage 2 - Jan 2014 Requires “providers to use secure e-mail with patients” to qualify for incentive payments
Reimbursement of E-health Limited in both private and federal programs In some states Medicaid pays for Telemedicine Private payer CPT 99444 exists – Many limitations to use of code Cost of health IT ≠ reimbursement
State Medical Licensing Issues Policies differ among states regarding e-health Full license required to practice electronically – Limited to the state where the patient lives Unintended consequences – Expensive and time consuming to obtain multiple state licenses – Decreased access to care – Proposal of national medical license
Security Increased physician and patient risk when using e- health on unencrypted sites. Un-secure Messages – Manipulated – Forwarded – Read by unintended recipients – Contain protected health information (PHI)
Three Pilot Projects Group Health Cooperative 2003 “Shared Health Record” Online medical records Secure email messaging 235,000 (54%) of eligible adults accessed services 1,055 physicians engaged 23% of their encounters now occur via secure messaging Replaced 27% of office visits and 66% of telephone calls Kaiser Permanente Experience 2004-2010 “Suite” online services 2.3 million (64%) members enrolled by 2010 7,000 physicians had received over 5.8 million secure messages 35,423 patients who used secure messaging had a reduction in office visits and an increase in health quality outcomes Virtuwell/ HealthPartners Minnesota and Wisconsin 2010 Online health care service Medicare coverage Accessed by 40,000 patients Visits screened by nurse practitioners via protocol $88 savings per visit In-person office visits were displaced by 90% 94% patients satisfied
Pilot Project Feedback Critical to the success of each program included attention to provider work flow, reimbursement, and organization of the information transmitted electronically. Access Quality Cost
Recommendations: Payment Reform Traditional fee-for-service will not support e-health. Develop e-health business models for private insurers. Overhaul federal e-health incentive programs. – The MU program designed to run through 2016 should be lengthened instead of assessing penalties.
Recommendations: State Medical Licensing Develop uniform licensure rules among all states. State medical licensing boards retain control of all licensing fees and disciplinary regulation. Integrate all medical licensure into a national database. Establish clear definitions among electronic health subsystems for policy making groups. Prevent telemedicine or e-health from being singled out as a medical specialty or granted special license.
Recommendations: Security Secure confidential information through a patient portal. – Adhere to HIPPA and AMA medico-legal guidelines. National policy making groups collaborate regarding security. Educate physicians through CME on E-health best practices. – Recommend clear practice policies regarding: Message response times The amount of information transmitted electronically Types of conditions treated with e-health technology
Well-designed e-health systems have the potential to increase physician efficiency, patient engagement, and health outcomes. The full potential of e-health is yet to be understood; virtually every patient could be touched by this innovation.
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