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Learn The Lingo

Learn the Lingo: Key Terms for Navigating the Value Based Care World

With the shift toward value-based payment models, pharmacists are seizing new opportunities to improve patient care in medical homes, accountable care organizations, and other innovative care models. This resource includes acronyms and terminology commonly used when practicing in or discussing innovative practice models. Each term includes a short description and references so you can further your practice in a value based care world. This is the first of multiple volumes that will be published by the Medical Home/ACO SIG.

Published on Friday, March 11, 2022

Telehealth

Definition: Telehealth is defined as the exchange of medical information through electronic communication to improve a patient’s health.¹ Although often used interchangeably with “telemedicine,” telehealth encompasses a broader array of services and activities. Telemedicine solely describes the use of telecommunication to provide health care directly to a patient, while telehealth includes talking to a doctor live via phone or video chat, sending/receiving secure messages between providers, and remote monitoring of medical devices. Telehealth is one element of digital health, which is a broader term that includes “disruptive technologies that provide digital and objective data accessible to both caregivers and patients.”2 Examples of technologies that provide digital data include wearable devices and mobile health technologies.

During the COVID-19 pandemic, there has been an increased use of telehealth. The Office for Civil Rights (OCR) at the Department of Health and Human Services (HHS) recently released a notice allowing for the use of common platforms such as Apple FaceTime®, Facebook Messenger® video chat, and Zoom® during the COVID-19 public health emergency (PHE).3 This has further increased utilization of telehealth communication methods; however, a change in technology will be needed if this is not maintained after the PHE ends.

How it relates to ACO/PCMH: Under the PHE, Centers for Medicare and Medicaid Services (CMS) is reimbursing providers for telehealth services, including services rendered from primary care providers, in addition to specialists including but not limited to physical therapy, occupational therapy, and ophthalmology.4,5 The majority of the services billable for telehealth can be conducted via video conference applications. Furthermore, many clinical pharmacy services have shifted to telehealth as well, while others have remained in-person.6 The positive impact on patient care due to pharmacist interventions delivered via telemedicine has been well-documented.7 As access and utilization of telehealth services have increased, it is critical to note if patients are satisfied with care delivered through this medium, as patient satisfaction scores play a role in reimbursement as an important quality measure.4,8,9 A meta-analysis published in the British Medical Journal included 44 articles to evaluate factors associated with patient satisfaction in the context of telehealth, and overall patients reported moderate to high levels of satisfaction with telehealth services, with some studies reporting patients preferred telehealth visits over in-person visits.9 Some factors associated with high patient satisfaction scores include improvement in behavioral outcomes, decreased waiting times, reduced travel time, and increased access to services.

Involved organizations/oversight: As long as HHS continues to designate the pandemic as a PHE, CMS is likely to continue to reimburse for telehealth services using the expanded flexiblities.4,5 Telehealth reimbursement among commercial payers is highly variable; however, many states have enacted new rules broadening the use of telehealth, resulting in commercial payers following suit.9,10,11 When considering billing for telehealth services, it is important to understand the specific state and federal regulations that may apply, such as required documentation elements. Once the PHE designation is lifted, we may see changes to telehealth billing models.

Resources:

1. Tuckson RV, Edmunds M, Hodgkins ML. Telehealth. N Engl J Med. 2017;377(16):1585–92.

2. Meskó B, Drobni Z, Bényei É, et al. Digital health is a cultural transformation of traditional healthcare. Mhealth. 2017;3:38.

3. HHS. Notification of enforcement discretion for telehealth remote communications during the COVID-19 nationwide public health emergency. HHS.gov. https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html

4. Centers for Medicare and Medicaid Services. List of telehealth services. CMS.gov. https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

5. HHS. Telehealth: What to know for your family. CMS.gov. https://www.cms.gov/files/document/c2c-telehealth-patient-toolkitdigital508c.pdf

6. Traynor K. Pharmacists turn to telehealth to meet patients’ needs. ASHP: Pharmacists advancing healthcare. https://www.ashp.org/news/2020/07/29/pharmacists-turn-to-telehealth-to-meet-patients-needs

7. Niznik JD, He H, Kane-Gill SL. Impact of clinical pharmacist services delivered via telemedicine in the outpatient or ambulatory care setting: A systematic review. Res Social Adm Pharm. 2018;14(8):707–17.

8. Robinson J, Borgo L, Fennell K, et al. The Covid-19 pandemic accelerates the transition to virtual care. NEJM Catalyst. https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0399

9. Kruse CS, Krowski N, Rodriguez B, et al. Telehealth and patient satisfaction: A systematic review and narrative analysis. BMJ Open. 2017;7(8):e016242.

10. American College of Physicians. Private payer coverage during COVID-19. ACP Online. https://www.acponline.org/system/files/documents/clinical_information/resources/covid19/payer_chart-_covid-19.pdf

11. Augenstein J, Marks J, Morgan V, et al. Executive summary: Tracking telehealth changes state-by-state in response to COVID-19—July 2020. JD Supra. https://www.jdsupra.com/legalnews/executive-summary-tracking-telehealth-74025/

 

Contributing Authors:

Armen Fstkchian, PharmD, BCPS

University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences

 

Jarrett Bremmer, final-year PharmD candidate

University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences

 

Sara Wettergreen, PharmD, BCACP

University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences

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Author: Annette Jones

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