LOOKING FORWARD IN THE PROFESSION TO TELEMEDICINE

“GOOD MORNING, Mrs. Smith, what did you need to see me about this morning?”

“Well doctor, I woke up with my eyes stuck shut with some crusty stuff, and they are kind of goopy now and very red.”

This describes the beginning of another day, another case history, another office visit, right? Maybe not, if Mrs. Smith isn’t actually in your office — and neither are you.

Welcome to the year 201X; today is Thursday and your morning provides remote care.

LOOKING FORWARD

The practice environment of today is vastly different from that of the recent past. The technology we love in our smartphones, cars and watches is the very technology we are fighting in our profession. The use of artificial intelligence (AI) has been in medicine for years, for example IBM’s Watson Health, and will continue to proliferate and, perhaps even dominate, the landscape in the not-too-distant future.

Delivering health care remotely is a growing area carriers — and third party coverage companies — are working to cover. Telehealth and telemedicine are methodologies of delivering care when the physician and patient are separated by distance and using telecommunication technologies.

As recently as November, CMS broadened its coverage of telemedicine services to include health risk assessments and chronic care management, according to MedCityNews. The foundation of the policy clearly states it is focusing on “patient-centered innovations,” whereas previous CMS policies contained disincentives for physicians to embrace telehealth.

Eye care is a profession poised to take advantage of these concepts and technologies. We are a profession where much of the diagnostic testing we provide is based on digital imagery that can be transmitted, evaluated and attached to a diagnostic or treatment plan.

Office visits for medical eye care issues can also easily be conducted via remote telecommunication. Current codes, approved by CMS in eye care for remote office visits, primarily applicable to us: Evaluation and Management codes, 99201 – 99205 and 99212 – 99215. However, the ophthalmic codes 920XX are not approved by CMS for telemedicine coverage or reimbursement. From a procedural basis, only two CPT codes, both of which were effective January 2011 for ophthalmic imaging, are approved for telemedicine:

92227 – Remote imaging for detection of retinal disease with analysis and report under physician supervision, unilateral or bilateral.

92228 – Remote imaging for monitoring and management of active retinal disease with physician review, interpretation and report, unilateral or bilateral.

Virtually all guidelines specify that any encounter has to be a face-to-face video encounter, where the physician and patient interact. Some guidelines are more restrictive on where the patient must be, i.e. in a federally qualified healthcare facility or at their home. Nonetheless, this is an important juncture in how care is delivered. And make no mistake ­— we are not the only players. Companies, like Walgreens, CVS, and others, are figuring out how to deliver care to non-urban America, where there are shortages of physicians and specialists.

CHANGE IN DELIVERY

Telemedicine is going to transform healthcare delivery. With AI, these may very well transform our profession and our relevance in the healthcare system. It is worth your time to get familiar with the present and future potential to figure out how you can incorporate these concepts successfully. OM

DR. RUMPAKIS is founder, president and CEO of Practice Resource Management, Inc., a consulting, appraisal and management firm for healthcare professionals. Email him at John@PRMI.com.