March 1, 2011
Attendees (phone and in-person):
- Kathy Webster, Loyola University Medical Center
- Jeff Bennett, SIU, Springfield
- Judy Storfjell, UIC College of Nursing
- Joshua Server, SIU
- Robert Wesley, SIU
- Julie Bonello, Access Community Health
- Laura Zaremba, Office of Health Information Technology (OHIT)
- Wes Valdes, UIC/OHIT
- Mary McGinnis, OHIT
- Mark Chudzinski, OHIT
- Sunil Hazaray, American Telemedicine Association
- Linda Reynolds, Effective Community Involvement
Wes Valdez opened the meeting with introductions and roll call. Wes led the group to approve the minutes report from the last meeting, with minor corrections on participants' names and organizations.
Laura Zaremba provided an update, on the progress of the ILHIE. The Authority Board has been confirmed by the state Senate, with a date for the Inaugural Meeting set in April 2011. Now that the Authority Board is seated the work to meet the statutory requirements can begin. The Advisory Committee will be appointed by the Authority Board Members and this committee will be another forum for stakeholder input. If the work groups have been working on specific policy or have specific recommendations, they can put something together for the Authority Board to review and consider.
Wes provided an update regarding a meeting that he had with representatives from Healthcare and Family Services (HFS). Wes discussed a list of questions for HFS from the last work group meeting, and received positive feedback. Some of the questions included coverage for the "store and forward" method of sending telehealth information, coverage for telehealth services provided to nursing homes, and a few other claims coverage questions. At present, HFS is paying for telehealth services. However, the question about the need to have two licensed healthcare professionals for mental health patients' needs additional review and clarification.
Julie Bonello asked for clarification on the definition of 'licensed professional.' For example, if she wanted to start a virtual clinic, can a licensed professional also be someone who is responsible for equipment? If a nurse is used for this purpose, then the nurses would be working below their training and profession. Wes agreed, and stated that having the other licensed professional present during these sessions brings up privacy and security issues. Julie added that this is especially true with psychiatric patients. Having the third party professional present is not only a barrier for communication, but it is also an extra expense that makes the session less cost effective.
Jeff Bennett added that there could be cases where third party professionals are needed, as in visits with elderly or disabled patients, and stated that additional reimbursement would be warranted for their services. Because telehealth services require interdisciplinary teams, it may be helpful to understand how to properly reimburse for different type of patients.
Wes asked if additional reimbursement would help the federally qualified health care centers. Julie stated that it would be great to understand the service modalities that would require those services, so we can better define telehealth performance. It was suggested that the work group should work on providing a standard template for all organizations to understand the cost analysis. Sunil Hazaray agreed, and said the American Telemedicine Association can assist the State of Illinois with developing this matrix. Kathy Webster added the business plan matrix already exists on the ATA Web site.
Laura inquired about the private sector payer's position on reimbursing telehealth services. Wes responded that Jim Anfield, from Blue Cross/Blue Shield of Illinois, is a member of the work group and generally offers insights from this perspective. Wes indicated that the subject of reimbursement for telehealth is a frequent topic for discussion, and that coverage varies from state to state. Wes mentioned that some states have mandated telehealth legislation, and this group may think about bringing this topic for review by the Authority Board.
Bob Wesley asked if the group had decided on mandating telehealth reimbursement, to which Wes responded that the work group has not done so. Bob said the push back from third party payers will happen either way, so we would not lose anything if we recommended it to the Authority.
Laura wanted to be sure that the work group understands that the Authority is charged with establishing policies and standards to statewide information exchange. Reimbursement is outside of the scope of their statutory responsibilities. The focus of this work group should be on the promotion of telehealth and its use.
Wes said that while we are not going to propose mandating telehealth reimbursement to the Authority, we can bring up the issue of the third party professional. Jeff agreed to draft a document on why this third party professional issue is important, and then it will be circulated to the work group. The work group wanted to include the question of whether a resident trainee can bill for attendance.
Linda Webster had an addition comment about the third party professional, in an emergency setting for mental health patients, a third party professional would be very helpful. Wes agreed and stated that the environment, and setting this issue takes place in, is an important factor to consider.
Wes provided an update on Illinois House Bill 107. Wes received a call from AHA stating that HFS had to develop policies for telehealth reimbursement. Representative Naomi Jacobsen, from Champaign, is now sponsoring the bill. There may be an opportunity to speak to Rep. Jacobsen and discuss mandating telehealth reimbursement. Wes stated that the work group can circulate the other states' mandate bills. HB 107 is to mandate HFS to develop policies on telehealth reimbursement, which seems redundant, because of the rules that are already in place.
The work group began a discussion about credentialing and privileging. Josh asked about the practice of allowing hospitals, in Illinois, to assist other hospitals in credentialing. Does one hospital credential the physician, or do multiple hospitals credential for the same physician through a separate process? Jeff proposed to review the credentialing process to see if there was any progress in achieving the goal of reducing redundancy. Mary McGinnis offered that the Master Provider Directory can be a solution to the credentialing problem. The first step is to build a comprehensive, robust directory. It is noted that other states have a function in their directories that credential doctors and professionals, but it is not determined that Illinois will offer that service. Laura emphasized that if adding the credentialing component in the Master Provider Directory was important to the work group, then it should be brought up as a recommendation to the Authority Board.
Mary McGinnis said building the Provider Directory is a core service of the ILHIE and that OHIT plans to gather as much information as possible upfront, to populate the Directory. The Directory implementation process will begin in 2011. OHIT is currently talking to representatives from the Wisconsin Medical Society, regarding how their provider directory was developed, and the steps needed to incorporate the directory into the state HIE. The WI directory is not accessible for public viewing, because the information on it is privileged and confidential.
The purpose of a separate credentialing process for telehealth was discussed. Josh stated the importance of a separate credentialing process for telehealth, so physicians do not have to credential with each individual hospitals they may work with. In this scenario, physicians and professionals only have to credential themselves once with the state, therefore eliminating redundancy. Judy stressed the importance of the distinction between credentialing and privileging. She is concerned that citing examples such as these will narrow the definition of telehealth. Judy reminded work group members to remember that credentialing is not restricted to just hospitals, but also includes clinics, tele-monitoring, pharmacy, advanced nursing, and/or dentistry. Wes agreed that the language may need to be tweaked a bit because we are discussing all of telemedicine.
Mary McGinnis mentioned the USDA grant opportunity that was sent to the work group earlier today. Mary cited many instances in which distance learning and telemedicine grants were given for telemedicine service expansion. Wes added, that although this grant is interesting, UIC has decided not to pursue this opportunity. Wes suggested that perhaps smaller, rural areas should focus on it. Bob Wesley indicated that he spoke to the FDA about it, and has also decided not to pursue the grant. The grant's focus and Southern Illinois's focus are two different things at the moment. Where the grant focuses on distance learning, Southern Illinois is focused on how to pay for telemedicine and clinical care. Bob also requested that Josh Server and Glen Graver be added to the work group.
No additional comments were made.