This article is more than 5 years old. Information may no longer be current.
Telehealth delivery of diabetes education extends staff, personalizes care
Click Here to Manage Email Alerts
ORLANDO — Remote delivery of diabetes education by live webcam presents a practical and cost-effective opportunity to better engage patients in diabetes self-management, a speaker said at the American Association of Diabetes Educators Annual Meeting.
Rynn Geier, MBA, RD, CDE, LD, patient education program development coordinator, Olmsted Medical Center in Rochester, Minn., helped start a telehealth program that extended the network’s reach and helped retain patients who may otherwise have opted out of diabetes education.
“Nine out of 10 of our patients who received diabetes education through telehealth would recommend it to friends and family, and the staff showed high satisfaction, too,” Geier said.
Olmsted Medical Center, a health complex with a main clinic and 10 satellite facilities throughout southeast Minnesota, employs more than 200 clinicians and 1,000 employees. The staff sees about 600 patients annually (80% people with type 2; mostly Caucasian; average age, 54 years).
Ninety-two percent of participants in the program were brand-new to diabetes education and had never received in-clinic education before.
Developing telehealth programs
Geier said a key to early program development was that the facility found a champion for telehealth who worked in the psychiatric services department; psychiatric services via telehealth are covered by Centers for Medicare and Medicaid Services, which boosted the facility’s budgetary considerations to found the program.
The budget for developing telehealth care for diabetes education should include start-up costs, including equipment, marketing and resource costs, staff time, and any consultancy or project planning fees, which can save costs overall, according to Geier. Having a consultant review the facility’s current care model was helpful:
“The biggest tip the consultant gave us was understanding our process flow. You need to dissect this ad nauseum, from both the patient perspective and the staff perspective. … You need to identify who is responsible and what materials are used with each patient.”
After the process flow was well-developed and reviewed, Geier’s team secured resources, including staff and funding, for the project.
The last step of program development was to recruit staff and patients to participate in the first implementation of the program. Staff were trained, with full troubleshooting practice and protocols, before the first patients were brought in.
Patients were recruited through marketing materials like brochures, a mailing, and a page on the health center’s website.
Software, hardware requirements
To run the telehealth program, the health care center uses Vidyo software, a popular video chat that is HIPPA-compliant. The center also uses DeepFreeze and LogMeIn for daily operations. The center uses a webcam, dual monitors, and a combination speaker/microphone set on the health care provider’s end. The patient sits in a remote exam room with similar hardware, including a 27-inch touch screen monitor. The large monitor is used so that the health care provider’s image is a lifelike size, which is intended to provide patients with a seamless experience, Geier said. Additionally, a rolling version of the telehealth cart with computer and monitor can move from exam room to conference room, or from one facility to another.
Billing details
For patients who receive telehealth counseling, the counseling must meet certain Medicare/Medicaid Criteria, Geier said. Specifically, the care beneficiary must be present (99201 GT modifier), and the education must be an approved DSMT program (HCPCS codes G0108 and G0109). There is a list of qualified health care providers who can provide care in a telehealth diabetes education program, including physicians, nurse practitioners, physician assistants, nurse midwives, clinical nurse specialists, clinical psychologists, clinical social workers and registered dieticians. Finally, Medicare/Medicaid lists several specific settings that are appropriate for telehealth programs, including physicians’ offices, hospitals, rural health clinics, skilled nursing facilities and more.
Geier noted that there are some limitations to telehealth diabetes education, and that it may not be suitable for all patients and scenarios.
“One thing we take for granted is the exchange of information by hand,” she said, adding as an example that taking a blood glucose reading on the fly is impossible in telehealth care.
Disclosure: Geier stated no relevant financial disclosures and noted that she received no compensation from the aforementioned software and hardware companies.