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Sleep doctor talks about making telehealth work

For our article on telehealth in the current Part B News, we spoke to Seema Khosla, M.D., a fellow of the American Academy of Sleep Medicine and medical director of the North Dakota Center for Sleep in Fargo, N.D., which utilizes telehealth in its work. (Dr. Khosla has also contributed to a scholarly paper on the interface of sleep medicine and telehealth.) To follow are some excerpts from our interview:

Part B News: Many physician practices don't bother with telemedicine or telehealth because, outside of HPSAs, Medicare Part B doesn't do much with it. Are there reasons to give it a second look?

Dr. Seema Khosla: I believe so – many practices have multiple commercial payers that may actually cover telemedicine services. I know that we utilize Medicare criteria for many things but this may be one area where commercial payers may already be covering these services. It is a way to start small and build up your practice. The other thing (and probably the more important factor) is that many areas qualify to be HPSAs – even those near metropolitan cities. Before dismissing the possibility, I would suggest going online to see if there is an area nearby that qualifies. Many of my colleagues who have done this are pleasantly surprised to see that they already service some of these areas.  

Are there care and business opportunities through other payers or even a self-pay model for telemedicine that physician practices should consider?

There are various programs that offer a cash-pay model. Even the American Academy of Sleep Medicine has a program, called AASM SleepTM, that will assist with both the actual visit utilizing their program but also the billing aspect – they recently introduced a self-pay model as well. There are many commercial products available that pay the physician per online consultation. Those patients are cash-pay patients who are looking for medical providers through telemedicine.

How is telehealth working out for you?

So far, so good! We have been doing this for just over eight years. We grow and change depending upon both regulatory issues and patient demand. We are currently looking into developing telemedicine programs across state lines. This brings with it new challenges, but since our practice is small we are able to be nimble.

Are there "extra care" opportunities that make it worthwhile (e.g., for chronic care management)?

One recurring theme has been with the new compensation models – if we can minimize hospital readmissions by seeing patients in their home or in a skilled nursing facility, making a few medication adjustments or adjustments to their positive airway pressure device, perhaps we will be able to intervene at a much earlier time and prevent clinical deterioration by picking up on more subtle signs and symptoms – not making patients wait until they are sick enough to go to the hospital.

What would you say to physicians who just want to wait till Medicare loosens up on originating sites?

This may depend upon your comfort level... I believe we can either create the program we want or wait for someone else to create a program for us. If we accept this wholeheartedly, we are then in a unique position to define our program and run it according to what we feel best serves our patients’ collective needs. Clinicians usually are better patient advocates than non-clinicians. We should be part of the decision-making process.

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