Reimbursement for telemedecine

1. Reimbursement for telemedecine Workshop on Telemedicine European Commission DG INFOSOC Brussels, 2 March 2010 Dr Philippe SwennenAIM

2. International Association of Mutual Benefit Societies (AIM) Europe North Africa Subsaharian Africa Middle East Latin America Autonomous health and social protection bodies solidaritynot for profit Funded in 1950 42 members 32 countries 230 million people     (www.aim-mutual.org)

3. Broad range of Telemedicine applications • Tele-Diagnosis: Radiology, Ultrasound, EKG, Holter. • Remote Monitoring of Chronic Patients • Tele-Consultation (videoconference) • Tele Ophthalmology/Dermatology/neuro/pathology… • E-Prescription • SMS, ehealth • Medical Support by Call Center

4. Barriers for telemedicine • Technical issues, including interoperability and infrastructure; • Organisational issues, including users’ uptake, training, financing, and public procurement; • Regulatory issues, including accreditation and certification; and • Legal issues, including personal data protection, reimbursement, liability, tax and competition.

5. Key messages • We are in a transition period, with an effect of ‘’generation’’ (younger generation is born with a computer culture) • We have to tackle all the 4 barriers and particularly the legal barriers • But the barriers cann be solved • Reimbursement barrier does exist, but: • even if it seems a bigger one, it is only a technical one • some conditons to solve the reimbursement issue

6. 27 EU universal health systems BismarckInsurance-based Employers & Employees Public-private mix BeveridgeTax-based Government driven Public provision North East Center South

7. Possible added value of ehealth – telemedicine? Access and equity • Similar health services to members all over the country • Faster diagnosis to remote areas (online). • Extension of service hours. Quality • Improved diagnosis using Digital Tools. • Improved Quality Control and Quality Assurance. • Sharing information among physicians for treatment and consultation • Better quality of life for the patient - Patient empowerment Cost-effectiveness – ROI (less evidence) • Maximization of medical staff time and Answer to shortage of HC providers • Diminution in hospital bed days ? (less complications), less adverse effects, less duplication of medical acts • Diminution in workdays lost, schooldays lost, waiting and travel time for the patient • Paper-less, film-less

8. Conditions for reimbursement • Need to convince payers and healthcare providers that ehealth/Telemed has an added value through • evidence based cases (documentation) • health technology assessment (HTA) of telemedecine with appropriate tools (role of European Commission to coordinate the development of European quality standardised tools) • Evidence on cost benefit analysis - ROIBusiness cases for telemedicine applications (until now majority fails to give evidence; need to clarify definition of business case)

9. Conditions (2) • Need to have a definition of telemedicine within the health law and/or Medical Association (ex France) • Description of the procedures (standard, guidelines.) • Need for training, accreditation, authorisationof HC providers • Need to clarify the legality question • Need to clarify the data protection question • Need of quality assurance

10. Conditions (3) • Reimbursement itself depends of the health system: • question of revision of national nomenclature(standfard tariffs) • or integration in national health financing (NHS) • The trend should be towards: • striving to integrate ehealth/TM in health system and health policies • integrating TM as a tool in the package « chronic disease »

11. Conditions (4) • Need to rethink the reimbursement of providers (chronic disease): • Fee for services / lump sum /capitation / DRG or mixed models • role of incentives and Pay for performance (P4P) • No one-size-fits-all solution, 27 health systemsdifferent systems different solutionsbut need to learn from best and bad practices

12. When telemedicine gives and added value and the barriers are solved , need to pass from pilots to scaling up programmes

13. Key principles • Need of a political will ready to invest • Ehealth/TM should enable solutions to improve the broad scope of healthcare • Facilitate the work and the quality of HC providers • Patient focused to improve their quality of life and empowerment • Ehealth/TM should be thinked in a integrated way: towards integrated care models • Ehealth/TM will become a routine part of Healthcare • Reimbursement will not be a problem in itself • Involvement of the healthcare providers is crucial

14. The main challenge • Telemedicine is a useful tool which can help the organisational problems, but it is only a tool • Substantial effects on healthcare organisation due to - ehealth/telemedicine - Chronic diseases - Long Term Care - Shortage providers / geographical disparities - Budget restrictions - Quality and safety - From hospital to home care - Need of coordination

15. The main challenge is: • Need for HC providers/Gov/payers and patients to rethinktogetherthe organisation of healthcare delivery:need of new visionnary healthcare model towards patient coordinated healthcare • Need to reinforce the coordination between long term care and health care, between primary and secondary care • New role for HC providers (nurse, GP..) • New jobs (case managers,..)

16. Thank you

17. ‘’eHealth for e Healthier Europe’’a report from the Swedish Presidency A report from the Swedish Presidency • 100,000 adverse drug eventscould be avoided yearly through Computerised Physician Order Entry and Clinical Decision Support. • 5 million prescription errors could be avoided yearly through the use of ePrescriptions. • 11,000 diabetic deaths could be avoided every year by the use of Electronic Medical Records and Chronic Disease Management. • 9 million bed-dayscould yearly be freed up through the use of Electronic Health Records, corresponding to a value of €3,7 billion.