Internet Technology: How to make the most of technology in your nutrition practice

1. Internet Technology: How to make the most of technology in your nutrition practice Susan Drake, M.S., R.D. Advanced Nutrition Concepts, LLC

2. Disclosures I am affiliated with SeedingEdge – a company providing remote coaching products.

3. Goals and Objectives • Define tele-nutrition, tele-nutrition tools and how they will impact your practice in the changing healthcare climate. • Apply insurance reimbursement knowledge when incorporating technology into nutrition care. • Understand the research behind remote tools and client success associated with remote tools.

4. Ever Changing Healthcare Climate • Patient Centered Medical Home • Tele-Health / Tele-Nutrition • Economy • Reimbursement • Access to Registered Dietitians – Supermarkets, Insurance Companies, Corporate Wellness Companies

5. Patient Centered Medical Home (PCMH) • Innovative program to improve patient care • Set of Standards to coordinate care • Emphasis on being a TEAM under one roof • Facilitates partnerships between patients, and personal physicians, and when appropriate, the patient’s family • http://www.ncqa.org/tabid/631/default.aspx

7. NCQA (National Committee of Quality Assurance)– Certification Requirements NCQA Recognition programs distinguish clinicians who follow medical evidence to deliver quality care and improve over time. Insurers, medical specialty boards and others use NCQA Recognition to identify providers for quality-based financial incentives and maintain board certification. HEDIS Measures – Outcome driven/Performance Measures. Organizations having to move towards outcome based programs for Risk Reduction.

8. What is Tele…..? • TeleHealth • Passive communication • Generic term • The use of electronic means to support long distance clinical care and education. • TelePractice • Interactive • Engage in Dx, Evaluation and Tx • TeleMedicine • Interactive • Applicable to physicians • Use of medical information exchanged from one site to another via technology http://www.eatright.org/HealthProfessionals/content.aspx?id=11276

9. Communication Passive Communication • Blogs, Websites • Social Media (FaceBook, LinkedIn, Twitter) Interactive Communication • Individual communications • Emails, calls, webinars, video conferencing etc. • Social Media

10. Intra vs. Interstate Communication Intrastate • Communicating with patients within your state Interstate • Communicating with patients in another state

11. TeleHealth Considerations • How will you maintain HIPAA compliance? • Confidentiality matters can arise • Malpractice insurance may not cover TeleHealth • Insurance companies may not reimburse if you are licensed in the state the patient resides

12. HIPAA/HITECH AMENDMENTSBusiness Associate Agreement • Storing Personal Health Information (PHI) • Communicating with clients • Phone • Email • Skype or other • Information disclosure to other parties

13. Are There a Benefits to Telehealth?

14. Remote Coaching:Evidence Analysis Library Evidence Analysis Library What you will find inside the Academy's Evidence Analysis Library: Use Academy Evidence-Based Guidelines to apply cutting-edge, synthesized research to practice!

15. Telenutrition Effectiveness What is the effectiveness of telenutrition interventions and counseling provided by an RD? Conclusion: Consistent evidence reports that telenutrition interventions and counseling provided by a RD resulted in significant improvements in weight, BMI, A1C and/or serum lipids. Additional research on each outcome is needed. Grade I

16. MNT Effectiveness What is the effectiveness of MNT provided using different delivery methods (in-person, phone, internet, email, video conferencing)? Conclusion: Limited evidence showed no significant differences in outcomes between telehealth and traditional in-person sessions. Grade III

17. Cost Effectiveness What is the cost effectiveness, cost benefit or economic savings of telenutrition interventions and counseling provided by an RD? Conclusion: There were no cost effectiveness analyses identified, however limited evidence reports varying differences in cost between telehealth and traditional interventions, depending on the components included. Studies also report significant reductions in travel related costs for patients and their families living in distant locations. Grade III

18. Personal Experiences: Remote Coaching • Decreases financial costs to patient • Defy the economy • Decreases travel time and costs for patient and RD • Increases number of clients you can coach • Is more difficult to establish personal relationship

19. Keys to Remote Coaching Success • Specify expectations with client • What will the client receive and when? • Email, phone call, video conferencing • Schedule specific appt. time • Treat remote coaching sessions exactly like they are in person

20. Remote Coaching Programs Creating a complete program: • Nutrition Management • Fitness Management • Lifestyle and Behavioral Health • Education

21. What to Look for in a Program • Food/Exercise logging tracker • Can you view your clients journals? • Can you message back and forth? • Can you collaborate together online? • Are there education programs? • Is it HIPAA compliant? • Are the data bases up to date? • Are they keeping up with technology? • Does the program create meal plans? • Does the program support recipe creation, meal creation, grocery lists and other features? • Is the program interactive? What do YOU need?

22. Online Education Programs • Ensure they are created by a health professional • Ensure they meet your professional philosophy • Ensure they are evidence based

23. NCQA’s Wellness Standards • Employer and Plan Sponsor Engagement • Privacy and Confidentiality • Engaging the Population • Health Appraisals • Identification and Targeting • Self-Management Tools • Health Coaching • Rights and Responsibilities • Measuring Effectiveness • Delegation • Incentives Management (No Point Value)

24. How Will Tele-Nutrition Impact Your Business? • Increase the number of patients you see? • Increase your revenue? • Improve patient outcomes? • Reach new customer segments? • Penetrate corporate accounts more effectively? • Help you be a part of cutting edge technology • Help you meet your client’s expectations and needs

25. How Will You Charge? What do you need to consider in the year 2013?

26. Accept Insurance or Cash Pay? • Considerations • Clientele demographics • Location in which you are practicing • In-person or remote coaching • Licensure

27. Medical Nutrition Therapy (MNT) Academy of Nutrition & Dietetics Definition: • Performing a comprehensive nutrition assessment determining the nutrition diagnosis • Planning and implementing a nutrition intervention using evidence-based nutrition practice guidelines • Monitoring and evaluating an individual’s progress over subsequent visits with the RD

28. MNT Inclusions RD’s provide MNT and other nutrition services for diseases and conditions including: • Cardiovascular disease, hypertension, dyslipidemia, CHF, Diabetes, Disease prevention, GI Disorders, HIV, Food Allergies, TPN, Enteral Support, Oncology, FTT, Inborn Metabolism Errors, COPD, Renal Disease, Obesity treatment, Bariatric Surgery, Eating Disorders, Pregnancy, Osteoporosis, Anemia http://www.eatright.org/healthprofessionals/content.aspx?id=6877

29. Insurance Reimbursement • MNT disease specific – Diabetes and Renal disease or per insurance company • Becoming a provider for each insurance company • Pre-authorization • Letter of medical necessity from physician • Delay of payment: May have to resubmit • Have patient submit for reimbursement: Super Bill • Your location and clientele may expect it http://www.eatright.org/mntprovider/ TrailBlazerGeneralListserv@ls.trailblazerhealth.com

30. Obesity Reimbursement: Medicare • Physicians, Nurse Practitioners and Physician Assistants can bill for Obesity Treatment and utilize ancillary professionals to do the coaching • RD’s can work under these practitioners • CPT Code: G0047 • Average reimbursement: ~$16 per 15 minutes • Only 1 increment can be billed for per visit

31. How Can RD’s Capitalize on the Medicare Ruling

32. TeleHealth Reimbursement • Medicare reimburses under specific requirements related to rural health access; private insurers will vary • CPT Codes used: 98966 – 98968 • Payment will be contingent upon whether it is a covered service by the individual’s health insurance plan • Licensure may be an issue • May require interactive audio and visual technology http://www.eatright.org/Members/content.aspx?id=7341

33. Licensure • The majority of states have enacted licensure or certification laws that regulate the practice of dietetics • 7 states have no licensure • Other states have either licensure or only have certification • Unlicensed practitioners may be subject to prosecution or sanction for practicing • State licensure or certification typically must be done in addition to registration • Providing MNT across state lines is permitted in some states, but not in others. Check licensure laws where the service is provided. http://www.eatright.org/HealthProfessionals/content.aspx?id=7093

34. State Reciprocity • Some states may allow you to practice in their state if you are licensed in another state • Others do not • Similar to “Nurse Licensure Compact”

35. Bottom Line • Check with the each state • Safest course of action is to become licensed/certified in the state you want to practice

36. Colorado Programs • FitLogix (National Jewish) • GetFit Colorado • Technology Transfer • Weigh and Win (Kaiser) • Remote Scale • 9 News Health Screenings • Results delivered via HIPAA compliant website • IAteGreat • Collaborative and education driven programs

37. In Summary… Telenutrition….. • Is science based • Is an accepted means of client education • Is cutting edge • Will increase the number of patients you can accommodate • Meets many clients needs in a cost effective manner How are YOU going to compete in today’s healthcare world?

38. Thank you! Susan Drake, M.S., R.D. susan.drake@healthin12.net