e Consult overview Oct 2019 Ronald Tamler MD

e. Consult overview Oct 2019 Ronald Tamler, MD, Ph. D, MBA Director, Digital Health Implementation, MSHS

What Are e. Consults? • • e. Consults are consultations sought by one provider from another through an electronic portal – in this case Epic for providers at MSHS and Epi. Care Link (ECL) -> EPIC for our community partners “Store and forward" workflow, allowing for asynchronous consultation The consulting physician does not interact with the patient, but may help facilitate an appointment Insurance is now billed for the triage work flow. Literature and our own experience shows reduction of inperson visits by 30 -70% Work flow of e. Consults to triage referred patients already in long-standing use at VA, other nationally known integrated health systems, increasingly H&H Workflow has been vetted for malpractice, compliance

e. Consults can considerably expedite care Cardiology referrals at an FQHC over the course of a year: - 17 “intervention” PCPs vs 19 controls - 229 referrals from intervention group, 361 from controls - Of the 229 referrals sent by the intervention group, 120 were sent as e. Consults Olayiwola et al. , Ann Fam Med 2016 3

e. Consults may improve clinical outcomes Olayiwola et al. , Ann Fam Med 2016 4

Curbside consult I have someone here with… Consultant - Usually verbal Undocumented Incomplete history Often involves a third party (resident, fellow), leading to unreliable transmission of information - Malpractice nightmare 5

Primary Care Doctors can bill • Referring providers can bill for sending an e. Consult. For now only Medicare (not dual-eligible) 0. 7 w. RVUs professional billing, 0. 7 RVUs facility fee • Prerequisites (to be documented): • • • 16 minutes or more to review, prepare and send e. Consult • Verbal or written consent by patient • • • Referral templates have been outfitted with language compatible with Medicare billing Referring provider bills CPT code 99452: Enter it in order field after you put in your e. Consult BUT: If you need >3 minutes to send an e. Consult, we need to hear from you so we can fix it!

Billing for e. Consultants • • e. Consultants can bill 99451 for an e. Consult Conditions: • Referring provider documents written or verbal consent from patient (templates have been outfitted) • Consultant documents it took 5 minutes or more to perform e. Consult • Consultant does NOT recommend an in-person visit • The following payors reimburse: • • • Medicare FFS and most managed Medicare plans Dual eligible Medicare/Medicaid (Medicare is billed) Many commercial payors, e. g. United, Aetna, GHI, BCBS Many managed Medicaid plans, e. g. Health. First No reimbursement: • Straight Medicaid • No insurance

MSHS e. Consults: Available Specialties (all ambulatory) Service Nephrology* Neurology (starting at IMA in Oct, then going broad in Nov) DM*: Triage for CAM Endocrine*: Triage for CAM Primary Care (limited) GI* Geriatrics Rheumatology*: Triage for CAM and Downtown Liver Disease Hypertension* Podiatry* Medical Genetics: coming late October ID/Travel Medicine *Indicates available to community partners in ECL Behavioral Health* Pulmonary* In development Med. Rec/Pharm* Hematology Palliative Care Allergy / Immunology Cardiology* Addiction: Coming early November Transgender Dermatology 8

e. Consult champions • GI-IBD: Ryan Ungaro • Pulmonary: Stacey-Ann Brown • GI: Pascale White • Behavioral Health: Omar Mirza • Nephrology: Mukta Baweja • Liver: Amreen Dinani • Endocrinology/DM: Robert Bernstein, Grenye O’Malley • Geriatrics: Veronica Rivera • Palliative Care: Bethann Scarborough • Transgender: Josh Safer • PCP Champions: Jonathan Arend, Roy Cohen, Andy Coyle • • Rheumatology: Wendy Chi / Priya Chokshi • Podiatry: Bryan Markinson • Pharm. D: Ruchi Tiwari & Team • Community Physician: Zehra Siddiqui • Gen cardiology: Krysthel Engstrom • In development: • CHF: Maya Barghash • Hematology: Larry Cytryn • ID: Madhavi Ponnapalli • Allergy/Immunology: Hsi-en Ho • Dermatology: George Han • Addiction Medicine: Tim Brennan • Med Genetics: Noura Abul-Husn • Neurology: tbd (referral templates are ready) 9

Are you ready for your first e. Consult? 10

Enter “econ” into the order field 11

You can go faster, e. g. with “Econ Rheum”… 12

Complete the referral template in the comment box. Use the “F 3” key on the keyboard to enlarge the comment box. Move between selections using the “F 2” key on the keyboard. Click “accept” when done. es 2 k a t s Thi es minut 13

Zztest, Joey 14

Up to 3 business days later… (usually 1 business day) 15

Hit “Quick. Note” to correspond with e. Consultant 16

17