VGM Playbook:
Technology and the Patient Care Continuum
Table of Contents
LETTER FROM THE PRESIDENT..................................................................................... page 3 Clint Geffert, President, VGM & Associates
TELEHEALTH LANGUAGE CAUSES CONFUSION FOR DMEPOS SUPPLIERS .......................... page 4 Wayne van Halem, President, The van Halem Group, a division of VGM & Associates
DMEPOS BUSINESS DEVELOPMENT STRATEGIES IN THE COVID-19 ENVIRONMENT........... page 7 Ryan Ball, Director, VGM Market Data, a division of VGM & Associates
REMOTE SECURITY, E-COMMERCE, AND TELEHEALTH: ADAPTING TO COVID-19 THROUGH TECHNOLOGY............................................................... page 11 Cassi Price, Manager of Marketing Strategy, VGM Forbin
TELEHEALTH AND THE NEW NORMAL................................................................................... page 15 Healiant
PUTTING POWER AT YOUR FINGERTIPS: CLINICAL CASES WITH CARE ORCHESTRATOR AND CONNECTED TRILOGY................................................... page 17 Philips Respironics
TELEHEALTH: A LOW COST, CONVENIENT BENEFIT OFFERING...........................................page 20 Katie Morris, Director of Employee Benefits, VGM Group, Inc.
NO PHISHING: KEEPING YOUR ORGANIZATION SECURE.....................................................page 22 Jared Hughes, Information Security Analyst, VGM Group, Inc.
VGM Playbook: Technology and the Patient Care Continuum
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Letter From the President Technology. It is key in the patient care continuum, particularly as healthcare becomes increasingly virtual. Is your organization
ready? VGM & Associates is constantly seeking and evaluating solutions for you in this realm, and that is why we are focusing our second playbook of 2020 on technology. I recently read an article from Harvard Business Review, “Are You Leading Through the Crisis…Or Managing the Response?” This paragraph was an eye opener for me personally: It is useful to think what distinguishes what was, is, and will be. There was a past of relative stability and predictability. There now is chaos and disruption. There will be … a different state. As this future unfolds, some organizations will be resilient. For others, this future will be catastrophic. The actions of executives and their teams now, in the midst of this crisis, will significantly determine their fate. As leaders, now is the time to ensure our companies, employees, families, and customers are taken care of in the “what will be” stage. VGM is here to help you be as proactive as possible to lead for tomorrow, instead of only fighting the fires of today. As the post-acute healthcare industry continues to change and evolve, especially with the recent pandemic, it is important for you to look at your business models differently and embrace new technology, products, services, and workflows in order to best provide what patients and caregivers need. In the pages to follow, VGM’s experts and industry partners will help you navigate the importance of virtual services while remaining compliant and keeping your business safe with proper cybersecurity measures. Our goal is to provide you with insight on how to maintain your business operations while integrating new technology and communication channels to positively impact the patient experience now and in the future. We hope you enjoy Technology and the Patient Care Continuum, the second installment of VGM & Associate’s 2020 playbook series. Throughout the rest of the year, we will tackle other imperative topics such as data and human capital. Thank you for being a valuable part of the VGM family, where you are certainly a part of so much more—as we’ve proven together in the last couple of months. We will continue to relentlessly work for your success. Kindest Regards,
Clint Geffert, President VGM & Associates Clint.Geffert@vgm.com 319.874.6990 office 281.734.3391 cell Follow me on LinkedIn. VGM Playbook: Technology and the Patient Care Continuum
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Telehealth Language Causes Confusion for DMEPOS Suppliers By Wayne van Halem, President, The van Halem Group, a division of VGM & Associates
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here’s been a lot of questions and confusion surrounding telehealth services and how they relate to DMEPOS claims. Before going further, I would like to clarify that this article is pertaining to whether or not telehealth services can be used to qualify a patient for an item of DMEPOS during the public health emergency (PHE). This article will not address whether or not a DMEPOS supplier can utilize telehealth services for visits with their patients. Suppliers are not reimbursed for telehealth services, so there are very few limitations (from a CMS perspective) on suppliers who would like to utilize telehealth services. There are some state laws that suppliers need to be familiar with, but the telehealth waivers that CMS has granted are solely for providers who get reimbursed for providing telehealth. Therefore, it is relevant to DMEPOS only for the face-to-face evaluation requirements. In a fact sheet released by CMS on March 17, they used the broader term, “Virtual Services.” Under the virtual services umbrella, they described three types of services: 1. Telehealth 2. Virtual Check-Ins 3. E-Visits In this document, they noted that “telehealth” visits must have both audio and video capability while virtual check-ins could be done via audio or video technology. The third category, e-visits, are communications managed through a patient portal. In a second fact sheet dated March 30, under the section called Further Promote Telehealth in Medicare, it has a sentence that reads, “Providers also can evaluate beneficiaries who have audio phones only.” This caused a significant amount of confusion. Is CMS saying that a telephone call with the beneficiary qualifies as a telehealth visit? On the same date, the first of two Interim Final Rules with Comment Period (IFC) (CMS 1744 IFC) was released, and CMS indicated the following: Our regulation at § 410.78(a)(3) states that telephones, facsimile machines, and electronic VGM Playbook: Technology and the Patient Care Continuum
mail systems do not meet the definition of an interactive telecommunications systems for purposes of Medicare telehealth services. As we interpret it, this regulation does not apply to mobile computing devices that include audio and video real-time interactive capabilities, even though such devices are now referred to colloquially as “phones” since they can also be used for audio-only telecommunications. In light of the PHE for the COVID-19 pandemic, we believe it is important to avoid the potential perception that this language might prohibit use of any device that could otherwise meet the interactive requirements for Medicare telehealth, especially given that leveraging use of such readily available technology may be of critical importance. Therefore, we are revising § 410.78(a)(3) to add an exception to this language on an interim basis for the duration of the PHE for the COVID-19 pandemic. We are adding the following language at § 410.78(a)(3)(i): “Exception. For the duration of the public health emergency as defined in § 400.200 of this chapter, Interactive telecommunications system means multimedia communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner.” Since then, they clarified this more in a FAQ on April 9, 2020 with the following question and answer: Question: Can practitioners provide Medicare telehealth services using their phones? Answer: Yes, for use of certain phones. Section 1135(b)(8) of the Social Security Act allows the Secretary to authorize use of telephones that have audio and video capabilities for the furnishing of Medicare telehealth services during the COVID-19 PHE…The Office of Civil Rights has also issued guidance allowing covered health care providers to use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Telehealth Language Causes Confusion... | 4
Telehealth Language Causes Confusion for DMEPOS Suppliers continued... By Wayne van Halem, President, The van Halem Group, a division of VGM & Associates or Skype, to provide telehealth without risk of penalty for noncompliance with the HIPAA Rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency.
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For a physician to bill for a telehealth visit that meets the faceto-face requirement, they must include video and audio.
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Based on this information, it was clear that in order for a physician to bill for a telehealth visit that meets the face-to-face requirement, they must include video and audio. They could still provide care using audio only for virtual check-ins and certain evaluation and management (E/M) services outlined in the first IFC, but there was no guidance whether a virtual check-in or “audio only” and E/M services could take the place of a face-to-face, and contractors were educating in some instances that they would not. On April 30, CMS released their second Interim Final Rule with Comment Period (CMS 5531 IFC) which expanded telehealth even further with the following acknowledgment related to the audio only E/M services: In the time since we established these payment amounts, stakeholders have informed us that use of audio-only services is more prevalent than we had previously considered, especially because many beneficiaries are not utilizing video-enabled communication technology from their homes. In other words, there are many cases where practitioners would under ordinary circumstances utilize telehealth or in-person visits to evaluate and manage patients’ medical concerns, but are instead using audio-only interactions to manage more complex care. While we previously acknowledged the likelihood that, under the circumstances of the PHE, more time would be spent interacting with the patient via audio-only technology, we are now recognizing that the intensity of furnishing an audio-only visit to a VGM Playbook: Technology and the Patient Care Continuum
beneficiary during the unique circumstances of the COVID-19 pandemic is not accurately captured by the valuation of these services we established in the March 31st COVID-19 IFC. Recognizing that physicians were having audio-only calls to discuss complex issues that would normally be performed via in-person or telehealth arrangements, CMS said, “Additionally, given our understanding that these audio-only services are being furnished as substitutes for office/outpatient E/M services, we recognize that they should be considered as telehealth services, and are adding them to the list of Medicare telehealth services for the duration of the PHE,” and they established new codes with higher reimbursement to reflect the higher complexity for physicians providing these services. Face-to-Face Waivers Despite all this discussion about telehealth, however, it is very important to also keep in mind that during the PHE, the IFC also eliminated the face-to-face requirement for any item of DMEPOS that requires one, with the exception of power mobility devices. It is not just limited to respiratory equipment.
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Get as much documentation as possible up front—CMS has indicated they may audit claims for DME delivered during the PHE.
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We are encouraging our clients to still try to get as much documentation up front, even under these complex circumstances, because CMS has indicated that they may audit claims for DME delivered during the PHE. While they are waiving the requirements currently, there will likely be some process where suppliers must go back and have to requalify patients in order to continue billing. For this reason, if you are able to get the documentation, you should try. If you can’t get it, you can proceed, but know you may have to go back at a later date and show that the patient meets the criteria for coverage.
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Telehealth Language Causes Confusion for DMEPOS Suppliers continued...
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By Wayne van Halem, President, The van Halem Group, a division of VGM & Associates
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DME MACs have indicated that CMS has not given them guidelines regarding virtual visits, so we may have more clarification on that in the near future.
Regarding virtual check-ins, the only question that really remains, in my opinion, is for after the PHE declaration is lifted. If CMS requires patients to get requalified in order to continue billing, would a virtual check-in that occurred during the PHE be allowed in lieu of the face-to-face? We know that telehealth visits would be, but we do not know about virtual checkins. The DME MACs have indicated that CMS has not given them guidelines regarding virtual visits, so we may have more clarification on that in the near future.
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Get as much documentation as you can to support your claims now to avoid having to go back and requalify later.
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So, quick summary, despite the fact that face-to-face requirements have been waived during the PHE, if you are still trying to get as much documentation as you can to support your claims now to avoid having to go back and requalify later, then a telehealth visit with audio and video capability will be sufficient to satisfy the face-to-face requirement. A phone can be used if it has video capability. If you have questions, feel free to contact The van Halem Group at 404-343-1815 or Info@vanHalemGroup.com.
VGM Playbook: Technology and the Patient Care Continuum
ABOUT THE AUTHOR Wayne van Halem, President, The van Halem Group Wayne van Halem founded The van Halem Group in 2006. The Atlanta-based firm merged with VGM Group in 2014, and Wayne currently serves as its president as they assist providers with navigating complex issues related to audits, appeals, enrollment, and compliance. A former auditor and national Appeals Director with Medicare, Wayne is also a published author and well-known lecturer. He is an Accredited Healthcare Fraud Investigator through the National Health Care Anti-fraud Association (NHCAA), a Certified Fraud Examiner through the Association of Certified Fraud Examiners (ACFE), and an active member of the Health Care Compliance Association (HCCA). He also sits on the American Association for Homecare’s Regulatory Council, Medtrade’s Educational Advisory Board, Medicare DME MAC Jurisdiction C and D Advisory Councils, and on the Advisory Board for HME Business Magazine. Since 2006, his company has saved suppliers over $70 million in overpayments and denial recoveries. Connect with Wayne on LinkedIn or at wayne@vanhalemgroup.com.
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DMEPOS Business Development Strategies in the COVID-19 Environment By Ryan Ball, Director, VGM Market Data, a division of VGM & Associates
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OVID-19 continues driving change to our daily lives and will likely cause significant disruption to DMEPOS business operations in the coming months. While patients in need of products like ventilation, oxygen, and hospital beds in certain areas are likely to see significant volume increases due to the pandemic and eased billing restrictions, providers are finding difficulty formulating plans for when and how they will be able to resume sales activities with key referral sources in their markets. To be sure, this pandemic will change to how providers plan for and communicate with referral sources in their markets. With uncertainty surrounding the timing of the resumption of elective surgeries, sleep testing, and physician visits across the country, now is the time for providers to focus on training, planning, and market analysis to position themselves for future success and take advantage of pent-up demand to ensure a more rapid business recovery.
Focus on Data, Market Analysis, and Planning With many physician offices and facilities operating in a remote environment or currently limiting face-toface interaction, providers are left largely unable to perform traditional business development activities. Understanding sales personnel have additional time on their hands, many have challenged their business development teams to focus on planning and better understanding where new opportunity exists in their markets to set themselves up for future success. Quantify and Identify Market Opportunity Providers can harness the power of targeted claims data to focus on identifying geographic areas where they are underpenetrated or where relevant referral sources are likely to be underserved with an influx of additional patients needing in-home equipment. VGM Market Data’s new visualization platform can help HME’s create a plan by: •
VGM Playbook: Technology and the Patient Care Continuum
Valuing current or prospective markets by overall HME product volume
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DMEPOS Business Development Strategies in COVID-19 Environment continued... By Ryan Ball, Director, VGM Market Data, a division of VGM & Associates •
Quantifying state/county-driven HME provider market share analysis for specific products
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Creating and assigning lists of key physicians or facilities to focus efforts moving forward
VGM Playbook: Technology and the Patient Care Continuum
DMEPOS Business Development Strategies... | 8
DMEPOS Business Development Strategies in COVID-19 Environment continued... By Ryan Ball, Director, VGM Market Data, a division of VGM & Associates •
Identifying physicians currently sending business to competitors to plot a strategy for engagement based on competitive differentiation
Focus on Payer Negotiations Providers should also focus on where they can improve payer contracting opportunities. VGM’s new reimbursement intelligence data provides industry-leading market intel on what specific commercial payers are paying specific providers for DMEPOS products. VGM’s consulting offering can provide analysis for providers on which payers in their market present the best opportunity to renegotiate rates or explore new payer partnerships based on existing rates being paid to competitors in their market.
Understanding the competitive landscape in your markets and plotting strategy for growth are of equal importance in this analysis and will set providers up for success moving into the second half of 2020. VGM Playbook: Technology and the Patient Care Continuum
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DMEPOS Business Development Strategies in COVID-19 Environment continued...
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By Ryan Ball, Director, VGM Market Data, a division of VGM & Associates
Our sales teams must learn how to communicate and manage referral source relationships through other platforms.
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Sales Adaptation and Training in a COVID-19 Environment COVID-19 is changing how HME providers do business—nowhere is that more apparent than for sales and marketing professionals. Upon resuming activities, physician offices are likely to severely limit patient volumes and unnecessary personnel in their facilities. We must be cognizant of and seek out new policies and requirements in hospitals and institutional facilities tracking sales representative movements and activities. Gone are the days where sales teams can walk into key referral source offices and offer important services. Our sales teams must learn how to communicate and manage referral source relationships through other platforms like Zoom/web conferencing, email, and additional phone calls in order to remain competitive and continue providing value. Meet Them Where They Are When reaching out to referral sources, determine the preferred method of communication for the office and key personnel. Many physician offices are already moving to telehealth platforms in order to communicate with patients and more broadbased web conferencing platforms to communicate internally or with vendors, so adapting with them is important. Lead with changes you’ve made to business operations due to the pandemic and develop a more consultative approach to providing value with the services you can provide.
Develop New, Relevant Messaging Tactics Create talking points to be used by your team that focus on: •
Patient device remote monitoring capabilities
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Additional in-home precautions being taken
VGM Playbook: Technology and the Patient Care Continuum
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Non-delivery model therapies like portable oxygen concentrators
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Expanded service area or capabilities
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Available volume of relevant equipment
Begin and end each conversation with a simple question, how can we best serve you and your patients moving forward in this changing environment? Be Ready and Willing to Adapt Be willing to adapt, think outside of the box, and know that the services you provide will never be more necessary and important to maintaining healthcare continuity than they are in the coming months.
ABOUT THE AUTHOR Ryan Ball has worked in the healthcare industry for VGM & Associates for more than a decade as director of VGM Market Data and various analyst roles within VGM’s Government and Regulatory department. Prior to working as a regulatory analyst, Ryan worked as a political campaign consultant, focusing primarily on developing and analyzing data to identify statistically significant market trends and make recommendations on efficient resource allocation. For the past several years, Ryan has been the director of VGM Market Data. In his role, Ryan works with VGM members to provide market intelligence data to identify key referral source opportunities in their markets and provides tools to provide actionable intelligence to post-acute healthcare sales/marketing teams. Connect with Ryan on LinkedIn or at Ryan.Ball@vgm.com.
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Remote Security, E-commerce, and Telehealth: Adapting to COVID-19 Through Technology By Cassi Price, Manager of Marketing Strategy, VGM Forbin “If it doesn’t challenge you, it doesn’t change you.” – Fred DeVito
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t’s safe to say that we’ve all been personally challenged and changed by the pandemic of 2020. When this is all said and done, you’ll ask yourself— did your business rise to the challenge and adapt technology to accommodate new patient needs, or did you stand by while the world changed around you? If you’re in the group that’s rising to the challenge, you’re likely in the middle of a transition. Changing processes, training staff on new software, updating your website, and finding new ways to connect with your patients via telehealth and e-commerce are just a few things you’re doing to adapt. As a business, you’re running exercises on how you’ll adjust to the many possible scenarios out there about how we’ll “return to normal,” or what the new normal will be.
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Take a step back to make sure you’re protecting what made your business unique and successful in the first place.
relaxed guidelines that may leave your business to stagger staff that will be in the office and staff that will be home. You may also anticipate that a flareup of the coronavirus in your state will lead to your staff transitioning back to remote work and patients back to telehealth. Either way, you’ll be keeping those subscriptions to Office 365, RingCentral, Zoom, and/ or Continuum. Before you commit to the annual subscription, you need to ask these questions to remain in compliance. Ask Your New Vendors: •
When was your last risk assessment performed and would you be willing to send me a copy of the report?
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What steps do you take to protect the ePHI you’ll maintain?
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While you’re doing the right things, when you’re deep into this transition it’s possible that you can’t see the forest for the trees. This means you need to take a step back to make sure you’re protecting what made your business unique and successful in the first place, and then be extremely vigilant in prioritizing employee/ patient safety, data security, and patient experience. So, let’s take a step back and examine the technology transitions you’re likely in the middle of and address the questions you need to ask to ensure you’re staying on track. For Employees’ Work From Anywhere Software— Qualifying Compliant Vendors
While many states saw months of strict social distancing measures, we’re dipping our toes into more
VGM Playbook: Technology and the Patient Care Continuum
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Are you willing to sign or provide a business associate agreement?
Any software company that is maintaining, transmitting, or storing ePHI needs to sign a BAA with you.
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Any software company that is maintaining, transmitting, or storing electronic protected health information (ePHI) needs to sign this agreement with you. If you’re talking about a patient during a conferencing meeting, you’re transmitting ePHI. You may need to go through this with any conferencing companies, chat software, and file-sharing vendors such as Dropbox or OneDrive. In fact, free Gmail accounts don’t include a business associate agreement (BAA) and are not HIPAAcompliant. You’re required to purchase G Suite to access those resources. In our experience, almost all free software and service providers will not sign a BAA, so do your due diligence when moving forward with these new technology providers.
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Remote Security, E-commerce, and Telehealth: Adapting to COVID-19 Through Technology continued... By Cassi Price, Manager of Marketing Strategy, VGM Forbin get you your emails. It’s recommended that you also add security in the form of multiple vendors scanning your emails to make sure they’re secure before they’re delivered. At VGM Forbin, most of our customers that have Office 365 have also elected to use Barracuda as an extra layer of security. You may also be using Mimecast.
Ask Yourself: •
Have you reviewed and updated your backup, disaster, and contingency plans to protect your business?
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Have you updated your security suite to cover remote employees’ workstations and those connections back to the office?
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If employees connect to your network from personal computers, are you making sure those computers are not presenting new threats?
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Those working from home are doing so from places that you haven’t had to secure before. If they’re connecting to your network from personal computers, are you making sure those computers are not presenting new threats to your network? Do those computers have an updated antivirus software installed? Does working from home require users to store ePHI or other personal protected information (PPI) on their home computers, and is that information being backed up with your current backup solution? For Data Security—Backup, Email Protection, and User Security Now that we’ve covered updating your backup plan, there are extra steps to keep all that data in the cloud secure and protected. Here are the areas to focus on to keep your cloud covered: •
Cloud Backup: This is your disaster recovery. In the event of system failure, outage, or other disasters, it’s recommended to have your database backed up off-site and readily available when needed. The most common cloud backup services we work with are Microsoft Azure and Barracuda, but you may also work with iDrive, Acronis, or Dropbox Business.
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Email Protection Layers: Don’t trust your email provider to be secure all by itself. It’s their job to
VGM Playbook: Technology and the Patient Care Continuum
Enable a solution that verifies its user with a username/password AND a fingerprint or random code sent to a different device.
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Multi-factor Authentication or Two-factor Authentication: With the mixture of employees working from both the office and home, it’s vital to enable a solution that verifies its user with not only a username and password but also something physical like a fingerprint or random verification code sent to a different device. You see this enabled on Facebook, Google, and even Nintendo Switch. Most often, the vendor of choice for this function is Duo.
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Businesses around the globe are bending over backwards to keep serving customers and patients while practicing social distancing.
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For Patients—Website Experience, E-commerce, and Telehealth In addition to making your employees’ systems secure, we’re sure you’re also working hard to keep patients and clients coming back to you. We’ve seen businesses around the globe bending over backwards to keep serving their customers and patients while practicing social distancing. As we see some of these social distancing measures continue for longer than originally expected, here are a few areas to examine within your business to make sure you’re continuing to evolve to the new normal of patient experiences:
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Remote Security, E-commerce, and Telehealth: Adapting to COVID-19 Through Technology continued... By Cassi Price, Manager of Marketing Strategy, VGM Forbin Telehealth
E-commerce/Online Catalogs
Make sure your website clearly defines the steps to having a great experience in your store virtually. This is done by providing step-by-step instructions on how to consult with your business virtually to get the same friendly experience that you would have face to face in your store.
If you have a product catalog featured on your website, you’ll also want to start improving the experience on those pages. We see many DMEPOS businesses transitioning to e-commerce models so their patients can continue to purchase products easily from them without contact. If you’re diving into e-commerce, here are some very important items to keep in mind:
If you’re researching long-term telehealth service, the functions to consider include: •
Secure and compliant mobile apps to gather ePHI via messaging, video, fax, or voice calls
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Focus on Product Pages: Whether you’re doing e-commerce or not, if you have product pages, we recommend you dedicate time to improve the information on those pages. Areas to improve could be product descriptions, features, specifications, photos, and any other information that’ll help customers find that page and learn about the product. This can influence whether they make the choice to purchase the product or contact you about it. If you have A LOT of products already listed on your site, prioritize the products that you sell often. If you’re just starting your online catalog, stay focused on your main products. Don’t put a catalog out there of product descriptions that you hurried through. Take your time and create polished pages for your key products that you really want to sell.
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Choose Your Payment Gateway: This solution authorizes payments for your merchant account. Most of the solutions out there offer similar functions but vary greatly in terms of transaction and subscription fees. Look closely at whether your payment gateway offers discounts based on volume and make sure those fraud settings and address verification settings are all turned on. The payment gateway we most commonly work with is Authorize.Net.
» Look for security certifications such as HITRUST CSF that shows the vendor is supported by a strong security risk management framework •
Easy, dynamic call routing that you can adjust from home for an influx of calls that may come in at different times for different purposes
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Voicemail transcription to increase the speed of response by the team
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Multi-level interactive voice response (IVR) capabilities—this means you can easily create a multi-layer phone routing menu to get patient calls routed to the right people.
We’ve seen solutions like RingCentral cover these functions. Another possible solution in this area that focuses specifically on healthcare is BlueJay Mobile Health.
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Many businesses are transitioning to e-commerce models so patients can continue to purchase products easily without contact.
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VGM Playbook: Technology and the Patient Care Continuum
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Remote Security, E-commerce, and Telehealth: Adapting to COVID-19 Through Technology continued...
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By Cassi Price, Manager of Marketing Strategy, VGM Forbin
Customers were accustomed to trying a product in your store before purchasing, so return policies are key.
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Determine Shipping/Delivery Options: Great shipping options are crucial in today’s e-commerce environment. Get your contracted rates set with FedEx or UPS and then see where you can offer free shipping. This may be the service that determines whether a customer buys from you or your competitor. Determining Return Policy: In a situation where your customers were accustomed to trying a product out in your store before purchasing but can no longer do that, this service is key. Determine what your return policy will be and if you can offer free returns, then you’re set. Make those policies crystal clear and make sure they’re on your website. Managing Sales Tax Compliance: Make sure you’re well-versed in where you can charge tax and where you don’t have to. When it comes to e-commerce, you may want a service that’ll instantly calculate rates based on geolocation and product classification as well as distribute payments to tax jurisdictions. A great vendor to go with is Avalara, who’s also offering 3-months free to help businesses during this time. The offer expires on June 30, 2020.
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Integrations to Automate the Process: Finally, there are many ways to make your e-commerce run efficiently for you and your customers. At VGM Forbin, we’ve developed integrations specifically for the DMEPOS business including:
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Insurance verification with vendors like Zirmed/ Waystar
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Billing software integrations with Brightree and USS
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Catalog integration with fulfillment centers like VGM Fulfillment and Preferred Medical/NDC
VGM Playbook: Technology and the Patient Care Continuum
If you’re overwhelmed by all that comes with updating the technology within your business, you’re not alone. It’s impossible to be an expert in all areas of both your technology infrastructure and online experience. The most important thing you could do for your company right now is to find the right partners that are experts in these areas and can help you bring it all together. At VGM Forbin, we have been proudly serving VGM members for over two decades. We’re committed to helping your business thrive with the right technology and web solutions! You don’t have to navigate this alone. We’re here, your VGM technology and web partner, to help you overcome these challenges. Reach out to connect with our team today!
ABOUT THE AUTHOR Cassi Price, Manager of Marketing Strategy, VGM Forbin Specializing in social media campaigns, search and social advertising, and writing optimized content for websites, Cassi plays a vital role in Forbin’s web marketing. Before joining Forbin, Cassi bolstered her skills as Director of Communications for the Orthotic and Prosthetic Group of America (OPGA) and has attended conferences and completed the 7 Step Sales Process Training for Emerge Sales. A lover of music and anything outdoors, Cassi finds satisfaction in finding a client’s unique target audience through search and social advertising, as well as creating interactions through social media. Connect with Cassi on LinkedIn or at cprice@forbin.com.
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Telehealth and the New Normal By Healiant
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ately, it seems the question on everyone’s mind is, when? When will this all end? When will things go back to normal? In many ways, the real answer to this question is never. The way that healthcare is delivered is one of those ways that will likely never return to the recent view of normal. The new normal is evolving rapidly, driven by new CMS guidance and the evolving needs of providers and patients during this public health crisis. In early March, the president and CMS expanded Medicare’s telehealth benefits under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. The net effect is that now clinicians can provide more services to new or established beneficiaries across the country via telehealth. Prior to this announcement, Medicare paid for very little and the fee schedule was very different from the one providers used for in-office visits. Telehealth can now be billed for most clinical visit types and providers will be reimbursed under the Physician Fee Schedule at the same rates as in-person services. Medicaid and most private payers have or will be mandated to follow suit. This new policy and payment scheme have allowed for beneficiaries across the country to have some access to their care providers and, perhaps more dramatically, for providers to continue to practice medicine, albeit remotely. The suddenness of the onset of this pandemic and the shelter-in-place directives saw very few providers, regardless of size, prepared to respond to the changes in telehealth reimbursement. While there were many technologies built to support telemedicine, they were not broadly adopted, and most practices were not prepared to respond with a real and compliant technology solution to remotely support their patient populations.
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It is highly unlikely that this “no rules” environment will persist any longer than our current emergency lasts.
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VGM Playbook: Technology and the Patient Care Continuum
CMS, understanding this challenge, additionally waived the long-required HIPAA compliance rules that normally govern electronic communication of patient health information. Zoom, Skype, and GoToMeeting are now fair game for providers to deliver services to their patients. It is highly unlikely that this “no rules” environment will persist any longer than our current emergency lasts, but in the meantime, most providers have been able to stay engaged with their patients and continue to operate. It is important to note that while some services are being provided through telehealth during this crisis, many clinical practices have seen reductions of 50% or more to their visit volume and billing. Clinical practice visit volume and billing have reduced by
50% or more.
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Telehealth has been an essential tool—it’s now clear that virtual care will be a permanent component of how care is delivered.
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Telehealth has been an essential tool for a sheltered population, and it is becoming increasingly clear that virtual care will be a permanent component of the way care is delivered and accessed. Telehealth is more of a concept than it is any one specific thing. And it has been described in many ways—virtual care, remote monitoring, telemedicine, telecare, to name a few. These terms all speak to the same notion—of providing healthcare remotely by means of technology.
Telehealth and the New Normal | 15
Telehealth and the New Normal continued... By Healiant Over the last two decades, the pace of the technology evolution to support safe and effective remote care has been staggering. The cost and access to wearable and remote monitoring hardware has redefined what is possible outside of a physician’s office or hospital. The Apple iWatch is now a Class II medical device, and we are surrounded by other connected devices capable of providing real-time remote compliant monitoring of everything from our blood glucose to our vital signs with remarkable accuracy. In many ways, it is this evolution in technology that is the catalyst for the coming of age of telehealth as a real alternative to in-person care. This new age of telehealth born out of necessity, while profound, is just beginning.
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New innovations continue to reshape what is possible and further extend patient care outside of a brick-and-mortar setting.
knowledge and clinical credentials from their home and at their own pace. Now and in the future, doctors and nurses will expect to be able to access knowledge and learning without the need to travel. “For many years, e-learning has been unengaging, boring, and somewhat ineffective,” says Josh Heuchan, Managing Director of Healiant Training Solutions. “We are unconditionally committed to creating new and more engaging ways to transfer knowledge remotely, which is why we invest so much time, energy, and financial resources on our programs. Adult learners have come to expect, and now are starting to demand, more from their education and training providers.”
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Almost daily, there are new innovations that will continue to reshape what is possible and further extend our medical professionals’ ability to care for their patients outside of a brick-and-mortar practice setting. As these devices become more capable, more accurate, more reliable, more mobile, and more affordable, the historical notion of a medical office with traditional walls will become less relevant. Our care providers will be able to securely connect to a wide array of integrated remote tools to access more data about our medical status than is available today in most office settings in real time. These remote technologies will allow constant monitoring, trends over time, and change-in-condition alerts that will power more knowledgeable and timely interventions. In addition to these amazing clinical tools, providers are being introduced to a broad array of online support tools. We have all seen the importance of distance online learning, and today more than ever, our clinicians and providers are utilizing online e-learning platforms to advance their knowledge and credentials. Healiant Training Solutions, one of the many online credential preparation providers, offers e-live and virtual learning to support nurses to advance their VGM Playbook: Technology and the Patient Care Continuum
Telehealth can reduce the time and inefficiencies of aptly named waiting rooms and much of the travel for in-person care.
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Telehealth as part of our new normal and the future hybridized healthcare delivery model has profound promise. Telemedicine can bring best practices and clinical interventions more elegantly and quickly to our rural communities. Telehealth can reduce the time and inefficiencies of aptly named waiting rooms and much of the travel required for in-person care. Telecare, when coupled with the amazing and evolving array of remote technologies, will give doctors more timely and relevant information to make the best decisions to optimize outcomes. Virtual care promises to reduce costs through earlier and lower cost interventions to more who need access. Regardless of the name we use to define this new form of care provision, we should see the amazing opportunity it presents to a worried population to have better access to care during these trying times.
Telehealth and the New Normal | 16
Putting Power at Your Fingertips: Clinical Cases With Care Orchestrator and Connected Trilogy By Philips Respironics
H
ealthcare is more complex than ever due to a growing aging population and soaring healthcare costs, along with increased pressure to reduce those costs without sacrificing the quality of care. This increases the need for accurate, real-time data for patient and provider accountability that will lead to the delivery of the right care at the right time.
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With the changing healthcare landscape, providers need to be more efficient in their daily practice and reduce overall costs.
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With the changing healthcare landscape, providers need to be more efficient in their daily practice and reduce overall costs. Efficiencies can be found by reducing the requirement to drive to a patient’s home for an unnecessary troubleshooting visit or by
VGM Playbook: Technology and the Patient Care Continuum
communication and coordination between the patient and members of the care team, such as the respiratory therapist at the provider, physicians, and nurses. Actionable information offers clinicians the ability to act quickly and decisively to provide patient care in a timely and efficient manner. Combining Care Orchestrator, a patient management software system, with a ventilatory support device, Trilogy, allows for quality care to be delivered while gaining operational efficiencies. Connected care from Philips responds to the need for data and the proactive delivery of care across the healthcare continuum. Care Orchestrator empowers providers to work smarter and more efficiently and to make more informed decisions regarding patient care. It will convert the raw data into insights. This gives providers, physicians, and patients the power to impact care at the right time.
Putting Power at Your Fingertips... | 17
Putting Power at Your Fingertips: Clinical Cases With Care Orchestrator and Connected Trilogy continued... By Philips Respironics With Care Orchestrator, customized rules and notifications to remotely monitor and provide proactive notification of a patient’s changing condition can be established for fast, informed clinical decisions. There are three types of notifications that can be set for a patient: usage rules, health rules, and reminders. Usage rules are triggered when the device has not downloaded any therapy data after a customized set number of days. Health rules are part of the rule set assigned to a patient and are triggered on therapy data download alerting you of a changing clinical condition. Reminder sets are a way to set a time-based notification for different patient sets for tasks such as follow-up, resupply, or other. Connected Trilogy health rules alerted through Care Orchestrator can be customized with patient-specific ventilator parameters to trigger notifications that proactively identify patients with potential increased need for intervention.
CLINICAL CASES Decrease in % Patient-Triggered Breaths Case 1 A patient with amyotrophic lateral sclerosis (ALS) on the Connected Trilogy, monitored by Care Orchestrator, alerted for a decline in the patienttriggered breaths to the mid 40% range, suggesting a worsening of muscular weakness due to progression of the ALS. The respiratory therapist (RT) switched the sensitivity from AutoTrak to AutoTrak Sensitive, resulting in better ventilatory synchronization, and increased the patient-triggered breaths to the 80–90% range. Subjectively, the patient stated that they felt significantly better. Case 2 Care Orchestrator alerted that the % patient-triggered breaths of a morbidly obese user with muscular dystrophy (MD) ventilated via a Trilogy was less than 20%. The ventilator was changed from AutoTrak to AutoTrak Sensitive, assisting in increasing the % patient-triggered breaths to 60–80%. The patient was now more at ease with the device.
The ventilator was changed from AutoTrak to AutoTrak Sensitive,
assisting in increasing the % patient-triggered breaths to
60-80%
The patient was now more at ease with the device.
VGM Playbook: Technology and the Patient Care Continuum
Putting Power at Your Fingertips... | 18
Putting Power at Your Fingertips: Clinical Cases With Care Orchestrator and Connected Trilogy continued... By Philips Respironics Case 2
High Leak Case 1 High leak alert from Care Orchestrator signaled to the RT to contact the chronic obstructive pulmonary disease (COPD) patient to understand the issue. Through a phone call, it was determined that a hole in the mask was causing the higher-than-normal leak. A new mask was shipped (avoiding an in-person visit) to the patient and follow-up data downloads determined that the leak was now in a normal range.
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Information from Care Orchestrator helped the RT counsel the user on applying the current mask vs. a refit to a new mask.
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Case 2
A patient with spinal muscle atrophy (SMA) had a set VT of 700 cc in the AVAPs mode on Trilogy. The Tidal Volume Threshold alert notified the RT that the patient was receiving between 575–625 cc with an inspiratory positive airway pressure (IPAP) of 32 cmH2O at the setting for the AVAPS Max limit. The patient was monitored over the next few days via Care Orchestrator. The VT increased to the 700 cc level, the respiratory rate decreased from 12 bpm to 10 bpm and the % patient-triggered breaths increased from 40% to 90%, indicating a positive treatment result in the changes made.
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Having targeted and efficient care at your fingertips is a powerful way to help patients get the care they need.
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On data review, prior to a routine visit, a chronic respiratory failure and COPD patient was noted to have a high mask leak. Information gleaned from Care Orchestrator guided the RT to counsel the user during the visit on the application of the current mask vs. a complete refit to a new mask. Follow-up data downloads revealed that the leak had decreased, as well as an increase in adherence to therapy.
Care Orchestrator empowers your connected care teams to make better, faster, and more informed decisions regarding patient care. More than 830,000 patient lives have been managed through Philips cloud-based solutions since 2018—proof that having targeted and efficient care at your fingertips is a powerful way to help patients get the care they need.
Tidal Volume (VT) Threshold Case 1
Caution: U.S. federal law restricts these devices to sale by or on the order of a physician.
Prior to the monthly visit, a patient with COPD noninvasively treated with a Trilogy in the automatic volume assured pressure support (AVAPS) mode was noticed on Care Orchestrator to be consistently receiving 25 cmH2O but not obtaining the set VT of 450 cc. The maximum AVAPS limit was increased to 30 cmH2O, so that the VT could be achieved. The referring physician was notified of the patient’s change in condition.
*Based on snapshot data from Philips EncoreAnywhere database. Average 30-day daily patients with at least one associated therapy download via EncoreAnywhere = 833,229 as of January 2018.
VGM Playbook: Technology and the Patient Care Continuum
Putting Power at Your Fingertips... | 19
Telehealth: A Low Cost, Convenient Benefit Offering By Katie Morris, Director of Employee Benefits, VGM Group, Inc.
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rior to COVID-19 turning our world and schedules on their heads, we constantly had that hustle and rush to get everywhere—work, school, workouts, lunch dates, practices—the last thing you needed was to have something slow you down like a sore throat. Now with the limited direct contact due to the COVID-19 pandemic, telehealth has increased in prominence, with the biggest selling point being that you can visit with a doctor and receive new prescriptions and refills without leaving your home. Not only does this allow people to avoid the exposure of the waiting rooms and hospitals, it gives employees the flexibility they’ve been looking for all along, making it a low cost, convenient benefit to add to your company offerings.
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Telehealth options are perfect for common conditions and less severe symptoms like the common cold or seasonal allergies.
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What Is Telehealth? Adding telehealth as an option allows employees to access a doctor and, if needed, a prescription on the go via their laptop, phone, or tablet without stepping foot in an actual medical facility. While telehealth options are not to be used for catastrophic or life-threating situations (e.g., shortness of breath, dizziness, or chest pains), they are the perfect option for common conditions and less severe symptoms such as rash, common cold, flu and seasonal allergies, headaches (including migraines), heartburn, and more.
Emergency Room Visit
$1,000
How It Works Depending on the telehealth service, a visit could consist of a questionnaire with a follow-up call or text, with some services requiring video chat capabilities. Typical visits are around 15 minutes with a potential follow-up. The options are endless—there are even some telehealth services that offer mental health assistance. Additionally, some Employee Assistance Programs are going virtual as well, which allows those visits to be more convenient and accessible for employees. Types of Telehealth Options and Cost There are many different telehealth options out there. Some are linked to a specific health insurance company and some are private pay through local hospitals or online companies. Regardless of the type of telehealth option you choose, it’s a winwin for employees and employers for its cost and convenience. Typically, the cost of a telehealth visit is under $75 even for private-pay options. If it is linked to the company’s health insurance, the copay is usually low and may even be free. There are other savings capabilities for the company, too—self-funded and fully insured health plans benefit from offering telehealth options since the cost for the visit to the plan is much less than your typical visit to the emergency room, primary care physician, or an urgent care facility. Typical primary care physician visits cost around $175$200, and the middle-of-the-night ER visit for an ear infection could cost over $1,000 for the plan.
Physician Visit $175-200
VGM Playbook: Technology and the Patient Care Continuum
Teleheath Visit
$75
Telehealth: A Low Cost, Convenient Benefit Offering | 20
Telehealth: A Low Cost, Convenient Benefit Offering continued...
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By Katie Morris, Director of Employee Benefits, VGM Group, Inc.
Initial introduction of telehealth can be underutilized as some employees are resistant to new ways of medicine.
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Gaining Employee Participation The initial introduction of telehealth to an organization can be underutilized as some employees are resistant to new ways of medicine or they forget it’s even offered. It is important to inform employees often and have multiple ways they can access the information. At VGM, we post information on our internal social media site, company intranet, and payroll platforms. Another way to boost the participation in this benefit is to offer the first few telehealth visits for free or set an extremely low copay each plan year. Some may be put off by not physically being seen or even talking with a doctor, but once people try it, they love it!
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To get started, reach out to your health insurance provider and see if they offer any telemedicine options.
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VGM Playbook: Technology and the Patient Care Continuum
Getting Started To get started offering this benefit, reach out to your health insurance provider and see if they offer any telemedicine options. Even if they don’t offer these options directly, they will likely be able to offer some advice on private-pay options. Especially with the COVID-19 pandemic, telehealth is a topic health insurance providers are used to being asked about. Regardless of what you decide, telehealth is a great option for almost any company. Between the low cost and the convenience and flexibility it grants to your employees, there’s no reason not to look at adding this benefit.
ABOUT THE AUTHOR Katie Morris, Director of Employee Benefits, VGM Group, Inc. Katie began her career at VGM Group, Inc. in 2009 and holds a bachelor’s degree in communications from the University of Northern Iowa. As Director of Employee Benefits, Katie is responsible for benefit planning and administration for VGM Group’s more than 950 employee owners located in 24 different states across the country. Connect with Katie on LinkedIn or at Katie.Morris@vgm.com.
Telehealth: A Low Cost, Convenient Benefit Offering | 21
No Phishing: Keeping Your Organization Secure By Jared Hughes, Information Security Analyst, VGM Group, Inc.
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he threat from phishing emails has long been the most common source of data security incidents for both businesses and individuals alike. Current events haven’t really changed that reality, though they have given the hackers a common subject to build their phishing campaigns around. Due to the massive prevalence of COVID-19-related stories in world, national, and local news, the attackers have readymade talking points to capture your attention and trick you into clicking links or opening attachments.
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The threat from phishing emails has long been the most common source of data security—current events haven’t changed that reality.
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VGM Playbook: Technology and the Patient Care Continuum
The Usual Signs Fortunately, the signs to look out for in these COVID-19 phishing emails remain the same as in any other phishing email. Simply ask yourself: •
Is the email expected or unexpected?
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Does the name of the sender match the email address of the sender?
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Is there an unusual looking or unexpected attachment with the email?
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Is there an unusual looking or unexpected URL in the email that the sender is asking you to click on?
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Does the tone of the email take a sense of urgency, asking you to immediately reply, click a link, or open an attachment?
No Phishing: Keeping Your Organization Secure | 22
No Phishing: Keeping Your Organization Secure continued... By Jared Hughes, Information Security Analyst, VGM Group, Inc. The Two Forms of Phishing Emails Phishing emails arrive in your inbox in one of two common forms—completely unexpected from an unknown sender, or an apparent reply from a known sender. The unexpected phishing emails are usually the easiest to spot and ignore. They may be from an unknown contact and resemble marketing spam emails. Since these phishing emails come from unknown senders out of the blue, it’s a little easier to stop and think through whether the content in the email makes sense or is suspicious and needs a closer look.
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It’s always a good idea to check whether the name of the sender matches with the email address of the sender.
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A telltale giveaway of a phishing attack is an email reply that doesn’t fit with the rest of the conversation in the chain.
A telltale giveaway in these phishing emails is that the hacker’s reply doesn’t usually fit with the rest of the conversation in the email chain. For example, if you and the contact were discussing an upcoming round of competitive bidding and the hacker replies to one of those emails asking you to pay an invoice, that sudden change in topic is a sign of a phishing email.
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It’s always a good idea to check whether the name of the sender matches with the email address of the sender. For example, legitimate emails will show the sender’s name and their email address that you’re already familiar with, such as John Doe <john.doe@ vgm.com>. Phishing emails will commonly show different sender names and email addresses, such as John Doe <billsmith56@gmail.com>. A clear conflict between the sender’s name and email address is a key indicator that you’re looking at a phishing email. The trickiest phishing emails are those that come from a known sender or contact and appear to be a reply to an email you sent them. Phishing emails of this variety come about when a hacker takes over someone’s email and begins sending phishing emails to their contacts, which may include you. Instead of sending a fresh email as a new conversation, the hacker will go through their recent emails and reply to an email you sent your contact. This gives the appearance of continuing conversation with a known contact.
VGM Playbook: Technology and the Patient Care Continuum
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Two of the most common titles for malware attachments are “my resume” and “invoice.”
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Attachments, URLs, and Malware Though email security systems are getting better at removing dangerous attachments, it’s still common to receive a phishing email with a malware-laden attachment. Perhaps the two most common titles for malware attachments are “my resume” and “invoice.” Many computers have been infected when a “resume” is opened that ultimately just contains malware, even when the person opening the resume doesn’t work in a management or hiring capacity. Taking an extra second to consider whether the email you’re looking at makes sense for you to act on will do wonders to keep you safe. Attachments that simply say “invoice” are becoming much more common over the last few years or so. Like the phishing emails that contain “my resume” attachments, taking an extra second to determine whether you should be receiving an invoice from this sender is a great defense. Have you ever received an invoice from this sender? Are they performing any work that is likely to result in an invoice? If the answer to any of these questions is “no,” there’s a good chance that you’re looking at a phishing email. No Phishing: Keeping Your Organization Secure | 23
No Phishing: Keeping Your Organization Secure continued...
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By Jared Hughes, Information Security Analyst, VGM Group, Inc.
A clickable link may be a single word or image in the email body or signature, even a picture made to look like an attachment.
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More and more, we’re seeing phishing emails that include a malicious URL to click on instead of an attachment. A major difference between a clickable link and an attachment is that attachments usually show up the same way in an email and they’re opened the same way, whether safe or not. With URLs, clickable links, they can be presented many ways that can be used to trick you into clicking on them. A clickable link may be a single word or image in the body of an email, something in the signature line, or even a picture made to look like an attachment. A giveaway with these URLs is that when your mouse hovers over one, it will change slightly to show the link. For example, the mouse pointer may change into a small hand. The website that the link will attempt to reach will also be displayed when you hover over it. Seeing if the website matches with the claim in the email will help determine whether you’re looking at a phishing email or not.
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Phishing emails are basically highpressure sales situations. Attackers tap into your emotions to convince you to take action.
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All phishing emails are effectively high-pressure sales situations. The attackers are trying to tap into your emotions and convince you to take an action, such as replying to the email, opening an attachment, or clicking a link. Sometimes this means attackers write lengthy emails that are multiple paragraphs in length, laying out all the false reasons why you should do this or that. Other times attackers will be extremely abrupt, writing out only a single brief sentence, such as “see attached invoice.”
VGM Playbook: Technology and the Patient Care Continuum
What to Do With a Phishing Email After considering the above, just what do you do with a phishing email after you’ve identified it? If the email appears to come from a known contact that you can reach by phone, then giving that person a call will always be a good idea. They can confirm over the phone whether they sent the email or not. If not, they’ll know that there may be a security problem with their email that needs to be fixed. If you have co-workers who specialize in information/cybersecurity, ask for their help with the email. With their knowledge, training, and experience, they can help you with next steps if you’re unsure.
ABOUT THE AUTHOR Jared Hughes, Information Security Analyst, VGM Group, Inc. Jared has been with VGM Group, Inc. since 2010. He holds the CompTIA Security+ certification and is a certified GIAC Penetration Tester. In his current role, he is responsible for improving and driving company-wide cybersecurity initiatives, ensuring PCI and HIPAA compliance. He also leads the corporate security committee, educating and advising on the varied and constantly evolving challenges faced by VGM’s divisions, employee owners, and customers. Connect with Jared on LinkedIn or at Jared.Hughes@vgm.com.
No Phishing: Keeping Your Organization Secure | 24
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