California Department of Health Care Services Steps Forward with Proposed E-Consult Reimbursement Policy (October 2018)

The Department of Health Care Services (DHCS) has released two policy document drafts that include reimbursement of e-consult for specialty care delivery, making California one of only two state Medicaid programs that officially support provider-to-provider consultation services. The Center for Connected Health Policy (CCHP) calls this new policy direction is a “significant step forward,” reports Healthcare Informatics.

The two documents include a State Plan Amendment (SPA) and an update to the telehealth section of DHCS’s Medi-Cal Provider Manual. The SPA addresses the clarification of specific circumstances under which Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)may be reimbursed for e-consult services. The section on Store and Forward Telehealth Services notes “an FQHC or RHC may bill at its PPS rate for ophthalmology, dermatology, and dentistry Store and Forward Services provided to its Established Patient” if it meets requirements specified by DHCS in the SPA. In the updated version of the Telehealth Provider Manual “asynchronous electronic consultation services are reimbursable between two health care providers for the purpose of offering a coordinated multidisciplinary case review, advisory opinion, and recommendation of care for complicated symptoms or illnesses.” The document includes two CPT codes, one for the first e-consult hour before and after “direct patient care” and the other for each additional 30 minutes.

DHCS is requesting input from stakeholders on the content of both documents. The CCHP E-Consult Workgroup will gather workgroup member input for submission to DHCS. Send submissions by November 14th to electronic_consult@bluepathhealth.com.

Stanford Healthcare Dermatology E-Consult Pilot Educates Primary Care Physicians and Saves Time for Patients (October 2018)

Source: PhotoCareMD, HIMSS NorCal ePatient Summit (2017)

A recent e-consult pilot at Stanford Healthcare studied the benefits of integrating dermatology e-consults with an EHR. For the pilot, researchers developed a store and forward workflow tool called PhotoCareMD for an Epic-based EHR. Using the system, 36 PCPs from eight outpatient clinics submitted 215 e-consults, 73% of which were resolved electronically and 27% of which resulted in scheduled face-to-face meetings with a dermatologist.

Among the PCPs participating in the pilot, 100% said they would recommend PhotoCareMD to their colleagues and 95% said PhotoCareMD was a helpful educational tool that increased their expertise in diagnosing skin issues. Among patients, 96% said they had a positive experience and 95% said that it saved them time.