The Payment Model
Currently 11 hospitals participating in telehealth pay approximately $600 per consultation with a UNMH neurologist. $300 goes to NMXS to cover overhead, maintenance, support and profit; the other $300 reimburses the neurologist's time and assessment. The telehealth consultation allows local hospitals keep their patients, rather than transporting them to UNMH, so the reimbursement from insurance goes to the local hospital.
The innovation in the payment model for ACCESS is that, after the funding period, hospitals in the state will reimburse the consultation for the neuro-emergent disorder on a per encounter basis. The volume of consultations for neuro-emergent conditions will increase over time once the benefit is evident to the hospitals. This will provide the financial strength for operating the model after the three-year cooperative agreement ends. Additionally, the model is very scalable to other areas such as general and orthopedics surgery, psychiatry, oncology and others.
How funds will flow under the payment model
The CMS Innovation Award will fund the upfront cost of implementing the ACCESS program in New Mexico and provide the ability to assess the impact of the program with respect to costs savings to Medicare, Medicaid and other insurance providers as well as the impact on the state's patient population requiring neurosurgical-emergent care. The innovation in the payment model for this program is that, after the funding period, hospitals in the state will reimburse the consultation fee on a per encounter basis. These local hospitals keep their patients, rather than transporting them to UNMH, so the reimbursement from insurance goes to the local hospital.
NMXS has developed and implemented the technology to facilitate comprehensive consultation to hospitals at no upfront cost to the hospitals. The hospitals pay a per consultation fee to a specialist for assessment and plan-of-care decision-making.