Healthcare experts have suggested the time has come to electronically link the skills and knowledge of Memphis’ experienced medical specialists to underserved rural communities that are in desperate need of greater access to such care.
The idea is actually not new. The first interactive telemedicine system, was launched in 1989 over standard telephone lines. It was designed to remotely diagnose and treat cardiac patients at 12 hospitals in the United States. Since 1998, Memphis-based Interactive Solutions, Inc. (ISI), a leader in the field, has designed, installed and supported more than 1,500 telemedicine units across the country for a wide range of medical specialties and subspecialties, from neurology, emergency medicine and high-risk OB consults to stroke networks, surgery collaboration and more.
Brock Slabach, senior vice president of the National Rural Health Association (NRHA), says the need is definitely there and notes that 20 percent of Americans live in rural communities and only 9 percent of the nation’s doctors practice there.
The need is exceptionally keen in the Mid-South. Mississippi has the highest stroke prevalence rate in the nation, and Arkansas, Tennessee, Alabama and Louisiana are among those sharing the top six highest rates; Mississippi likewise has the highest infant mortality rate, with Louisiana, Alabama, Tennessee and Arkansas close behind.
Telemedicine has proven it can work – impressively and productively: The University of Arkansas for Medical Sciences (UAMS) has spent $20 million to set up a model telemedicine program and, working in partnership with ISI since 2006, has deployed more than 500 remote/rural sites across the state. It continues to grow and evolve, offering every flavor of telemedicine and subspecialty, and serving those who might otherwise go without healthcare service in any form.
The American Telemedicine Association Conference’s credentials as the fastest-growing trade show in the U.S. also demonstrate the increasing fascination with the field. Yet, according to Jason Moore, ISI’s account manager, fewer than 10 percent of Memphis-area specialists are being utilized for telemedicine.
Slabach agrees that “although there are some specific niche programs that telemedicine has been used for and continues to be very effective in terms of utilization, the spread of it has not gone as fast and as far as possibly we would have hoped.”
While the technology may be marvelous in its design and execution, the concept and operation are relatively simple. Jeremy Johnson, vice president of sales for ISI, described a hub-and-spoke structured network, with typically a convenient desktop terminal at the doctor’s end and a mobile cart that administrators or nurses at each of the participating rural clinics or hospitals can move from room to room, utilizing specialized technology that ranges from basic video conferencing to add-ons such as a
digital stethoscope, an ultrasound machine or an ear, nose and throat scope, for example.
“With some of the clinical assessment tools, we can integrate into these consults; it really is the closest thing to being there,” Johnson said.
Additionally, as new needs are discovered, e.g. for telestroke or telecardiology, the ISI technology can easily be expanded with additional scopes, pieces, even a computer — to make it as flexible and cost-effective as possible. The video conferencing equipment is versatile enough to do double duty in also offering on-site access to CME credits for the physicians, Moore pointed out.
As in so many other contemporary healthcare frustrations, cost seems to be the culprit, Moore said. “A lot of the challenges with telemedicine — and something that’s really starting to change — is the reimbursement for it.”
An in-person consultation with a physician is reimbursed at a different rate than a telemedicine visit — which reimburses at “much less,” Moore said. “That’s been the big hesitation, I think, for a lot of people: how can they make enough money doing this to sustain the program?” ISI helps to identify available grant sources to fund the equipment and get the program going, but, Moore said, once the grant money is gone they haven’t been able to sustain, due to limited reimbursements.
Individual states are now starting to reimburse for many more procedures, he points out — Mississippi is leading the charge as one of 16 states that have open reimbursement for different levels of telemedicine.
The House Energy and Commerce Subcommittee on Health is also seeking input on how 21st-century technology can improve healthcare and help patients — through government support of technology adoption and identification of ways the government is currently inhibiting the use of such technologies — good news, indeed, for telemedicine’s future.
Slabach agrees that Medicare has already done some work on its telehealth reimbursement policy. “The real issue for Medicare is not that they don’t want to pay for it, necessarily, but that there’s a scarcity of data that shows the effectiveness of telehealth services," he said. "A lot of research is being done now, however, so we should start seeing some peer-reviewed science coming out that could, with time, change Medicare’s mind on some of their payment policies."
Prices of the technology itself also seem to be improving.
“The equipment and the software to run it have really become much more affordable,” Moore said. “A few years ago folks would spend typically $30,000 on a high-definition site; today, sub-$5,000.”
Costs will vary, depending on the different subspecialties and the tools required, but outreach through telemedicine may be becoming a venture increasingly worth investigating.
“People are looking at this as much more than just a technology decision,” Johnson said. “It’s now an access to care decision. We need to make sure that the hospital logistically is ready to serve potential patients in the most effective way possible.”
To learn more:
Go online to: Americantelemed.org or isitn.com.
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