Taking Rural Healthcare to Heart, Creativity, Collaboration ...


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Taking Rural Healthcare to Heart, Creativity, Collaboration ...

  1. 1. VOLUME 4, ISSUE 6 JUNE 2009 Taking Rural Healthcare to Heart Creativity, Collaboration and Commitment Bring Specialist Care to the Peninsulas By Nora Haile disturbs Kitsap and Olympic Pen- The independent physician group Contributing Editor insula leaders like Mary Berglind, specializes in all aspects of cardi- Washington Healthcare News Administrator of Kitsap Cardiolo- ology, vascular services and elec- gy Consultants, and Camille Scott, tro-physiology (rhythm disorders), CEO of Forks Hospital. striving to keep the patient, proce- Forks is located at the northern dures and resulting revenues in the tip of the Olympic Peninsula and local communities whenever pos- Forks Hospital is part of the Clal- sible. For more acute conditions, lam County Hospital District #1. patients are transferred to Harri- Its service area covers over 9,000 son Medical Center in Bremerton people, including four tribes. The where they offer comprehensive population struggles continually in cardiology services. an economic downturn since the Care Innovation drop in logging and commercial The rotation model works, but fishing, once the area’s mainstay Scott wanted patients to have ongo- industries. ing care without constant travel on How did Forks get a leg up? Old- the part of either doctor or patient. fashioned partnering. Berglind ex- That’s when she began exploring plains, “We’d heard Camille was telemedicine as an option. Through Forks, Washington, is lucky. Not bringing in specialists from Seattle. the USDA Grants under the Rural because it boasts a lush green She’s very passionate about quality Development Distance Learning landscape fed by nearly 100 inches care in her community. So I called and Telemedicine Program, hos- of rain annually. Or even because to talk about the feasibility of pro- pitals can receive matching funds of its recent claim to fame as the viding cardiology care in Forks.” for equipment and deployment. setting for the popular Twilight The two quickly established a rap- Telemedicine (also called e-health books. It’s lucky because the resi- port that lead to cardiac care in or telehealth) allows health care dents have access to specialist care Forks, expanding accessibility. professionals to evaluate, diagnose – locally. and treat patients through devices For Kitsap Cardiology, partnership In a town of roughly 3,000, local is part and parcel of how it does connected via telecommunications access to specialist care is not typi- business. In addition to Forks, it technology. Its uses in radiology cal, a plight shared by rural dwell- serves patients in Port Townsend, are widely known, but less so in a ers who make up 25% of the US Sequim and Port Orchard, with cardiac care situation. population. In fact, nationwide, the several other Critical Access Hos- Too, Scott wanted to take tradi- specialist ratio is approximately 40 pitals (CAHs) in the offing. All tional uses a step further. At a re- per 100,000 rural residents as com- Kitsap Cardiology doctors share gional trade show, she discovered pared to around 134 specialists per equally in the region’s rural clinic one of the products that Alaska 100,000 urbanites.i That disparity coverage, when and where needed. uses to provide care in remote -1-
  2. 2. areas called the AMD Integrated cardiac ultrasound machine and so the time spent hammering out the Medical Cart. Its application in- forth. We house the audio/video details, but Scott gives full marks trigued her, because they were us- equipment in our clinic.” Prior to to the Kitsap group for educating ing it more extensively than she’d purchase, they had to determine staff and drafting the protocols. realized possible. Next, she set out what the cardiologist would need Also, Kitsap Cardiology takes any to learn how other rural clinics and in order to work remotely with a patients that Forks refers, a recep- hospitals were using telemedicine. patient. The two entities decided tiveness Scott deeply appreciates. Understand that Forks area resi- on a highly versatile cardiology- “It’s tough to find willing partners, dents are largely dependent on based telemedicine unit. It can but Mary and her group were as Medicare, Medicaid and self-pay, show EKG streaming in real-time, enthusiastic as we were about the since there are few employers to has a stethoscope attachment so potential and dived right in with provide coverage. “We have a big the doctor or nurse practitioner can us.” enough population to exist, but not hear the heartbeat, and has a hand- With the trial phase complete, they large enough to draw services like held camera that lets the physician are filling slots for the virtual car- you get in urban settings,” Scott see the patient’s every physical de- diology clinic; however, Scott es- says. Moreover, there is a high tail. timates it will take another twelve incidence of cardiovascular dis- During deployment, doctors con- months before patients feel fully ease in the population. The near- tinued to travel to Forks because as comfortable with the setup. “It’s est hospital neighbors, Aberdeen Berglind explains, “We’ve found not the kind of care situation we (110 miles to the south) and Port telemedicine works best if you grew up with, but once you see the Angeles (65 miles to the north) are develop a relationship to discover potential, it’s amazing. Of course, limited on the number of Medicare what truly needs to be supported in kids think it’s the coolest thing and Medicaid patients they take. their community.” The organiza- ever,” she laughs. The program’s Northern peninsula patients would tions co-developed policies, pro- aim is to address the chronic care often find themselves making a cedures and training to fully sup- issues where people can’t access nearly four hour trip to Seattle for port the care goals they wanted the specialist care because of either specialty care. program to provide. Trust and hard locale or affordability. “Patients work on the part of both organi- come in for a regular office ap- “When we started down this road zations helped make it happen, in pointment, we get them attached, two years ago, I couldn’t find any- some cases turning potential ob- the doctor is on the other end and one else in the lower forty-eight stacles into positives. off we go!” Scott enthuses. Quality using telemedicine to the extent For instance, Kitsap Cardiology is isn’t compromised because the pa- we are now,” Scott says. Realizing a nationally accredited cardiac ul- tient is seeing a practitioner face- the benefits such a product could trasound site, but the accreditation to-face – via live video. bring to rural areas like Forks, she cost is prohibitive to many small and her colleagues took a leap of Model Efficiency hospitals. So the group added the faith. hospital under their license, an ar- Besides the obvious benefits to Collaborative Commitment rangement allowing the hospital the patients, Scott says the model Berglind remembers the initial to participate as a site without in- is highly efficient. “People are do- conversations between her and curring the expense of accredita- ing the jobs they need to be doing Scott. “Kitsap Cardiology had tion, if (1) the hospital follows the – lab results, patient prep, testing never done telemedicine. Yet we Kitsap Cardiology’s template and – all done prior to when the phy- decided to work together and get (2) if Kitsap’s doctors handle the sician becomes involved.” She the program going based on a review and quality assurance. An- acknowledges there is a drawback handshake – very old-school,” other area that needed synchroni- on the revenue side. The specialist she laughs. They collaborated on zation was insurance – there were collects on the visit yet the hospi- the grant, though Berglind says network and coverage gaps to ad- tal receives only the lesser facility Scott was the driving force. “Ca- dress. fee. That’s an issue for insurers to mille got the grant money for the Both parties credit the success to address as telemedicine becomes cardiology equipment – treadmill, a strong relationship bolstered by more widespread. -2-
  3. 3. The best thing about their telecar- Paying It Forward Nora Haile is a Contributing Edi- diology program? It’s highly rep- With sights set on the future and tor with the Washington Health- licable, a feature that the USDA the program in full roll-out, Scott care News. Haile is also the owner Distance Learning and Telemedi- is forging ahead. The second unit and founder of nhaile solutions in cine grantors use to measure suc- is set for installation at the Clal- Seattle. nhaile solutions provides cess. Scott believes the program lam Bay Clinic this summer. Ex- communications services to health meets important criteria, such as pansion plans include extending care and other organizations in being key to care-giving, expand- the “how to” package – imple- the Pacific Northwest. She can able and able to withstand the mentation plan, training, policies be reached at 206-650-3308 or test of time. “I truly believe this and procedure templates – to their nora@nhaile.com. is the direction health care is go- nine-member CAH collaborative Mary Berglind began her health- ing. You’ll have the specialist in and beyond. “We must help oth- care career over 25 years ago in one area and using this modality, ers in the same situation. Because nursing in Spokane, WA. She went you’ll be able to get to the rural, we’re cost-based reimbursed, on to management roles in health even some urban, areas.” Such ac- there’s not a lot of extra money. insurance, home care and for the cessibility is essential, and if the Also, we anticipate an $800,000 past 9 years, cardiology. Berglind primary care physician downturn loss on our state-funded programs grew up in Grandview, a rural continues, all areas of care will between this year and next. Just community in Eastern Washing- use telemedicine. because the monies don’t come ton. Berglind adds that telemedicine through doesn’t mean the need for Camille Scott has been in health- has the potential to help creatively care stops.” care for over 40 years. She holds address physician shortages. “Con- Commitment from both organi- degrees in Nursing (BSN) and sider the age most physicians re- zations is making the difference Hospital Administration (MA) and tire,” she says. “If there was a way in the lives of people frequently has worked in large urban facili- for them to continue to provide underserved merely because of ties and small rural programs from care without carrying a full patient where they live. Both leaders are the Eastern US to Washington’s load, many would.” She points to effusive about the benefits of tele- Olympic Peninsula. She has served cardiac ultrasounds as an example, medicine and its boost to accessi- on the Idaho Hospital Association reiterating that doctors can read bility. But give credit where credit Board, Association of Washington those without being in the same is due – technology is only as good Public Hospital District Board, room as a patient. “If this [tele- as the people who use it. It takes Clallam County Board of Health medicine] catches on, then you collaboration and care to make a and is a member of ACHE. Scott is will have qualified cardiologists real difference. For these enthusi- currently Chairperson of the West- who continue practicing longer.” astic entrepreneurial spirits, it’s all ern Washington Rural Health Care It also helps independent practices about getting the very best care for Collaborative. and small hospitals stretch their re- the people in their communities. i Statistics from Rural Health People 2010 sources, allowing for a safety net Telemedicine is simply the best - “Healthy People 2010: A companion when there’s staff turnover. tool they’ve found to do that. Document for Rural Areas.” Reprinted with permission from the Washington Healthcare News. To learn more about the Washington Healthcare News visit wahcnews.com. -3-