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Chapman Presentation Transcript

  • 1. Virginia Telehealth Summit March 18, 2010 Institute Conference Center Danville Virginia Telehealth in FQHCs Howard Chapman, Jr., Executive Director Southwest Virginia Community Health Systems, Inc.
  • 2. SVCHS Site Map
  • 3. SVCHS Patient Origin Map
  • 4. UVA Telemedicine Program
  • 5. Telemedicine: History  Alexander Graham Bell  Hugo Gernsback (vision)  Massachusetts General  University of Nebraska  NASA  Dept of Defense  University of Virginia
  • 6. Motivating Factors that prompted entry into Telemedicine  Access to Specialty Care - HRSA Grant provides access for primary care and prevention - There is a shortage of area Specialty Providers in the rural areas we serve - These area Specialists have heavy schedules of paying and insured patients - They have no requirement or provision to provide care to indigent or uninsured patients
  • 7. Motivating Factors that prompted entry into Telemedicine (continued) - When specialty services are not available to patients they usually go without or the primary care physician tries to offer what level of care they can - Too often this results in their completing procedures over their head or that the practice is not equipped to provide - This becomes a “Risk” issue, especially with FTCA coverage and practicing within the approved Scope of Services
  • 8. UVA Telemedicine
  • 9. Cancer outreach: Mobile digital mammography
  • 10. UVA Teleradiology  SVCHS installed two Digital X-Ray Units from our CIP Grant from the Economic Stimulus Funding  We now use the UVA Department of Radiology for our X-Ray interpretations  SVCHS is charged a flat fee per X-Ray procedure  SVCHS then bills for both the professional and technical component  UVA Radiologist is available to consult with SVCHS providers for STAT readings  STAT readings during evening and Saturday hours is through the link with the ER at UVA
  • 11. Other Motivating Factors  Rural Isolation  Telemedicine Removes much of the “Rural Isolation” and makes it easier to recruit and retain physicians and providers  Providers and staff can receive CME Training and credits through Telemedicine  It puts the resources of a major university at the fingertips of a rural physician  Grand Rounds schedules are available through UVA for our providers who want to participate  Poison Control is available through the UVA Telemedicine Link 24/7
  • 12. Other Motivating Factors  Patient Education  Shortage of other Health Care Resources and Ancillary Care Providers (i.e., Health Educators, nutritionist, etc.)  Patient Education Programs - Established Format - Customized Programs for our Patients  Important for the participation in the Health Disparities Collaborative and Patient Self-Management Goals  CDC First Responders Training was provided through the UVA Telemedicine Link at our Saltville site for the Anthrax terror alert
  • 13. Planning Steps  The University of Virginia (UVA) was working to establish the Southwest Virginia Telemedicine Health Alliance and had grant money to support the program  There was no investment on our part except for the space and staff time devoted to training and using the equipment  SVCHS had to agree to make the telemedicine equipment and services available to the entire community and other area providers as part of our commitment  After two years we had to pick up the cost of the communication lines (same lines we use for our EMR and practice management System)  Universal Services Administration assistance with the communications and connectivity cost  UVA’s first connection in rural southwest Virginia was over $4,000 per month for a T-1 line in 1994
  • 14. Planning Steps (continued)  SVCHS was added in 2001 and the cost was about $1,000 - $1,200 for a rural T-1 connection (Universal Service Administration assistance moved that to about $450 / month)  Now a broadband fiber connection is about $400 / month without the Universal Services Administration Assistance  Communication lines are now required for EMR and data exchange anyway  The cost of Telemedicine Equipment is down as well. In 2001 the equipment was around $60,000 and now the cost around $22,000
  • 15. Implementation Schedule  SVCHS has been operational since 2001 with the UVA Telemedicine Program  Expansion to other sites include initial UVA training and orientation  We have our Telemedicine Manager conduct training and orientation with the provider (NP) that will be using the equipment and the providers and staff that will be making the referrals
  • 16. Facilitators/Impediments in the Process  Karen Rheuban, M.D., Medical Director for the UVA Telemedicine Program is a great Champion and Facilitator for the use of telemedicine  UVA has been doing this for years and is one of the most advanced and recognized programs in the nation  Impediments include:  Reimbursement Issues (must be at least a mid-level provider operating the equipment)  Reliable Connectivity for the system  Laws and regulations around licensure  JCAHO and other credentialing issues
  • 17. Challenges  Funding of telehealth (Stark, Anti-kickback Laws)  Reimbursement  Outcomes  Confidentiality  JCAHO  Licensure  Malpractice  Telecommunications venue/costs  Integration with EMRS/RHIOS  Interagency alignment related to policies Federal (definition of rural, rural vs urban) State (eligible plans, coverage of store and forward)
  • 18. Reimbursement varies by state  Reimbursement - Virginia Medicaid (urban and rural) - TennCare MCOs - Medicare (rural) - Private payers - Anthem grant for Virginia - Contracts - Peds cardiology - Psychiatry - Dept of Corrections  Formal request of Virginia Medicaid 1995, expanded 2003
  • 19. Licensure  No portability  Primarily serve Virginians  Primarily provide consultations  International patients easier than other states  Discussion surrounding model of nurse compact  Tennessee BOM references a “telemedicine license” for out of state providers
  • 20. JCAHO  2000 JCAHO standards required credentialing and privileging at all the remote sites  2004 JCAHO standards revisions (more coming)  Credentialing and privileging at a JCAHO accredited consult origination site  Remote hospital medical staff to agree to telehealth relationship  Link to quality data for feedback  Agreements between institutions
  • 21. Successes and Accomplishments  SVCHS is one of the most highly utilized UVA Telemedicine Sites  SVCHS has a great working relationship with the UVA Telemedicine Program  We now have telemedicine equipment in 6 of our 7 sites (plans to add 2 additional telemedicine sites by December 2008)  UVA offers access to 33 separate specialties and services through telemedicine  They accept the SVCHS Sliding Fee Payment as Payment in Full for our indigent patients  They have private grant funding to support payment for patients whose insurance carrier does not cover telemedicine services  They have provided a digital retina camera for eye exams for our diabetic patients that can be emailed to the UVA Ophthalmology Department and the results emailed back
  • 22. Southwest Virginia Community Health Systems, Inc UVA Specialty/Subspecialty Participants  Cardiology  Obesity  Dermatology  Oncology/Tumor boards  Diabetes  Pain management  Emergency Medicine  Pediatric cardiology  Endocrine  Pediatric nephrology  ENT  Pediatric oncology  Gastroenterology  Genetics  Plastic surgery  Geriatrics  Psychiatry  Gynecology  Pulmonary medicine  Hematology  Radiology  Infectious Disease  Rheumatology  Nephrology  Surgery  Neurology  TCV  Neurosurgery  Toxicology/Poison control  Ophthalmology  Urology  Orthopedic  Wound care
  • 23. Lessons Learned  To receive Credit for the telemedicine encounters they must be provided by a mid-level (NP/PA) or physician.  This allows for the user and encounter data for BPHC and the UDS Report to count  Reimbursement as a consult visit (incident to visit) to be reimbursed to the specialist and the provider using the equipment and conducting the exam at the site  This is not the most ideal care for the insured patients, but they have transportation and the resources to seek care elsewhere  For our indigent and uninsured patients it is often the only option for access to specialty care  Video Conferencing is often a great way to conduct meetings and business among remote sites  UVA allows a bridge for that to happen, but connections are limited  For a fee more links can be accommodated for these meetings
  • 24. Health Center Controlled Networks – IT Funding  Community Care Network of Virginia (CCNV)  Owned by Virginia FQHCs  Statewide EHR Network (eClinical Works)  Quality Improvement Grant working with HRSA required data  Tracking Healthy People 2020 Guideline data as a quality measure  Patient Kiosk to enter patient data (PHQ-9 and other data)  IT Committee looking at “Enhancements” to current system (i.e., case mgt., patient call reminders, dental, mental health, etc.)  CCNV is included in the Regional Health Center Grants to connect to HIEs  CCNV is also part of the QI Grants that went to VHD  Collaborative partner on several Beacon Community Grants
  • 25. Health Information Exchanges  CareSpark and MedVirginia operational in Virginia  Collaboration of Patient Care by sharing data among community/regional providers  More informed and better decisions in managing patient care  New insurance Products (Active Health)  Reduction of Costly Procedures – MRIs, Cat Scans, etc.  Reduction of Medication Errors through e- prescribing  Pay-for-performance
  • 26. Thank You! Contact Information: Howard Chapman, Jr., Executive Director Southwest Virginia Community Health Systems, Inc. P. O. Box 729 /319 Fifth Avenue T. K. McKee Hospital Building Saltville, Virginia 24370 Telephone: (276) 496-4492 Ext. 108 Fax: (276) 496-4839 Email: hchapman@svchs.com Web Site: www.svchs.com