Missouri Rural Health Conference- Missouri Office of Primary Care & Rural Health E. Rachel Mutrux Sr. Program Director, Missouri Telehealth Network

Transcription

1 Missouri Rural Health Conference- Missouri Office of Primary Care & Rural Health E. Rachel Mutrux Sr. Program Director, Missouri Telehealth Network November, 2014

2 1. Missouri Telehealth Network ----Heartland Telehealth Resource Center 2. Missouri Telehealth Summit 3. FCC Rural Health Program Consortium 4. Show-me ECHO 5. Reimbursement

3 The use of electronic information and telecommunications technologies To support long-distance clinical health care, patient and professional Health-related education, public health and health administration. -HRSA Telemedicine is only the clinical applications of technology. -HRSA

4 Telehealth mhealth ehealth In-Patient/ ER Education / Training Store-n-Forward Specialty outpatient Home telehealth/ remote monitoring

5 Clinical care provided from a distance using video!! Primary care Medical Specialties Intensive Care Emergency Departments Home care-monitoring 5

6 Because clinical shortages & maldistribution. To increase access to high quality healthcare. To decrease travel, cost, & hardship. Because delayed treatment costs lives & $$. Because of language barriers. To provide clinical education. To provide training. To provide economic development.

7 University of Missouri- School of Medicine Started in 1994 Mission: to use telehealth to increase access & quality of healthcare & provide education & research. Educate and train people interested in starting their own telehealth program. We are a membership organization!

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9 9 Mirna Becevic, Associate Director Deb Denham, Business Support Specialist II Dr. Karen Edison, Medical Director Candy Garb, Telehealth Coordinator Omer Malik, Graduate Research Assistance Rachel Mutrux, Sr. Program Director Danny Myers, Project Development Specialist Mary Beth Schneider, Training Coordinator Wendy Vogel, Office Support Assistant IV Katie Vollmer, Telehealth Coordinator

10 Policy work Develop new telehealth clinics- work with providers Technology Provide CME Training conferences Research Missouri HIT Assistance Center- Missouri s REC Grants- USDA, FCC, HRSA, etc.

11 Some Clinical Specialties used.. Psych/Mental Health Dermatology Cardiology Radiology Neurology Rehabilitation Autism Surgical Follow-up Internal Medicine Genetics Gastroenterology Rheumatology Genetics Follow-Up Pediatric Dermatology Sign Language Interpretation Orthopedic Consults

12 Trauma Infectious Disease Diabetes Education Endocrinology Burn/Wound Care Pre-operative Evaluation ER Fetal Monitoring Ethics Consultations Geriatrics Tele-Home Care/ Remote Monitoring Bariatric Surgery Education Occupational Injury

13 Provider buy-in Additional personnel resources and training are required at both hub and spoke sites Costs- equipment & broadband Documentation and paper work flow disruption Reimbursement Credentialing/ Licensure Quickly changing environment Education- awareness

14 Telemedicine is simply a tool used to deliver health care at a distance. People are more important than technology. Telemedicine must be integrated into the everyday way physician s practice. It works best in augmenting established referral relationships.

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16 Hospitals & Health Systems Community Mental Health Centers Federally Qualified Health Centers Rural Health Clinics Nursing Homes Home Health Agencies Department of Veteran s Affairs Department of Defense State Facilities Division of Youth Services, Habilitation Centers, Department of Corrections

17 Types of Locations Hospitals Federally Qualified Health Care Centers Community Mental Health Centers Specialty Medical Clinics Rural Health Clinics Cancer Hospital Missouri Division of Youth Services locations Conference Rooms Army Hospital Rehabilitation Hospitals School of Medicine Nursing Homes State Health Facilities School of Nursing School of Health Professions Urgent Care Clinic Student Health Center Classrooms 17

18 Includes all MTN member site usage. 18

19 Is NOT a new service. IS a new service delivery mechanism. Increases Access! Moves information- not people. Reduces travel costs and other barriers.

20 1. Missouri Telehealth Network 2. Missouri Telehealth Summit 3. FCC Rural Health Program Consortium 4. Show-me ECHO 5. Reimbursement

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22 Karen Edison, MD Medical Director, MTN Rep. Diane Franklin State Rep, Dist. 123 Wayne Cooper, MD Primary Care Provider Lindsey Beckmann CME Coordinator Steve Kropp St. Luke s Health System Tom Hale, MD Mercy Health Systems Deborah Frost, PhD Pathways Community Health Robert McBee Dept of Veteran s Affairs Samar Muzaffar, MD MO HealthNet Morgan Waller, RN Children s Mercy Ruth Meyer Hollenback Anthem Susan Wilson Missouri Primary Care Association Justin Cramer, MD MissouriCare Bryant McNally, JD Missouri Hospital Association Andrea Routh Missouri Health Advocacy Alliance

23 Agenda VA telehealth in Missouri Improved Access & Quality Ted-style talks Provider Panel- experienced telehealth providers taking questions Dr. Sanjeev Arora- Project ECHO- keynote Payer Panel- models, potential, experience Legislative Panel- legislators experience with telehealth

25 Using Technology for Better Patient Outcomes University of Missouri s MTN & MOREnet is actively expanding its network to assist Missouri s eligible health care entities to upgrade their broadband connectivity and leverage this federal discount program.

26 Eligible Expenses Include Internet fiber: lease, build, or install. Connections to Research and Education Networks (MOREnet). Connections between off-site data centers & administrative offices. Deployment of new or upgraded broadband facilities. Equipment to manage & maintain broadband service.

27 Who Can Join? Rural health clinics; Not-for-profit hospitals; Community mental health centers; Local health department or agencies; Community health centers; Post-secondary educational institution offering health care; Instructional facilities, including teaching hospitals and medical schools.

28 Collaboration with other health care providers. MOREnet manages legal & financial documentation. Reliable infrastructure for telemedicine or online clinics. Reliable broadband for all Internet-based activities: Telehealth Electronic Health Records Health Information Exchange

29 Please contact Matt Parris at MOREnet (573)

31 Why ECHO? What is ECHO? Show-Me ECHO

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35 Primary Care Providers could treat patients with chronic conditions without referring them? Primary Care Providers felt more comfortable treating chronic conditions? There were communities equipped to care for individuals with chronic conditions eliminating need for travel? Specialists shared their knowledge and mentored PCPs to do this well?

36 Extension for Community Healthcare Outcomes University of New Mexico Dr. Sanjeev Arora and Hepatitis C Researched and published Replicated for diabetes, integrated addiction/psychiatry, chronic pain management, and more!! Projects now across the US and around the world

37 1. Use technology (multipoint videoconferencing and Internet). 2. Disease Management Model that reduces variation in processes of care and sharing best practices. 3. Case based learning: Co-management of patients with specialists (learning by doing). 4. HIPAA compliant web-based database to monitor outcomes.

38 No-cost CMEs Professional interaction with colleagues with similar interest A mix of work and learning Access to specialty consultation

39 Reducing Variations in Care Increasing Access for Rural and Underserved Patients Providing Workforce Training and Force Multiplier De-Monopolizing Knowledge Improving Professional Satisfaction/Retention Supporting the Medical Home Model Reducing Excessive Testing and Travel Improving Quality and Safety Providing Rapid Learning and Best-Practice Dissemination

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41 Internet access Forward facing camera ipad, Polycom, Computer/webcam Interest in learning more about chronic condition ECHO etiquette Hub of clinical experts to mentor spokes Hub technical & communications experts to make it run smoothly Attendance to ECHO clinic

42 Columbia- PCP Interdisciplinary Team- Hub Karl Haake, medical specialist Rich Lillard, behavioral health specialist George Oestreich, pharmacist Troy Lambert, nurse specialist St. Louis- PCP Chronic Pain Expert Hub Ellington- PCP Joplin- PCP Project Support Wendy Vogel, admin support Candy Garb, coordinator Katie Vollmer, Omer Malik, user support Mary Beth Schneider, communications Danny Myers, manager Mirna Becevic, evaluator Rachel Mutrux, director

43 ECHO Specialist outpatient care via video CME from MU School of Medicine- Grand Rounds

44 Partnered with UNM to replicate ECHO Working with legislators to fund multiple ECHO clinics Creating Advisory Council Applying for grants to fund ECHO clinics Starting 2 pilots: Chronic Pain Management Autism

45 Chronic Pain Management Mental Health/ Substance Abuse Autism Hepatitis C Diabetes Rheumatology High Risk OB Dermatology Infectious disease Cardiology Asthma Geriatrics Complex Costly Common Chronic

47 Live interactive is reimbursed; store-and-forward is NOT! Live Interactive Store and forward

48 Both pay for live-interactive appointments only. Medicare pays ONLY if patient is in rural areas or federally designated Health Professional Shortage Areas Both pay provider fees and facility fees with distinct eligibility. Both provide eligible CPT codes, eligible activities with distinctions.

49 MEDICARE Physician Nurse midwife Registered Dietician or nutrition professional Clinical psychologist Clinical social worker Nurse practitioner Clinical nurse specialist MO HEALTHNET Physician Advanced registered nurse practitioner Dentist or oral surgeon Psychologist Pharmacist Speech therapist Occupational therapist Physical Therapist

50 Patient has to be physically in one of these locations! Originating site (patient location) 1. Office of physician or advanced practice nurse 2. Hospital-based or critical access hospital-based renal dialyses center 3. Critical access hospital 4. Skilled nursing facility 5. Community Mental health center 6. Hospital 7. Federally qualified health center 8. Rural health clinic What s missing on this list?

51 Patient has to be physically in one of these locations! Originating site (patient site) 1. Hospital 2. Critical access hospital 3. Rural health clinic 4. Federally qualified health center 5. Nursing home 6. Dialyses center 7. Missouri state habilitation center or regional office 8. Community mental health center 9. Missouri state facility 10. Missouri residential treatment facility 11. Comprehensive substance treatment and rehabilitation (CSTAR) What s missing on this list?

52 Statewide Parity for private insurance coverage of telemedicine. House Bill No. 986 requires private insurers to reimburse on the same basis as for in-person services. What next? School-based telehealth & store-n-forward teledermatology

53 Missouri Telehealth Network Heartland Telehealth Resource Center American Telemedicine Association Center for Telehealth & ehealth Law FCC Rural Health Care Program

54 Thompson center video! E&feature=player_embedded

55 Contact: E. Rachel Mutrux Sr. Program Director, Missouri Telehealth Network 2401 Lemone Industrial Blvd. Columbia, MO