January 29, 2018
American Heart Month: Remote patient monitoring and heart health
Keeping hearts healthy is the focus of February’s American Heart Month, and telehealth is well-positioned to lend a hand. Digital stethoscopes and mobile echocardiograms make it easier for cardiologists to diagnose and treat patients in remote regions. Additionally, patient monitoring devices can collect and relay actionable data from a patient’s home to health care providers in real time. But like many other specialties, cardiology and stroke care are both victims of the unrequited love between telehealth potential and telehealth policy.
Cardiovascular disease is the leading cause of death in the United States and experts have predicted a shortage of cardiologists in the next decade that will affect rural areas the most. The American Heart Association stresses the vital role telehealth can play in reducing morbidity and mortality from the disease by alleviating the maldistribution. These underserved areas have the potential to benefit greatly from telecardiology and telestroke care, but they are often the least equipped with technology and training.
In order for telecardiology and telestroke services to be effective, the AHA emphasizes that “programs need timely data, appropriate staff and a feedback loop to patients with sufficient empowerment to understand and implement instructions.” Remote patient monitoring (RPM) devices are promising tools to fit these needs in prevention, emergency care and transitional care. In one study, an RPM transitional care program for chronic obstructive pulmonary disease and heart failure patients reduced 30-day hospital readmissions by 50 percent when compared to the control group.
However, lack of Medicaid reimbursement for RPM remains a significant barrier. According to the Center for Connected Health Policy, only 21 states provide reimbursement for RPM in their Medicaid programs. This deficit is because many states define telehealth as a live interaction with a health care provider, essentially excluding RPM programs from reimbursement eligibility. While Kansas, Missouri and Oklahoma each offer some form of RPM reimbursement, provision is limited to specific types of providers and services.
Like a rocky relationship, progress in telecardiology and stroke care is also slowed by an inability to reconcile differences, poor communication and financial conflicts. The AHA reports that in addition to reimbursement challenges, other hurdles for cardiovascular and stroke care via telehealth include disparities between different states’ laws and expectations, lack of telehealth licensing across state lines, unclear patient privacy and data security regulations, high technology costs and poor technological infrastructure in underserved areas.
The budding romance of RPM devices and cardiology and stroke care has the potential to help health care providers expand and strengthen patient care. But until the aspirations of telehealth proponents and the accommodations of policy are peacefully wed, the feasibility of widespread RPM adoption for heart health will remain uncertain.
Missouri Telehealth Summit
Jefferson City, Mo. February 1
The 2018 Missouri Telehealth Summit will focus on financial barriers and incentives for rural hospitals, successful Missouri telehealth projects, legislative updates and more. The keynote speaker will be Yulun Wang, Ph.D., founder and CIO of InTouch Health.
For those who want a crash course in telehealth basics, a pre-summit Telehealth 101 Workshop will be held January 31, also at the Capitol Plaza Hotel in Jefferson City, Mo.
Presentation by Project ECHO Founder Sanjeev Arora, M.D.
Kansas City, Kan. February 2
Join the University of Kansas Cancer Center (KUCC) for a special seminar by Dr. Sanjeev Arora, director and founder of Project ECHO. Arora will share the inspiring story behind ECHO’s inception, and how ECHO is helping to change the face of cancer care, particularly for underserved patients. The seminar will begin at 12 p.m. You can join in person at KUCC’s Wahl West Auditorium or via video conference at this link: https://zoom.us/j/807649467
|Opioid Addiction||Starts February 8||Kansas|
|Child Behavioral Health||Ongoing||Kansas|
|Chronic Pain Management||Ongoing||Missouri|
|Community Health Worker||Ongoing||Missouri|
|Opioid Use Disorder||Ongoing||Missouri|
HTRC welcomes new Oklahoma partner
This month, HTRC welcomes Tim Davis, M.S., as HTRC’s Oklahoma State Director. In addition to working with HTRC, Davis will continue to serve as Telehealth Manager for Oklahoma State University Center for Health Sciences (OSU-CHS). Prior to working in telehealth, Davis accumulated 18 years of experience in health care and information technology.
“We are thrilled to have Tim join our team,” said HTRC Project Director Janine Gracy. “His work with OSU-CHS, his experience in health care and his commitment to telehealth are an asset to HTRC and will help to further advance telehealth in the state of Oklahoma.”
USDA telehealth grants awarded to Oklahoma and Missouri orgs.
Two telehealth providers in Oklahoma and Missouri were awarded 2018 USDA Rural Development Distance Learning and Telehealth grants in January. YouthCare of Oklahoma, a statewide mental and behavioral health service provider, will receive $459,675 for video conferencing equipment to bring mental health services to 21 sites in 13 underserved communities. Lester E. Cox Medical Centers, based in Springfield, Mo., will get $120,246 to help school nurses and children connect with parents and providers at 22 sites in 11 rural communities. USDA Rural Development awarded a total of nearly $24 million in Distance Learning and Telehealth grants to schools and health care providers across the United States.
Results of Oklahoma Telehealth Utilization Survey
A recent survey sheds light on telehealth use in Oklahoma. The survey, which was collected through a partnership among the Telehealth Alliance of Oklahoma, Oklahoma Hospital Association, Oklahoma Department of Health and Oklahoma Board of Licensure, showed that funding and reimbursement remain top obstacles.
Despite the barriers, respondents indicated a vast array of telehealth uses in the state – totaling 45 distinct uses. Many of the well-known uses like cardiology, radiology and psychiatry were indicated but more novel uses like aviation medicine also made the list. REPORT SUMMARY
Missouri legislation would remove more barriers to telehealth
A new Missouri bill, sponsored by Representative Jay Barnes (R-Jefferson City), aims to reduce telehealth barriers and prevent future enactment of barriers. HB1617 would remove the requirement for a telepresenter except in cases where a second professional would be in the room for an in-person visit. For example, a nurse might be present for an in-person cardiology visit but a patient would likely be alone with one professional in a room for medication management. Barnes’ bill would also dispense with current provisions that limit which types of professionals can be reimbursed for asynchronous visits. Importantly, it would make it easier for Missouri schools to implement telehealth programs. Currently, schools are handicapped by the requirement that parents provide consent for each telehealth visit, whereas HB1617 would require only an annual parental consent.
HTRC will keep you updated on the bill’s progress.
Comment on Rural Health Care Program funding
You have until February 2 to respond to the Federal Communications Commission’s (FCC) request for comment on the Rural Health Care Program, which subsidizes the cost of rural broadband and equipment needed to provide health care services via telehealth in rural areas. On December 14, 2017, the FCC voted to raise the cap on the fund, which had previously been limited to $400 million per year. According to reporting by FierceHealthcare, fund requests totaled more than $420 million in 2016. However, raising the cap was a temporary measure that would only run through June 30, 2018, without further action. The FCC has asked for feedback from those who have utilized the program, ideas for determining eligibility, increasing efficiency and determining a new funding level.
FOR MORE INFORMATION OR TO SUBMIT COMMENT
If you need more information about how to request funding through the Rural Health Care Program, please contact HTRC at 877-643-HTRC.
Project ECHO is a program using telehealth to revolutionize medical education and improve access to specialty care. Project ECHO, which was developed by the University of New Mexico School of Medicine, works by connecting primary care clinicians with specialist teams via videoconference.
Each specialty area has its own ECHO, such as autism or chronic pain. ECHO teams meet regularly to collaborate with primary care providers. Learn more