Improving Access to Care in Rural WV: How Telehealth Can Help!

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1 Improving Access to Care in Rural WV: How Telehealth Can Help! West Virginia Rural Health Conference Canaan Valley Resort Tom Kuhn, M.S., M.H.A. Barbara McKee RN, MS, APRN October, 2017

2 Video

3 Mission: The Members of Partners in Health Network, Inc. will meet the health care needs of our communities striving for quality care throughout the network by leveraging existing resources while working collaboratively to improve organizational efficiencies.

4 Partners In Health Network, Inc. Mid Ohio Valley Rural Health Alliance Primary Care Centers Hospitals Ground Medical Transportation HealthNet Free Clinics Skilled Nursing Facility Kanawha May Tyler 32 Harrison 17 Racine, OH 17 Wood Ritchie Wirt Upshur Gilmer 15 Calhoun Randolph Jackson Roane 18 Braxton Webster 8 Putnam Clay Cabell Nicholas Pocahontas Boone Fayette Greenbrier 21 Logan Raleigh Wyoming Pleasants Mercer 24 Monroe 20 Mental Health Centers WV Medical Institute (WVMI)

5 Telehealth Service Area Hancock Brooke Ohio Marshall Mason Wetzel Monongalia Marion Tyler Preston Pleasants Mineral Harrison Taylor Hampshire Doddridge Wood Ritchie Grant Barbour Tucker Wirt Hardy Lewis Gilmer Calhoun Upshr Jackson Randolph Roane Braxton Pendleton Morgan Berkeley Jefferson Cabell Putnam Clay Webster Wayne Lincoln Kanawha Boone Nicholas Fayette Pocahontas Primary Service Area Mingo Logan Raleigh Greenbrier Secondary Service Area Wyoming Summers Monroe McDowell Mercer February 2017

6 How Telehealth can help Getting started! Determine the telehealth needs at your facility and within your local community Determine clinical opportunities preferred by local primary care providers and consultants Specialty care Follow up care Home monitoring

7 How Telehealth can help Currently, most clinical consultations are: Live, real- time with interactive audio and video Types of clinical consults Specialty, emergent and follow up care Behavioral health Surgical (pre- assessment and aftercare) Wound care Stroke and non- stroke neurology Renal Transplant (pre- assessment and follow up care) Pre and post natal care

8 How Telehealth can help Non- traditional types of consults Store and forward technology Home monitoring Heart failure Asthma COPD Wound care Post MI or post surgical cardiology

9 How Telehealth can help Support services by telehealth technology Assistance with clinical decision making CDE (Certified Diabetes Education) Physician and provider CME Nursing CE

10 How Telehealth can help Economic and Financial benefits to telehealth Goal is to maintain patients in their home communities for primary and ancillary care. >90% of telehealth patients are cared for locally after specialty telehealth consultations (Source: Teledoc, April 2017) Refer and transfer those patients who require tertiary care services. Access to variety of specialist that the community may not be able to support, financially.

11 Telehealth Reimbursement CMS has published the 2017 list of reimbursable telehealth services (CPT codes) for Facilities and Distant Site Practitioners As a condition of payment for distant site providers, the telecommunication must be A/V that permits real-time (live)communication between the practitioner and the patient at the originating site. Remote patient monitoring While some payers do reimburse remote patient monitoring, the gold standard is live video encounters.

12 CAMC Telehealth Steering Committee Partners in Health Network (co- Chair) Barbara McKee Operations Development Networking Outreach CAMC Information Services (co- Chair) Eileen Clark IT Development Telehealth Medical Champion Finance Billing/Coding Administration Transfer Center Imaging PIHN Member Health Center/Hospital CAMC Physician Group Office of Legal Counsel Potential Ad Hoc Specialties with Medical Champion: Research / Grants Emergency Medicine Dermatology Cardiology Behavioral Health Surgical / Wound Care Neonatology Obstetrics Neurology Ophthalmology Ear, Nose, & Throat Infectious Disease Endocrine Renal Transplant

13 How Telehealth can help Center for Telehealth: Responsibilities Ensure alignment with strategic plan Assess impact of proposed telehealth projects Provider leadership and direction to the project team Suggest appropriate allocation of resources Establish guidelines for review and selection of projects Support organizational communication and visability

14 Current Telehealth activities Diabetic Retinopathy Screening 8 sites with CAMC Ophthalmology Center WV Kids Pediatric & Adolescent Psych 10 PIHN sites with Process Strategies/Highland Hospital Tele-stroke 9 PIHN hospitals with CAMC Stroke Center of Excellence Home Monitoring (CHF and Post op vascular surgery)

15 Proposed Telehealth activities Tele- OB (USDA- RUS grant in review) Telehealth in Renal Transplant Neonatology Prison- based Diabetic Retinopathy

16 One of our Rollies

17 Diabetic Retinopathy Camera System

18 Actual Photos of Fundus, Sent by Telehealth Normal Fundus Abnormal Fundus

19 TeleMed 2020 Home Monitor Take home kit includes: Weight scales BP cuff O2 saturation monitor Thermometer Bluetooth I-pad Carrying case

20 Patient #1. Lives 2.5 hours from Charleston. The Care Manager was able to remotely monitor the wound, patient weight and VS without any outside intervention. Readmission to hospital was not needed during the 4 week monitoring period. Patient #2 Lives 30 min from Charleston and was monitored daily for 4 weeks. Data shared with care team. Antibiotic ordered and patient was not readmitted.

21 Questions, Discussion Thank you!

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