The Federal Communications Commission (FCC) moved relatively quickly to approve the Connected Care Pilot Program, approving broadband-enabled telehealth and remote patient monitoring services in underserved rural and remote areas. Funding for the program has been pegged at $100 million. The approval was unanimous on the program proposed by FCC commissioner Brendan Carr and Mississippi Sen. Roger Wicker.
CCPP will provide $100 million for subsidies to hospitals or wireless providers running post-discharge remote monitoring programs for low-income and rural Americans. An example is those run by the University of Mississippi Medical Center. The goal is to lower same-cause readmissions and improve patient outcomes. [TTA 13 July] Hearings late last month also were structured to support the program and start to fill out the details for a 2019 start [TTA 1 Aug].
Public comments are now open for a 2019 start to the program (see FCC website–look under Connect2Health which is the umbrella site for this and similar programs). Commissioner Carr had to look no further than the VA to see how Home Telehealth and other remote monitoring programs worked to drive down cost and improve patient outcomes. VA Health’s remote monitoring program cost $1,600 per patient compared to $13,000 for traditional care in one study. The trick is now translating this into an open system.
This is a nice boost to both real-time video and asynchronous remote patient monitoring in market development (and getting paid) in areas of great need. It’s also another Federal signal (so to speak) for 2019, following the proposed Medicare Physician Fee Schedule’s increased payments and broader applicability for both. mHealthIntelligence, Mobihealthnews, FCC Release Hat tip to reader Paul Costello of Medopad.
The expanded use of telemedicine in Texas–controversial and delayed by the state medical society, despite its use in distance medicine and prisons–is slowly starting to change rural health in the state. SB1107 passed the Texas legislature in 2017, removing the previous requirement for an in-person medical consultation. Texas, like many Western states, has an acute shortage of primary care doctors in 184 of 254 counties, according to the state health service.
Where telemedicine fills that gap is in areas such as emergency rooms in rural hospitals. In Van Horn, population 2,000, with the next hospital 90 miles away, telemedicine enables the ER to operate two trauma rooms and for the state, have a doctor there well within 30 minutes away which is the state requirement for a basic-level trauma facility. The ER connects with an office building in Sioux Falls, SD to a nurse and doctor on immediate call to help oversee care via the Avera eCare telemedicine system.
Universities have also worked to diversify telemedicine use in other settings. Texas Tech University Health Sciences Center has pioneered its use in ambulances and schools. The regional TexLa Telehealth Resource Center helps anyone looking to start a telemedicine project. By 2020, the University of Texas will have telemedicine fully implemented on campus. Houston Chronicle
In last week’s Senate subcommittee hearings on the Federal Communications Commission (FCC)’s Universal Broadband Fund and Rural Healthcare (RHC) program, the University of Virginia’s Center for Telehealth chalked up some substantial results confirming the effectiveness of telemedicine in rural areas. In advocating further funding for an expansion of the program, they presented the following:
- A 40 percent reduction in 30-day same cause hospital readmissions for patients with heart failure, acute myocardial infarction, chronic obstructive pulmonary disease, pneumonia, stroke, and joint replacement
- It enabled over 65,000 live interactive patient consultations and follow-up visits with high definition video within 60 different clinical subspecialties
- Their home remote monitoring program included over 3,000 patients and screened more than 2,500 patients with diabetes for retinopathy
- UVA delivered 100,000 teleradiology consults and provider-to-provider consults supported by the Epic EHR.
The UVA analysis also quantified travel savings in areas where medical and hospital care can be hours away–17 million miles of rural travel including 200,000 miles by high-risk pregnant mothers. For these mothers, NICU hospital days for the infants born to these patients were reduced by 39 percent compared to control patients and patient no-shows by 62 percent.
Karen Rheuban, MD, director and co-founder of the UVA Telehealth Center, recommended that the FCC continue to fund the RHC’s $400 million budget, with the caveat of exploring additional federal revenues should that budget be reduced. She also recommended that Medicaid and Medicare reimbursement for telehealth services be increased, the addition of wireless technologies, and including emergency providers and community paramedics in RHC funding. mHealth Intelligence, Subcommittee information and hearing video (archived webcast)
The Health Resources and Services Administration (HRSA), which is part of the Federal Health and Human Services (HHS) department, is making four grant programs available to support rural telehealth and quality improvement in 60 rural communities within 32 states, including a joint program with the Veterans Affairs Office of Rural Health. The four programs administered by the Federal Office of Rural Health Policy (FORHP) within HRSA are primarily three-year programs and include:
- The largest amount, $6.3 million, will go to the Telehealth Network Grant Program: $300,000 each annually in a three-year program to 21 community health organizations for telehealth programs and networks in medically underserved areas, with a concentration on child health
- The Flex Rural Veterans Health Access Program: $300,000 each annually in a three-year program to three organizations providing veteran mental health and other health services. This is a joint program with the VA totalling $900,000.
- Small Health Care Provider Quality Improvement: $21 million will support 21 organizations over three years in improving care quality for populations with high rates of chronic conditions, and to support rural primary care.
- Seven Rural Health Research Centers: $700,000 per year for four years, totalling $4.9 million, to support policy research on improving access to healthcare and population health in rural communities. (Funds that more usefully would have gone to veterans health?–Ed. Donna)
HHS release, Mobihealthnews, Healthcare IT News
Several years ago, CJ Rhoads, a business professor at Kutztown University of Pennsylvania and CEO of consultancy HPL Consortium, asked Editor Steve and Donna for some background information on telehealth. According to her note last month to us, the results of her research were reported to the Pennsylvania legislature and The Center for Rural Pennsylvania (a legislative agency of the PA Assembly), in 2014 and now have been published in a more readable form by CRC Press-Taylor & Francis Group. An excerpt from their summary:
Improving the quality of healthcare, while increasing accessibility and lowering costs, is a complex dilemma facing rural communities around the world. The Center for Rural Pennsylvania believed that telehealth, the use of electronic information and telecommunications technologies to support long-distance clinical healthcare was a viable solution so it recently provided grants to conduct a thorough investigation into the factors involved.
Telehealth in Rural Hospitals: Lessons Learned from Pennsylvania reports the outcome of this year-long investigation. Illustrating telehealth implementations in rural settings, it supplies an overview of telehealth as well as an assessment of its economic impact.
The book skillfully intertwines the research and academic aspects of telehealth with helpful insights from the author.
From the table of contents, it appears to be an exhaustively researched book on telehealth and its impact in rural healthcare. It’s available to purchase on CRC’s website. Thanks to author CJ Rhoads for the heads up!
[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/09/Nicholson-Center-FL.jpg” thumb_width=”150″ /]Moving beyond robot-assisted surgery (e.g. the well-accepted use of the daVinci system with prostate surgery), controlled by a surgeon present in the operating room, is telesurgery, where a remote surgeon uses a robot to fully perform surgery at a distant location. The Nicholson Center at Florida Hospital
in Celebration, Florida, which specializes in training surgeons and technicians in leading (bleeding?-Ed.
) edge techniques, is studying how internet latency (lag time to the non-techie) affects surgical effectiveness. Latency is defined in this case as “the amount of delay a surgeon can experience between the moment they perform an action to the moment video of the action being carried out at the surgery site reaches their eyes.” Their testing so far is that internet latency for surgery between hospitals has a threshold of 200-500 milliseconds before dexterity drops off dramatically (not desirable)–and that given the current state of the internet, it is achievable even at a mid-range distance tested (Florida to Texas). Making this a reality is highly desirable to military services worldwide, where expertise may be in, for example, Germany, and the casualty is in Afghanistan. It would also be a boon for organizations such as the Veterans Health Administration (VA) where resources are stretched thin, rural health and for relief agencies’ disaster recovery. ZDNet
Ahead of the forthcoming Australian Telehealth Conference 2015, one of the speakers has spoken to the media partner of the conference, Australian Aging Agenda Technology Review. In an article published on the Aging Agenda website, the speaker, Dr Shannon Nott, is quoted as saying “There needs to be a telehealth plan put in place in Australia. We need to start looking at telehealth and say this is something we should seriously invest in. We need to look at it and get it right from the start; that includes getting it right for indigenous communities [and] getting it right for rural and remote communities”.
Nott is said to have spent four months last year researching telehealth in rural and remote Alaska, Canada and Brazil including indigenous communities. The article quotes him as saying “In Alaska for every dollar that they spend on telehealth software and programs they save $10.50 in travel alone in terms of healthcare costs. Not to mention the hospital admissions avoided, the GP admissions avoided.”
[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/03/ATC2015.jpg” thumb_width=”150″ /]The Australian Telehealth Conference 2015 takes place on the 23rd and 24th of April in Sydney.
[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/10/Margelis.jpg” thumb_width=”120″ /]”Immature” and “focused on low-lying fruit such as fitness tracking and not focused on the big issues of management of disease” are also two of the compliments that Dr George Margelis
of the University of Western Sydney’s
TeleHealth Research & Innovation Laboratory (THRIL) has bestowed on the current state of health apps. Until the collected data ‘plugs into other digital platforms’–he mentions the Australian government’s PHR, eHealth–apps will not help those who need it the most. “Unfortunately, managing these diseases, in particular the chronic diseases that are a major part of the current burden, requires more than just tracking a few physical parameters which is what the app world is up to.” Dr Margelis called for collaboration between app developers and healthcare professionals; while he scores Apple’s HealthKit
, that may be the means to make his vision come true. It should be noted that Dr Margelis (more…)