The Role of Telemedicine in Rural West Tennessee

Crystal Broyles stands next to one of the telemedicine carts used at Baptist Memorial Hospital - Union City

Is telemedicine having an impact?

According to the Census Bureau, there are 60 million people who live in rural communities, but only nine percent of U.S. physicians practice in these areas. According to the National Rural Health Association (NRHA) in the U.S., there are only 30 specialists available for every 100,000 patients in rural areas. This can cause patients in rural or remote areas to endure longer travels just to access specialists and life-saving treatments for specific diseases. Rural health facilities are turning to technology to address these issues by bringing the specialists to the patients via telemedicine. West Tennessee hospitals are finding increasing ways to implement this in their facilities and some are finding grants to help cover the costs of bringing the technology.

Telemedicine is the use of telecommunications technology such as phones and computers to provide clinical services to patients over long-distance communication. Aside from connecting patients and medical providers, telemedicine also offers a way for healthcare professionals to consult with other physicians or specialists in the diagnosis or treatment of a patient without having to leave their own facilities.

A 2012 report by the Institute of Medicine for the National Academies, entitled The Role of Telehealth in an Evolving Health Care Environment, found that telehealth drives volume, increases quality of care, and reduces costs by reducing readmissions and unnecessary emergency department visits for rural communities. Through telemedicine, rural hospitals can serve rural patients at better costs and help cut down on the time it takes rural patients to receive care, particularly specialty care.

In 2003, Hardin Medical Center implemented telemedicine through working directly with Dr. Jeffrey Woodside who was then in charge of the telemedicine program at UT-Memphis. "Woodside later retired and moved to Hardin County where he serves on the HMC Board of Directors," said Nick Lewis, CEO of Hardin Medical Center in Savannah. "The telemedicine program offered patients access to specialties including dermatology, neurology, otolaryngology and psychology. Unfortunately, the program dissolved when UT-Memphis opted out of it."

Over the past two years Baptist Memorial Hospital-Union City has implemented telemedicine in several areas including the emergency room, medical-surgical and the critical care unit. "We currently utilize it for neurology, psychiatry, nephrology and infectious disease. We hope to add pulmonology soon since we have a large patient population with lung issues," said Crystal Broyles, CCU Nurse Manager for Baptist Memorial Hospital-Union City. "We also have an Electronic Intensive Care Unit, which is a form of telemedicine that uses state of the art technology to provide an additional layer of critical care service."

While the technology has been well received by both patients and physicians, unfortunately it still does not always prevent a patient from being transferred. "Telemedicine does not overcome the issue of rural area hospitals not having all the available equipment or services needed to provide some of the services that the telemed doctors prescribe," said Broyles. "This results in the patient being transferred to another hospital that can supply the needed equipment or services."

Behavioral health is another area where telehealth can have a critical impact, giving physicians and their patients access to scarce and often remote resources. The Veterans Administration, for example, recently launched a telehealth program for rural vets with Post Traumatic Stress Disorder. More than 500 vets signed up for the study, indicating how telehealth technology may be the only option for many rural residents.

West Tennessee Healthcare's Pathways Behavioral Health Services has utilized telemedicine for nearly five years, especially in its satellite locations. "It can be very beneficial in providing diagnostic support and in determining whether a patient in outlying areas needs to be transferred to a facility that can provide a higher level of care. Often times it is the only way to see a patient and provide the necessary medical management," said Wes Crawford, Behavioral Health Service Line Administrator for Pathways Behavioral Health Services a division of West Tennessee Healthcare. "It has also allowed our physicians to better utilize their time treating patients as opposed to traveling from satellite clinic to satellite clinic. Each of our satellite locations, Dyersburg, Union City and Lexington, are set up to access telemedicine services when necessary."

Pathways utilized a grant two years ago to purchase the equipment needed to allow the program to really grow. "Some of the stations we utilize cost between $12-15,000 when we implemented the program," said Crawford. "It has greatly improved our access to clients. They do have to be in one of our facilities to utilize it because it has to be a secure connection that is HIPPA compliant. We also have a nurse present to be sure we know who will be on the line when the call is made and that things are working correctly."

A primary concern among rural physicians is whether telehealth is a realistic solution for their practice--financially and technically. The good news is that federal programs and advancements in technology are helping to rectify disparities in care. The Centers for Medicare and Medicaid Services has unveiled a new Rural Health strategy designed to make it easier for clinicians in rural areas to use telehealth technologies by reducing some of the barriers to telehealth such as reimbursement, cross-state licensure issues, and the administrative and financial burden to implement telemedicine.

Thanks to a grant from the Delta Region Community Health Systems Development - Technical Assistance Program Hardin Medical Center hopes to utilize telemedicine again. "The purpose of this program is to enhance healthcare delivery in the Delta Region through intensive technical assistance to providers in select rural communities, including critical access hospitals, small rural hospitals, rural health clinics and other healthcare organizations," said Lewis. "It is our hope that some of the grant funding will be earmarked for a new telemedicine software program."

The grant, which was awarded in late 2018, is through the Delta Regional Authority (DRA), in collaboration with the Health Resources & Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) is launching the Delta Region Community Health Systems Development - Technical Assistance Program. "The terms of the grant stipulate the funding will be used for improving the hospital or clinic financial operations," said Lewis. "It is designed to increase the efficiency of the local healthcare delivery system practices by focusing on care coordination, social services integration, emergency medical services access, and workforce recruitment and retention. One of the goals of the program is to increase the use of telemedicine to fill service gaps and access to care."

Lewis sees the implementation of a new telemedicine program at Hardin Medical Center having an immediate influence on one of the most challenging issues for a rural community; access to care, especially specialty care. "The access will immediately improve health outcomes for those who might not otherwise receive the specialized care they need. Patients who participate will receive care faster and as a result, most will recover quicker," said Lewis. "In addition to providing patients with access to care, telemedicine programs can also support healthcare professionals through consults and educational programs."

Medicare reimbursement is a major challenge for telemedicine, with states each having their own standards by which their Medicaid programs will reimburse for telemedicine expenses. There is no single standard telemedicine reimbursement system for private payers, either.

In February 2018, the House and Senate passed a budget deal that included the Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2017 that allowed Medicare to cover more services for treating chronically ill patients. This was the largest boost to federal telehealth coverage in 17 years. The act has instigated legislators to funnel more Medicare money into telemedicine by allowing Medicare to cover more services for treating chronically ill patients.

With tools such as telehealth, rural physicians can better coordinate care for medically complex patients and address the root causes of diseases. Telehealth becomes the equalizer between urban and rural areas, giving everyone access to high-quality care, regardless of where they reside.


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