- For the two administrators responsible for guiding new telehealth projects to fruition across upstate New York, ROI doesn’t always mean reimbursement. Sometimes a new telemedicine program has to look beyond money for value.
“You need to find partnerships,” says David Johnson, telehealth network program coordinator for the Fort Drum Regional Health Planning Organization. “And then you get them thinking about different forms of ROI. Oftentimes it’s the death of a project … when you bring up reimbursement.”
Johnson and Katy Cook, telemedicine project coordinator for the Adirondack Health Institute, oversee some 33 active telehealth and telemedicine projects in the North Country Telehealth Partnership, covering a vast, 11-county expanse of New York that’s home to some of the most remote and underserved regions east of the Mississippi.
Johnson and Cook will be talking about their challenges and successes at the Northeast Telehealth Resource Center’s regional conference next week. “Taking Telehealth Mainstream” will take place May 23 and 24 at the University of Massachusetts in Amherst.
Andrew Solomon, the NETRC’s project manager, says the work done by Johnson and Cook is an example of how partnerships are springing up around the country to improve healthcare services and access where providers and funding are in short supply. The NETRC is part of the national Consortium of Telehealth Resource Centers, which consists of 12 regional and two national centers.
“The North Country Telehealth Partnership, and other networks such as the Georgia Partnership for Telehealth, are defining how collaborative telehealth can be sustained in rural and medically underserved areas,” he says. “Considering the alarming growth of provider shortages, a network model such as this can be a great solution to extend clinical capacity across a state and beyond.”
At a time when Medicare isn’t all that helpful in reimbursing for telehealth – the Centers for Medicare and Medicaid Services considers Jefferson County a metropolitan statistical area and therefore ineligible for most telemedicine reimbursements, even though it’s primarily a rural county with Fort Drum in its midst – and states like New York haven’t gotten on board with parity legislation, telehealth projects might live or die on their clinical and socio-economic benefits.
“You learn to think outside the box,” says Cook.
Cook, whose coverage area includes one county with three main roads, no stop lights and little to no cellphone or wi-fi service, says it’s vital to get healthcare providers on board early.
The challenge, she says, is in finding something that will pique their interest – a telehealth program with local school districts or the jail system, perhaps, where success is measured in the number of children kept in school and out of doctors’ offices or hospitals or the number of inmates receiving much needed substance abuse or behavioral healthcare services.
“Many of the providers in our region are extremely busy,” adds Johnson. “They’re not looking to expand their practices. They’re at capacity,” so they’d be more inclined to consider telehealth projects that ease their workflows and push services from the crowded office or clinic to the patient.
Likewise, says Cook, a telemedicine program at the Hamilton County Jail would be appealing to the county sheriff’s department because it would enable them to keep the county’s five deputies on duty, rather than pulling two out of the rotation to transport a patient from the Lake Pleasant jail to St. Mary’s Hospital in Amsterdam, some 60 miles away.
In another case, Johnson says he’s been working for several years to get a diabetic retinopathy screening program in place. Roughly half of the nation’s diabetics are screened regularly for eye issues, while the number in New York is closer to 70 percent. In the region covered by the North Country Telehealth Partnership, however, only about 20 percent are screened.
“We could be several years away from” reimbursement for such a program, he says. “So we have to find those partners who are willing to position themselves for the future.”
Johnson says he and Cook go through a 12-step program much like a version of The Dating Game to launch telehealth projects. Healthcare providers – or anyone else, for that matter – are asked what they’re looking to accomplish with telehealth, and then they’re asked what they might be able to provide to such a program.
When asked if he’s seeing healthcare providers come to him with ideas, replies, “I wish that were the case.” Oftentimes, he says, they’re too busy or too concerned with reimbursements and sustainability to consider new ideas.
But that may be changing. A raft of telemedicine-flavored bills in Washington D.C. aims to loosen the reins of reimbursement and support. And the gradual move toward value-based care is prompting healthcare providers to be more creative.
“There has been more interest over the last six months,” says Cook, whose challenges include trying to launch a remote patient monitoring program that makes use of landlines or portable wi-fi hotspots. “People are starting to realize that this new model of delivery is the answer to some of the challenges they’re facing.”