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RURAL TELEHEALTH

RURAL TELEHEALTH. Chuck Lail. OVERVIEW. Why Is Telehealth Needed Telehealth Opportunities Potential Benefits of Telehealth. Rural Health Landscape. 46 of 67 Alabama Counties Are Rural As Defined By Federal Office of Rural Health Policy. Rural Health Landscape. Rural Demographics

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RURAL TELEHEALTH

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  1. RURAL TELEHEALTH Chuck Lail

  2. OVERVIEW • Why Is Telehealth Needed • Telehealth Opportunities • Potential Benefits of Telehealth

  3. Rural Health Landscape • 46 of 67 Alabama Counties Are Rural • As Defined By Federal Office of Rural Health Policy

  4. Rural Health Landscape • Rural Demographics • An Older Population • Need More Medical Care • Have Lower Median Incomes • Limited Access to Health Care

  5. Rural Health Landscape (cont’d) • Shortage of Health Professionals • Primary Care • Mental Health • Dental

  6. Rural Health Landscape (cont’d) • Rural Hospital Closures • Seven in last 10 years • Aging Provider Workforce • Increasing Retirements • Shrinking Services

  7. Rural Health Landscape (cont’d) • Rural Hospital Closures • Seven in last 10 years • Aging Provider Workforce • Increasing Retirements • Shrinking Services

  8. Primary Care Physicians Actively PracticingIn Alabama By Age, 2006 Total = 3,048 Age Not Given = 4 Average Age = 50.1 years <31 35 40 45 50 55 60 65 70 75 80+ Source: Alabama Medical Licensure Commission Licensed Physician Data Base.

  9. Rural Health Landscape (cont’d) • Rural Hospital Closures • Seven in last 10 years • Aging Provider Workforce • Increasing Retirements • Shrinking Services

  10. Rural Health Landscape (cont’d) • Rural Transportation Barriers • Specialty Care in Urban Areas • Limited Public Transportation • Cost of Travel • Lost Health Treatment Time • Lost Work Time and Wages

  11. Telehealth Opportunities • The Reimbursement Paradigm Has Shifted • CMS Bringing Telehealth to Medicare Advantage • Starting in 2020, Patients Can Get Care By Phone or Video (CMS Fact Sheet) • CMS Expanding Medicare Physician Fee Schedule • BC/BS Has Begun Paying For Many T/H Services • VA Exceeds One Million Telehealth Visits • VA and Walmart: Transforming Telehealth • The Rural Connection • Spring 2019

  12. Benefits of Telehealth • Care Closer to Home and Family • Optimizes Health Professionals • Expanded Opportunity For Midlevel Care • Retention of Patients • Recruitment and Retention of Providers • Savings In: • Golden Minutes • Travel Time & $$$$$ • Lives • Improved Hospital Sustainability

  13. Summary • Great Need • Potential Benefits • Its Time Has Come

  14. CHARLES (CHUCK) LAIL Phone: 334-206-5438 Email: Chuck.Lail@adph.state.al.us Web: www.alabamapublichealth.gov/ruralhealth

  15. Leveraging Telehealth to Solve Alabama’s Rural Health Plight ADPH Office of Telehealth • Establish Telehealth Clinics at All County Health Departments • Collaborate with Healthcare Providers • Facilitate All Telehealth Services April 25, 2019

  16. Individual Telehealth Networks Providing Single Health Care Service

  17. Components Required to Build 1 Cart Ergotron SV43-53EO-1 Telepresence Cart 1 JedMed 39-7420 Series 1 Horus Handheld Camera w/3 Lenses 1 Cisco SX-10 Video Conference Cam/Encoder 1 Cisco SX-10 License 1 HP P4K05UT Desk Top Mini Elite PC 1 HP K7X31-6001 P232 Pro Display 23” Monitor 1 LG 24LF4520 24” LCD TV 1 Littman 3200BK27 Electronic Bluetooth Stethoscope 1 Ergotron 97-780-194 Scanner Shelf 1 Startech C6PATCH1BK 1’ Black Cat6 UTP Patch Cable 1 Belkin A3L980-04-BLK-S 4’ Black Cat6 Patch Cable RJ45/RJ45 1 Tripp-Lite P569-003 3’ High Speed HDMI Cable 1 Tripp-Lite P006-003 3’ Power Cord 125V, 10A 1 Tripp-Lite P582-006 6’ Display Port to HDMI 1 Tripp-Lite UL17CB-15 WaberPower Strip, 9 Outlet 1 ADesso AKB-510HBSlimTouchmini keyboard w/USB 1 Cyberdata PMP7793 3 Port Gigabit Ethernet Switch 1 Cables 2 Go 29652 10’ USB 2.0A to Mini-B Cable 1 Fastenal 0163160 M4-.7 x 12 screws to mount monitors 8 Fastenal 29508 10-32 x 5/8 screws to mount plate 4 Fastenal 0146964 10-32 x 9/16 screws to mount shelf 2 Fastenal 1136030 M4-.7 #10 nuts for mounting screws 6 Fastenal 1133735 External tooth lock washers 6 Graybar DT11B 11.25” Black cable ties 10 Graybar DT11 11.25” White cable ties 1 18’ Cat 5E Ethernet Cable for Connection to LAN at Health Depts. 1 Custom made mounting plate for monitors and video camera 1 Cut and bend scanner shelf for JedMed camera 1

  18. Telehealth Services ADPH Model: • Custom build Carts • Deploy to Site, Train and Support Staff • Manage Network • $10,000 per Cart Includes: Bluetooth Stethoscope Handheld Exam Camera

  19. Telehealth atADPH CountyHealth Departments Medical AIDS Outreach (HIV/AIDS) (First telehealth partner) CHD Telehealth Sites Started February 2015

  20. Telehealth atADPH CountyHealth Departments Medical AIDS Outreach UAB School of Medicine (Monthly appointments for home dialysis patients)

  21. Telehealth atADPH CountyHealth Departments Medical AIDS Outreach UAB School of Medicine AIDS Alabama (Mental health)

  22. Telehealth atADPH CountyHealth Departments Medical AIDS Outreach UAB School of Medicine AIDS AlabamaADPH STD Program (Patient education)

  23. Telehealth atADPH CountyHealth Departments Medical AIDS Outreach UAB School of Medicine AIDS AlabamaADPH STD Program University of South Alabama (Diabetes education)

  24. Telehealth atADPH CountyHealth Departments Medical AIDS Outreach UAB School of Medicine AIDS AlabamaADPH STD Program University of South Alabama Veterans Affairs 31 CHD Telehealth Sites As of February 2018

  25. Alabama County Health Departments: Single and Neutral Point of Entry for Telehealth Clinics For All Health Care Services Partnerships and Collaboration

  26. Milestones • 2014:Purchase components / build carts ($10,000 vs. $30,000 per cart) • 2015:44 of 66 county health departments have bandwidth for telehealth • Deployed 6 carts • 2016:Deployed 10 carts (16 total) • 2017:60 of 66 county health departments have bandwidth for telehealth • Deployed 13 carts (29 total) • 2018:54 ADPH County Health Departments have telehealth carts!

  27. Telehealth Clinics atADPH CountyHealth Departments 55 Active Telehealth Sites Grant Funding Awarded for 10 Additional Sites As of March 2019

  28. Alabama Telehealth Champions ADPH Programs AIDS Alabama Alabama Department of Mental Health Alabama Department of Rehabilitation Services Alabama Health Action Coalition Alabama Lions Sight Conservation Association Auburn University Birmingham VA Medical Center Children’s Hospital of Alabama Five Horizons Health Services Medical Advocacy and Outreach UAB Medical Center; UAB Genetics Department University of South Alabama

  29. Telehealth Services Behavioral health Cardiology Diabetes education Family planning Genetic counseling HIV/AIDS Maternal fetal medicine Nephrology Neurology Rheumatology Surgery Consults Sleep Medicine Urology Palliative Care Opioid agonist therapy for pregnant women Pre/Post procedure consultations STD education, counseling, partner tracing Also used for meetings and training

  30. Telehealth Services Coming Soon: Bone Marrow Transplant Physical Medicine and Rehabilitation Pre Exposure Prophylaxis

  31. Specialty Peripheral Equipment Vital Signs Electronic Monitor Family Planning Visualization Technology Ultrasound Probes Laboratory Training Maternal Fetal Medicine

  32. Data x Vision x First Steps Resistance (Obstacles, Challenges, etc) V

  33. States with Parity Laws for Private Insurance Coverage of Telemedicine American Telemedicine Association 2018

  34. Effective November 1, 2018 BCBS reimburses providers for all telehealth delivered services if they are presently covered under BCBS policy.

  35. CMS finalizes policies to bring innovative telehealth benefit to Medicare Advantage April 5, 2019 Final Rule will strengthen popular Medicare private health insurance plans, expand telehealth access for patients, and improve coordination for dual-eligible individuals The Centers for Medicare & Medicaid Services (CMS) finalized policies that will increase plan choices and benefits, including allowing Medicare Advantage plans to include additional telehealth benefits. These policies continue the agency’s efforts to modernize the Medicare Advantage and Part D programs, unleash innovation and drive competition to improve quality among private Medicare health and drug plans. “Today’s policies represent a historic step in bringing innovative technology to Medicare beneficiaries,” said CMS Administrator SeemaVerma. “With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth. By providing greater flexibility to Medicare Advantage plans, beneficiaries can receive more benefits, at lower costs and better quality.” The final policies announced today leverage new authorities provided to CMS in the Bipartisan Budget Act of 2018, which President Trump signed into law last year. CMS is finalizing changes that would allow Medicare Advantage beneficiaries to access additional telehealth benefits, starting in plan year 2020. These additional telehealth benefits offer patients the option to receive health care services from places like their homes, rather than requiring them to go to a healthcare facility. Before this year, seniors in Original Medicare could only receive certain telehealth services if they live in rural areas. Starting this year, Original Medicare began paying for virtual check-ins across the country, meaning patients can connect with their doctors by phone or video chat. Historically, Medicare Advantage plans have been able to offer more telehealth services, compared to Original Medicare, as part of their supplemental benefits. But with the final rule, it will be more likely that plans will offer the additional telehealth benefits outside of supplemental benefits, expanding patients’ access to telehealth services from more providers and in more parts of the country than before, whether they live in rural or urban areas.

  36. Dental Hygiene Practice Act Overview: Permitted Functions and Supervision Levels by State

  37. Our lives improve not at the moment of invention, but when we accept it as essential. And Adjust our Workplace Culture and Rules and Regulations.

  38. Alabama Public Health Office of Telehealth Michael Smith, MSPH, MEd334 - 206 - 5631michael.smith@adph.state.al.us Jessica Hardy, MPH, DNP, APRN, ACNS-BC334 - 206 - 5665jessica.hardy@adph.state.al.us April Golson 334-206-9347 april.golson@adph.state.al.us

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