Telehealth: The Time Has Come

1. Telehealth: The Time Has Come Georgia Partnership for TeleHealth, Inc Paula Guy Executive Director

2. Agenda Welcome and Introductions History 1995-2005 History 2005-present Infrastructure Budget Credentialing Utilization patterns and trends SWOTS

3. GA TM History - GSAMS • Georgia Statewide Academic and Medical Systems • Funding through GA Technology Authority and the Distance Learning and Telemedicine Act of 1992 • Large statewide videoconferencing infrastructure for education and telemedicine. • Schools • State Offices • Rural Health Care Facilities • Lost funding in 2001

4. Collapse of GSAMS • GSAMS obsolete and prohibitively expensive • Marketing or lack of marketing was a critical factor • Lack of reimbursement • Little to no administrative buy-in • Required active operational management from BellSouth Video Conferencing Service • Supports unnecessary overhead (GTA, DOAS) • $2700/month cost is averaged over all users and is not eligible for USF support

5. Southeast Telehealth PartnersWare County Health Department • OAT Funded: 1999, 2003 • STP original goals for first grant focused on organizational processes: • Involved consumers, clinicians, health care facilities, and service agencies • Focused on addressing perinatal health, teen health, and childrens medical services

6. Southeast Telehealth Partners… • The second OAT grant focused on expansion: • Network expanded from 4 sites to 13 • Includes:Hospitals, health department clinics, physician offices • Expanded from 7 network members to 16 • Multiple distance learning uses • Focused on addressing Infectious Disease, HIV/AIDS • CODEC • Ease of use and maintenance

7. STP cont… Program Expectation Measures: • Equipment • System Design/Network • HIPPA Compliance • USF • Reimbursement • State Activities • Evaluation

8. STP Success Success of Network resulted in further growth: • WIC funding • Georgia state bio-terrorism funding • Serving on state planning committee to expand to other counties

9. Creation of New GA TM Program • Negotiations with Commissioner Oxendine for Anthem and WellPoint Merger • Result – Oxendine’s Rural Health Initiative • $100 million over the next 20 years in rural capital bonds • Statewide Telemedicine Program • $11.5 Million over 3 years

10. Transition to Not for Profit 501 (3) cGeorgia Partnership for TeleHealth, Inc December, 2007 Mission Improve and promote the availability and provisioning of specialized healthcare services in rural and underserved areas of Georgia. Educate and provide training to hospitals and healthcare facilities that furnish, administer and finance Telemedicine programs and facilities. Reduce the service barriers that exist for patients who live in rural areas of Georgia at a distance from hospital and other medical facilities.

11. TeleHealth Infrastructure • Georgia Telemedicine Scheduling • Dedicated 800 phone # and staffing to support Program • Scheduling capabilities for Presentation Sites and Specialty Sites • Referrals to liaisons • Field-Based TM Liaisons • Regionalized coverage with specific targeted areas • Division of responsibilities between presentation and specialty sites • Expanded Reimbursement

12. Telemedicine Increases the Quality of Care • Goal: Provide all rural Georgians with access to specialty care within 30 miles • “This rural health initiative will provide Georgia citizens with access to the highest quality and most advanced medical care available anywhere in the state.” • Commissioner John Oxendine • Georgia Department of Insurance

13. Network Technology Private Internet…Intranet Central HUB-Archbold Medical Center, Thomasville Leased T-1 Lines carry data at rate of 1.54Mbps. Eligible for Universal Sevice Funding IP video conferencing standard- H.323 Internet Service provider and email vendor Thomasville Utilities Multi point video conferencing Cisco 515E firewall

14. Criteria for Selecting a Presentation Site • Rural –county population 35,000 or less • Proximity to sufficient patient volume • Sufficient demand due to lack of specialists • Availability of qualified presentation staff • Technological infrastructure • Not for profit • Less than 150 bed size • Greater than 30 miles from “urban center” • Leadership support for telemedicine

15. Criteria for Selecting a Specialty Center • Willingness to serve patients from all areas of Georgia • Availability of qualified staff • Technological infrastructure • Leadership support for telemedicine

16. Scheduling for Telemedicine The scheduling program is created with Share Point Designer, which gives access to anyone you designate to view information regarding appointments for each site. The server is accessed via the internet and logging in with username and password.

18. You are able to view any announcements on your site and all portals are on the right side of the page.

19. If you try to access a particular portal and you do not have permission to view, you will be asked to log in again and then an error message occurs letting you know you do not have permission. You may not view the portal without permission. Error: Access denied. You do not have permission to perform this action or access this resource. Access requests are not enabled. Troubleshoot issues with Windows Sharepoint Services.

20. Choose the portal you have permission to view. You can now see your current roster (any patients that are scheduled to be seen today going forward).

21. You also have a choice to see the past roster (any patients that were seen prior to today’s date).

23. Georgia Telemedicine Program Current Status • Telemedicine Network • 45 presentation sites • 15 Specialty/Specialist sites • 82 specialist representing 45 specialties • Sites offer: Dermatology, Endocrinology, Neurology, Psychiatry, Cardiology, Diabetes Education, Wound Care and Pediatric sub-specialties • Utilization began in November 2005 • Staffing, Training, Marketing is ongoing

24. Georgia General AssemblyHouse Bill 291 Section 3 (33-24-56.4) • On or after July 1, 2005, every health benefit policy that is issued, amended or renewed shall include payment for services that are covered under such health benefit policy and are appropriately provided through telemedicine in accordance with Code Section 43-34-31.1 …

25. Typical Barriers to Telemedicine Addressed:

28. Sample Images

29. Budget Initial grant revenues received from Wellpoint: $2 million Other Operating grants and contributions will be obtained in the amount of $250,000 in the 1st year of operation and $ 400,000 in the 2nd year of operation. Current sites will grow from the current 55 to 80 during 1st year of operation and to 120 by the end of the 2nd year of operation Current sites will begin to be charged a monthly fee of $ 225.00 per month beginning in 2009 and that fee will increase to $ 750 per month beginning in 2010 A proposal is in progress to add 39 sites with the Georgia Board of Corrections

30. Credentialing at a Glance All Specialists & Allied Healthcare Providers are required to complete the modified application that is accepted by JCAHO to include: a. All current licenses to practice medicine (State of Georgia required) b. DEA registration certificate c. Professional liability insurance certificate of coverage from insurance carrier. d. Evidence of board certification (if applicable). e. A curriculum vitae (listing all current affiliations). f. Letter from facility stating you are appointed to the Medical Staff along with a copy of the privileges you have been granted. g. Consent form. h. ECFMG – If Applicable.

31. Credentialing - continued All information is reviewed for accuracy and posted on the scheduling site for all credentialing personnel at the rural site to print and process. Information is kept up to date in Access Data Base so that we may query expirations for DEA, Licensure and Insurance. Each presentation site (that requires credentialing) must follow their Bylaws to complete privileging for that specialist. This would include the National Practitioner Data Bank and licensure verification. Telemedicine deemed status can be used for this process. Reappointment packets are sent for completion at due date. We utilize the Georgia Uniform Reappointment application.

32. Utilization Patterns and Trends

33. Overall Utilization By Specialty • Other Specialties • Cardiology • ENT • Gastroenterology • General Surgery • Genetics • Hematology • Hepatology • HIV/AIDS • Infectious Disease • Internal Medicine • Nephrology • Oncology • Ophthalmology • Orthopedics • Pain Management • Pulmonology • Wound Care • Urology

34. Georgia Telemedicine – Utilization

35. Strengths Robust network Universal Service Funded Network Specialists commitment to program Provides access to Specialists without having to travel and take time off of work. Store and Forward Technology Multi-point video conferencing Reimbursement for Consultants. Continuing Education

36. Weaknesses Reimbursement for Presentation Site is limited Co-payment process to Specialists Pre-certification process Specialists who accept Medicaid patients Zero funding for indigent

37. Opportunities Tele-Stroke Tele-Trauma Community Mental Health Service Boards Skilled Nursing Home Facilities Corrections County Jail Child Advocacy (Child Abuse) Child/Adult Protective Services

38. Threats Lack of funding for presenting sites Lack of funding to sustain program Lack of buy-in from “old school” PCP Lack of reimbursement from ASO’s

39. Questions?

40. Georgia Partnership for Telehealth, Inc. Paula Guy 1718 Reynolds Street Suite 100 Waycross, Ga 31501 Email: paula.guy@gatelehealth.org 866-754-4325