Telehealth: The Time Has Come

Paula Guy

Executive Director

Georgia Partnership for TeleHealth, IncGeorgia Partnership for TeleHealth, Inc

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Agenda

Welcome and IntroductionsWelcome and Introductions History 1995-2005History 1995-2005 History 2005-presentHistory 2005-present InfrastructureInfrastructure BudgetBudget CredentialingCredentialing Utilization patterns and trendsUtilization patterns and trends SWOTSSWOTS

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GA TM History - GSAMS

Georgia Statewide Academic and Medical SystemsGeorgia Statewide Academic and Medical Systems

Funding through GA Technology Authority and the Funding through GA Technology Authority and the Distance Learning and Telemedicine Act of 1992Distance Learning and Telemedicine Act of 1992

Large statewide videoconferencing infrastructure for Large statewide videoconferencing infrastructure for education and telemedicine.education and telemedicine.

• SchoolsSchools

• State OfficesState Offices

• Rural Health Care FacilitiesRural Health Care Facilities

Lost funding in 2001Lost funding in 20013

Collapse of GSAMS GSAMS obsolete and prohibitively expensiveGSAMS obsolete and prohibitively expensive

Marketing or lack of marketing was a critical Marketing or lack of marketing was a critical factorfactor

Lack of reimbursementLack of reimbursementLittle to no administrative buy-inLittle to no administrative buy-inRequired active operational management Required active operational management

from BellSouth Video Conferencing Servicefrom BellSouth Video Conferencing ServiceSupports unnecessary overhead (GTA, Supports unnecessary overhead (GTA,

DOAS)DOAS)$2700/month cost is averaged over all users $2700/month cost is averaged over all users

and is not eligible for USF supportand is not eligible for USF support4

Southeast Telehealth PartnersWare County Health Department

OAT Funded: 1999, 2003OAT Funded: 1999, 2003 STP original goals for first grant focused on STP original goals for first grant focused on

organizational processes:organizational processes:Involved consumers, clinicians, health care Involved consumers, clinicians, health care

facilities, and service agenciesfacilities, and service agenciesFocused on addressing perinatal health, Focused on addressing perinatal health,

teen health, and childrens medical servicesteen health, and childrens medical services

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Southeast Telehealth Partners…

The second OAT grant focused on expansion:The second OAT grant focused on expansion:Network expanded from 4 sites to 13Network expanded from 4 sites to 13 Includes:Hospitals, health department clinics, physician offices Includes:Hospitals, health department clinics, physician offices Expanded from 7 network members to 16Expanded from 7 network members to 16Multiple distance learning usesMultiple distance learning usesFocused on addressing Infectious Disease, HIV/AIDSFocused on addressing Infectious Disease, HIV/AIDS

CODECCODECEase of use and maintenanceEase of use and maintenance

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STP cont…

Program Expectation Measures:Program Expectation Measures: EquipmentEquipment System Design/NetworkSystem Design/Network HIPPA ComplianceHIPPA Compliance USFUSF Reimbursement Reimbursement State ActivitiesState Activities EvaluationEvaluation

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STP Success

Success of Network resulted in further growth:Success of Network resulted in further growth: WIC fundingWIC funding Georgia state bio-terrorism fundingGeorgia state bio-terrorism funding Serving on state planning committee to Serving on state planning committee to

expand to other countiesexpand to other counties

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Creation of New GA TM Program

Negotiations with Commissioner Oxendine for Negotiations with Commissioner Oxendine for Anthem and WellPoint MergerAnthem and WellPoint Merger

Result – Oxendine’s Rural Health InitiativeResult – Oxendine’s Rural Health Initiative

• $100 million over the next 20 years in rural $100 million over the next 20 years in rural capital bondscapital bonds

• Statewide Telemedicine ProgramStatewide Telemedicine Program

$11.5 Million over 3 years$11.5 Million over 3 years

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Transition to Not for Profit 501 (3) cGeorgia Partnership for TeleHealth, Inc

December, 2007

Mission Mission Improve and promote the availability and provisioning of Improve and promote the availability and provisioning of

specialized healthcare services in rural and underserved specialized healthcare services in rural and underserved areas of Georgia.areas of Georgia.

Educate and provide training to hospitals and healthcare Educate and provide training to hospitals and healthcare facilities that furnish, administer and finance Telemedicine facilities that furnish, administer and finance Telemedicine programs and facilities.programs and facilities.

Reduce the service barriers that exist for patients who live Reduce the service barriers that exist for patients who live in rural areas of Georgia at a distance from hospital and in rural areas of Georgia at a distance from hospital and other medical facilities.other medical facilities.

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TeleHealth Infrastructure

Georgia Telemedicine Scheduling Georgia Telemedicine Scheduling Dedicated 800 phone # and staffing to support ProgramDedicated 800 phone # and staffing to support Program

Scheduling capabilities for Presentation Sites and Specialty Scheduling capabilities for Presentation Sites and Specialty SitesSites

Referrals to liaisonsReferrals to liaisons

Field-Based TM LiaisonsField-Based TM Liaisons Regionalized coverage with specific targeted areasRegionalized coverage with specific targeted areas

Division of responsibilities between presentation and specialty Division of responsibilities between presentation and specialty sitessites

Expanded ReimbursementExpanded Reimbursement

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Goal: Provide all rural Georgians with access to Goal: Provide all rural Georgians with access to specialty care within 30 milesspecialty 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

Telemedicine Increases the Quality of Care

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Network Technology

Private Internet…IntranetPrivate Internet…Intranet Central HUB-Archbold Medical Center, Central HUB-Archbold Medical Center,

ThomasvilleThomasville Leased T-1 Lines carry data at rate of 1.54Mbps. Leased T-1 Lines carry data at rate of 1.54Mbps.

Eligible for Universal Sevice FundingEligible for Universal Sevice Funding IP video conferencing standard- H.323IP video conferencing standard- H.323 Internet Service provider and email vendor Internet Service provider and email vendor

Thomasville UtilitiesThomasville Utilities Multi point video conferencingMulti point video conferencing Cisco 515E firewallCisco 515E firewall

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Criteria for Selecting a Presentation Site

Rural –county population 35,000 or lessRural –county population 35,000 or less Proximity to sufficient patient volumeProximity to sufficient patient volume Sufficient demand due to lack of specialistsSufficient demand due to lack of specialists Availability of qualified presentation staffAvailability of qualified presentation staff Technological infrastructureTechnological infrastructure Not for profitNot for profit Less than 150 bed sizeLess than 150 bed size Greater than 30 miles from “urban center”Greater than 30 miles from “urban center” Leadership support for telemedicineLeadership support for telemedicine

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Criteria for Selecting a Specialty Center

Willingness to serve patients from all areas Willingness to serve patients from all areas of Georgiaof Georgia

Availability of qualified staffAvailability of qualified staff Technological infrastructureTechnological infrastructure Leadership support for telemedicineLeadership support for telemedicine

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Scheduling for Telemedicine

The scheduling program is created with The scheduling program is created with Share Point Designer, which gives access to Share Point Designer, which gives access to anyone you designate to view information anyone you designate to view information regarding appointments for each site.regarding appointments for each site.

The server is accessed via the internet and The server is accessed via the internet and logging in with username and password. logging in with username and password.

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

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•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.

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•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).

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

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Telemedicine NetworkTelemedicine Network 45 presentation sites45 presentation sites 15 Specialty/Specialist sites15 Specialty/Specialist sites 82 specialist representing 45 specialties82 specialist representing 45 specialties Sites offer: Dermatology, Endocrinology, Sites offer: Dermatology, Endocrinology,

Neurology, Psychiatry, Cardiology, Diabetes Neurology, Psychiatry, Cardiology, Diabetes Education, Wound Care and Pediatric sub-Education, Wound Care and Pediatric sub-specialtiesspecialties

Utilization began in November 2005Utilization began in November 2005 Staffing, Training, Marketing is ongoingStaffing, Training, Marketing is ongoing

Georgia Telemedicine Program Current Status

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Georgia General AssemblyHouse Bill 291 Section 3 (33-24-56.4)

On or after July 1, 2005, every health benefit On or after July 1, 2005, every health benefit policy that is issued, amended or renewed shall policy that is issued, amended or renewed shall include payment for services that are covered include payment for services that are covered under such health benefit policy and are under such health benefit policy and are appropriately provided through telemedicine in appropriately provided through telemedicine in accordance with Code Section 43-34-31.1 …accordance with Code Section 43-34-31.1 …

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BarriersBarriers Addressed by Georgia Addressed by Georgia TelemedicineTelemedicine

Lack of Dedicated StaffLack of Dedicated Staff Fully dedicated local coordinators Fully dedicated local coordinators to support sites as well as to support sites as well as centralized Telemedicine centralized Telemedicine Operations StaffOperations Staff

Healthcare Industry Healthcare Industry ReimbursementReimbursement

Comprehensive Reimbursement Comprehensive Reimbursement

Public AwarenessPublic Awareness Dedicated staff to market and Dedicated staff to market and maintain public awarenessmaintain public awareness

Clinical and Administrative Clinical and Administrative ChampionsChampions

Collaborate with key academic and Collaborate with key academic and rural providersrural providers

Typical Barriers to Telemedicine Addressed:

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Sample Images

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Budget

Initial grant revenues received from Wellpoint: $2 millionInitial grant revenues received from Wellpoint: $2 million Other Operating grants and contributions will be obtained in the Other Operating grants and contributions will be obtained in the

amount of $250,000 in the 1amount of $250,000 in the 1stst year of operation and $ 400,000 year of operation and $ 400,000 in the 2in the 2ndnd year of operation. year of operation.

Current sites will grow from the current 55 to 80 during 1Current sites will grow from the current 55 to 80 during 1 stst year year of operation and to 120 by the end of the 2of operation and to 120 by the end of the 2ndnd year of operation year of operation

Current sites will begin to be charged a monthly fee of $ 225.00 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 2009 and that fee will increase to $ 750 per month beginning in 2010per month beginning in 2010

A proposal is in progress to add 39 sites with the Georgia Board A proposal is in progress to add 39 sites with the Georgia Board of Correctionsof Corrections

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Credentialing at a Glance

All Specialists & Allied Healthcare Providers are All Specialists & Allied Healthcare Providers are required to complete the modified application that is required to complete the modified application that is accepted by JCAHO to include:accepted by JCAHO to include:a. All current licenses to practice medicine (State of Georgia required)a. All current licenses to practice medicine (State of Georgia required)

b. DEA registration certificateb. DEA registration certificate

c. Professional liability insurance certificate of coverage from insurance c. Professional liability insurance certificate of coverage from insurance carrier.carrier.

d. Evidence of board certification (if applicable).d. Evidence of board certification (if applicable).

e. A curriculum vitae (listing all current affiliations).e. A curriculum vitae (listing all current affiliations).

f. Letter from facility stating you are appointed to the Medical Staff f. Letter from facility stating you are appointed to the Medical Staff along with a copy of the privileges you have along with a copy of the privileges you have been granted.been granted.

g. Consent form.g. Consent form.

h. ECFMG – If Applicable.h. ECFMG – If Applicable.

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Credentialing - continued All information is reviewed for accuracy and posted on the All information is reviewed for accuracy and posted on the

scheduling site for all credentialing personnel at the rural site scheduling site for all credentialing personnel at the rural site to print and process.to print and process.

Information is kept up to date in Access Data Base so that we Information is kept up to date in Access Data Base so that we may query expirations for DEA, Licensure and Insurance.may query expirations for DEA, Licensure and Insurance.

Each presentation site (that requires credentialing) must Each presentation site (that requires credentialing) must follow their Bylaws to complete privileging for that follow their Bylaws to complete privileging for that specialist. This would include the National Practitioner Data specialist. This would include the National Practitioner Data Bank and licensure verification. Bank and licensure verification.

Telemedicine deemed status can be used for this process.Telemedicine deemed status can be used for this process. Reappointment packets are sent for completion at due date. Reappointment packets are sent for completion at due date.

We utilize the Georgia Uniform Reappointment application.We utilize the Georgia Uniform Reappointment application.

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Utilization Patterns and Trends

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Overall Utilization By Specialty

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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

Georgia Telemedicine – Utilization

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Strengths Robust networkRobust network Universal Service Funded NetworkUniversal Service Funded Network Specialists commitment to programSpecialists commitment to program Provides access to Specialists without having to Provides access to Specialists without having to

travel and take time off of work.travel and take time off of work. Store and Forward TechnologyStore and Forward Technology Multi-point video conferencingMulti-point video conferencing Reimbursement for Consultants.Reimbursement for Consultants. Continuing Education Continuing Education

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Weaknesses

Reimbursement for Presentation Site is Reimbursement for Presentation Site is limitedlimited

Co-payment process to SpecialistsCo-payment process to Specialists Pre-certification processPre-certification process Specialists who accept Medicaid patientsSpecialists who accept Medicaid patients Zero funding for indigentZero funding for indigent

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Opportunities

Tele-StrokeTele-Stroke Tele-TraumaTele-Trauma Community Mental Health Service BoardsCommunity Mental Health Service Boards Skilled Nursing Home FacilitiesSkilled Nursing Home Facilities CorrectionsCorrections County JailCounty Jail Child Advocacy (Child Abuse)Child Advocacy (Child Abuse) Child/Adult Protective ServicesChild/Adult Protective Services

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Threats

Lack of funding for presenting sitesLack of funding for presenting sites Lack of funding to sustain programLack of funding to sustain program Lack of buy-in from “old school” PCPLack of buy-in from “old school” PCP Lack of reimbursement from ASO’sLack of reimbursement from ASO’s

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Questions?

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Georgia Partnership for Telehealth, Inc.Georgia Partnership for Telehealth, Inc.

Paula GuyPaula Guy

1718 Reynolds Street1718 Reynolds Street

Suite 100Suite 100

Waycross, Ga 31501Waycross, Ga 31501

Email: paula.guy@gatelehealth.orgEmail: paula.guy@gatelehealth.org

866-754-4325866-754-4325

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