Telemedicine: Providing Care Closest to HomeDebbie Voyles, MBA HOMDirector of TelemedicineF. Marie Hall Institute for Rural and Community Health

Ratio of Providers per 100,000 Population

Primary Care DoctorsPhysician AssistantsNurse PractitionersRNsLVNsU.S., 20006914.433.7780.2240.8Texas, 2005 (2000)68.5 (56)14.7 (11.9)17.7 (24.4)628.6 (603.4)269 (280.9)West Texas, 200541.71613.4364.5424West Texas/Border, 200525.715.218.4230.7183.3

El Paso to LubbockBurn

Benefits to Using TelemedicineImproved access to specialty services and care care closest to homeHigh patient satisfaction improved access, reduced travel costs (mileage and travel time)reduced time away from home/school/workImproved patient outcomes earlier interventions, reduced complications, consistent use of evidenced based medicineHealthy People/Healthy Communities - better relationships with rural communities create, improve and maintain local access to appropriate high quality care

Bringing the Physician to the Patient

Texas Tech TelemedicineContact InformationDebbie Voyles, MBA HOMDirector debbie.voyles@ttuhsc.edu806-743-4440www.ttuhsc.edu/telemedicine

*One of the biggest challenges facing the US health care system is how to provide quality care to an increasing number of underserved, disadvantaged and at risk populations.

Access to health care services is something that everyone at some point in their lives will need. The importance of this access cannot be overstated. Access to care, however, can be affected by several factors, that include economic, geographic, proximity to a provider, and the overall supply of providers.

Currently there are 6433 Primary Care HPSAs with 66.9 million people living in them. It would take 17,798 practitioners to meet their need for primary care providers.

Access to healthcare is a critical issue, resulting in individuals who are unable to access care that results in poor health outcomes, poor quality of life, and decreased productivity in the workplace that contributes to a greater burden on healthcare costs. Geographic misdistribution simply makes the supply problem worse. The most underserved areas are, almost by default, rural and rife with poverty. Such factors as lack of educational and work opportunities, lack of transportation, and difficulties in communication, can make it extremely difficult for some individuals to access care, relying instead on emergency room visits as a substitute for a local primary care provider. Furthermore, in the most isolated areas, it is often nearly impossible to even get to a hospital for critical care.

Over 16% of the US population lives in rural areas and yet they are served by only 9% of the nations physicians. This discrepancy is expected to increase as medical school enrollment continues to fall, fewer medical students choose primary care and aging rural physicians retire with no one to replace them.*There are 3,795 Mental Health HPSA with 95.3 million people living in them. It would take 6,252 practitioners to meet their mental health care needs.

Mental health access continues to be a problem for many Americans. Especially those living in rural areas.*The next few slides show information about Texas. Even though we are talking about one state, many states with rural areas, such as New Mexico, Kansas, Montana, etc., all are facing similar access to care and physician shortages. It will also give you an understand as to why telemedicine is so important as a way to deliver healthcare services.

There are 32 counties without family practice physician27 counties only have 1 family practice physician**The shortage of primary care physicians has reached a critical level. When looking at speciality care the numbers in rural areas drop to between 0-2 depending on the speciality.This is a typical view of West Texas.

*Our service territory is 108 counties, 49% of the land mass but only 12% of the population.

8 hours by 7 hours with only 7 urban centers. Many people must travel at least 90 miles for basic health care.

As I mentioned before, there are 32 counties in Texas without a physician, 22 counties of them are in West Texas. Whats more interesting is that there are 12 counties without a physician, NP or PA*To give you an example of some of the challenges we face, El Paso, a city with a population of more than 750,000 has many challenges with health care access.

There are 7 dermatologist in El Paso and not one of them will take a Medicaid patients, most will only take cash payments. If not for telemedicine, Medicaid enrolled children would have to travel 6 hours one way for a dermatology appointment. If you have a patient on acutance they have to be seen once per month while on the medication. Without telemedicine these children would miss at least 2 days of school to travel back and forth. In addition, Medicaid would be charged anywhere from $532.73 to $1200 in travel costs depending on if the patient drove or flew.

*Another areas where El Paso has issues with care is for burn care. Lubbock has the only Level 1 Burn Trauma Center between Dallas and Phoenix. Without telemedicine these burn patients would have to travel to Lubbock, sometimes monthly for follow-up care.

**By providing care closest to home via telemedicine, patients that would normally wait until a situation became emergent, due to travel issues can be seen before the situation turns serious. In addition, patients with chronic conditions, that require more frequent access to care, can be seen without a burden for travel costs for themselves or the healthcare system.

In addition, telemedicine allows a better continuum of care by allowing the primary care provider direct access to the specialist for care issues with helps in the patient centered care models.Having access to quality health care should be something that everyone in the United States has. However, there are many areas both rural and urban when access to care is a challenge. Telemedicine has the potential to provide care closest to home, increase access to care allowing for healthier communities and reduce the cost on the healthcare system.

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