Transcript GPT Network Presentation Paula Guy 7-23-08

Telehealth: The Time Has Come
Georgia Partnership for TeleHealth, Inc
Paula Guy
Executive Director
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Agenda
Welcome and Introductions
 History 1995-2005
 History 2005-present
 Infrastructure
 Budget
 Credentialing
 Utilization patterns and trends
 SWOTS
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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
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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
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Southeast Telehealth Partners
Ware County Health Department
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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
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Southeast Telehealth Partners…
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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
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STP cont…
Program Expectation Measures:

Equipment
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System Design/Network
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HIPPA Compliance
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USF
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Reimbursement
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State Activities
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Evaluation
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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
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Creation of New GA TM Program
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Negotiations with Commissioner Oxendine for
Anthem and WellPoint Merger
Result – Oxendine’s Rural Health Initiative
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$100 million over the next 20 years in rural
capital bonds
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Statewide Telemedicine Program
 $11.5 Million over 3 years
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Transition to Not for Profit 501 (3) c
Georgia Partnership for TeleHealth, Inc
December, 2007
Mission
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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.
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TeleHealth Infrastructure
 Georgia Telemedicine Scheduling
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Dedicated 800 phone # and staffing to support Program
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Scheduling capabilities for Presentation Sites and Specialty
Sites
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Referrals to liaisons
 Field-Based TM Liaisons
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Regionalized coverage with specific targeted areas
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Division of responsibilities between presentation and specialty
sites
 Expanded Reimbursement
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Telemedicine Increases the Quality of Care
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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
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Network Technology
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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
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Criteria for Selecting a Presentation Site
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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
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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
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Scheduling for Telemedicine
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The scheduling program is created with
Share Point Designer, which gives access to
anyone you designate to view information
regarding appointments for each site.
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The server is accessed via the internet and
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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Georgia Telemedicine Program
Current Status
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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 subspecialties
Utilization began in November 2005
Staffing, Training, Marketing is ongoing
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Georgia General Assembly
House Bill 291 Section 3 (33-24-56.4)
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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 …
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Typical Barriers to Telemedicine Addressed:
Barriers
Addressed by Georgia
Telemedicine
Lack of Dedicated Staff
Fully dedicated local coordinators
to support sites as well as
centralized Telemedicine
Operations Staff
Healthcare Industry
Reimbursement
Comprehensive Reimbursement
Public Awareness
Dedicated staff to market and
maintain public awareness
Clinical and Administrative
Champions
Collaborate with key academic and
rural providers
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Sample Images
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Budget
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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
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Credentialing at a Glance
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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.
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Credentialing - continued
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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.
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Utilization Patterns and Trends
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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
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Georgia Telemedicine – Utilization
900
804
2007-2008 Comparison
800
693
700
699
625
600
505
500
400
349
341
329
357
351
379
371
376
300
206
200
145
153
154
100
0
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEPT
OCT
NOV
DEC
Utilization
2008
2007
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Strengths
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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
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Weaknesses
Reimbursement for Presentation Site is
limited
 Co-payment process to Specialists
 Pre-certification process
 Specialists who accept Medicaid patients
 Zero funding for indigent
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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
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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
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Questions?
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Georgia Partnership for Telehealth, Inc.
Paula Guy
1718 Reynolds Street
Suite 100
Waycross, Ga 31501
Email: [email protected]
866-754-4325
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