Connections, payments throttle telehealth’s ascent

The only primary care practitioner in Hancock County is Kemberly Smith, a nurse practitioner who was preparing to examine 80-year-old David Smith one recent day. He has pulmonary disease and circulatory problems that led to the loss of his right leg.

The two Smiths aren’t related. They weren’t even in the same room. Instead, video and technology connected them.

“Hey, Mr. Smith,” Kemberly said as she peered into a screen sitting in a hard-shell black suitcase, about the size of a carry-on.

“How you doing, baby,” David responded in a raspy voice.

One of the “telehealth” units was in the nurse’s office. The other was in her patient’s apartment. This wasn’t simply a discussion. It was a real examination.

Kemberly looked at David’s throat with a remote camera, peering into his mouth.

“I don’t see any drainage in there,” she told him.

A technician -- in this case Sam Stephenson of the Georgia Partnership for Telemedicine -- was with David.

Later in the session, a remote stethoscope was placed on David’s back. Kemberly used a touch screen on her end to guide where to put the scope. She asked David to breathe deeply while listening to him through her Bluetooth connection.

The session marked the latest use of technology in Georgia to bridge the primary care gap, which is especially acute in rural parts of the state. Georgia ranks in the top 10 of states needing primary care practitioners, according to a study by the Kaiser Family Health Foundation.

Telehealth now links south Georgia children to pediatric specialists farther north and connects transplant patients with remote physicians for easy follow-ups.

A novel use of technology is in Hancock County, one of Georgia’s poorest areas. Eventually county ambulances will use two telehealth units to pay remote house calls in the county’s main area, Sparta.

“We’re in the pioneering stage,” said Stephenson, whose organization is behind many of those telehealth efforts. “We are well out in front of what other states are doing.”

Hancock County EMTs will take over the telehealth sessions as soon as the county’s new ambulance provider learns about the new technology.

Kemberly Smith explained why the remote service is more than just a cool gizmo.

“We have two or three no-shows a day, and a lot of times it has to do with their transportation issues,” she said. “Sometimes I’m left wondering how that patient is doing because they weren’t able to get here.”

HURDLES TO CLEAR

But with all the advances of telehealth in recent months, the spread of technology for patients who are poor or older or housebound is slow. Outdated connectivity issues and old health care payment systems are a problem.

Stephenson said the Hancock County project will equip ambulances with mobile hot spots to improve Internet service as they travel. Even so, about 30 percent of residents in the county sit outside the wireless coverage area.

“There are a lot of cell towers in this state that aren’t being used. They need to be turned on,” said Dr. Jean Sumner, a rural physician in Wrightsville, about 40 miles southeast of Sparta. Sumner helped write state guidelines on telehealth. And she also helps direct a far-ranging project to improve rural health care, with Hancock County as the laboratory.

Sumner said two decades ago, when she first saw rural patients, she was a skeptic of telehealth. The units were large and the technology sketchy. And it was expensive, costing about $500,000.

The main telehealth units in Hancock County cost about $14,000 each with the laptops for providers priced at about half the cost.

Now, Sumner said, telehealth will play a crucial role in improving rural health care.

“It tears down a lot of the walls that have been built up between ourselves and our patients,” she said.

But not only does Sumner see a need to improve broadband capacity in rural stretches, she also said better training on technology is needed. Mercer University, where Sumner teaches part time, will soon begin a program on telehealth training.

Another barrier for spreading telehealth exists for people who live in urban and suburban areas.

It’s the rules that govern payment for telehealth services by Medicare, which serves millions of older Americans. The federal program limits telehealth reimbursement to those in rural areas.

Jonathan Linkous, CEO of the telehealth advocacy group Americans for Telemedicine Association, said private payers and even the states, through Medicaid, are paying for telehealth, no matter where the person lives.

“Medicare has yet to come across,” Linkous said. “They do provide some coverage, particularly people in rural areas. But it is still relatively limited.”

Advocates for telehealth are frustrated that Congress hasn’t passed a measure to broaden telehealth support by Medicare. A bill in the House failed a year ago. Georgia Rep. Sanford Bishop, D-Columbus, co-sponsored a proposal this year to close Medicare payment disparities for telehealth.

His message: don’t quit.

“Ultimately, persistence when there is a valid and needed issue pays off,” he said.

Bishop also wants to see Georgia and the federal government follow through on better broadband access.

David Smith of Sparta doesn’t pay much attention to broadband, however. When you visit the 80-year-old’s modest apartment, you notice there isn’t a computer -- or even a cell phone.

But he’s learning to appreciate technology since his remote visits to the doctor began.

“I’m glad they come here and see me every so often,” he said. “Then I won’t have to go down there in the wheelchair.”

This story was originally published October 13, 2015 at 10:23 PM with the headline "Connections, payments throttle telehealth’s ascent ."