Telemedicine in a Rural Tertiary Care Medical Center

1、telemedicine a fad or the future? julie j. mcgowan, phd regenstrief institute april 2000 telemedicine defined “.the use of electronic information and communications technologies to provide and support health care when distance separates the participants.” from: institute of medicine: telemedicine: a

2、 guide to assessing telecommunications in health care what is telehealth? video conferencing distance learning telemedicine asynchronous provider to provider synchronous provider to patient orthopedics image quality color reliability movement artifacts technology reliability of technology connection

3、s ease and reliability of contact interface standards peripheral equipment quality digital vs. digitized transmission protocols provider satisfaction referring providers assess: comfort level with technology comfort level with process comfort level with patient communication comfort level with consu

4、lting provider interaction unanticipated benefits unanticipated problems provider satisfaction consulting providers assess: comfort level with technology comfort level with process comfort level with patient communication? comfort level with referring provider interaction unanticipated benefits unan

5、ticipated problems patient satisfaction patients follow images the value equation home is where comfort issues environmental issues economic issues economic analysis of telemedicine 4 ways to look at $ prospective in managed care environment retrospective in multi- payer environment alternative savi

6、ngs training, patients cost-plus in captive patient populations prospective in managed care tele-endoscopy prospective in managed care tele-endoscopy six months chart review of endoscopic procedures in tertiary care center tcc determination of preferable locus of procedures in capitated market appro

7、priately referred to tcc initially done at tcc; could be done at local site unnecessary repetition of procedure at tcc tele-endoscopy study design determination of cost of procedure tertiary care center rural site (pc office or local hospital) cost of telecommunications amortization of equipment end

8、oscopist time mentoring time savings on travel time; missed appointment formula for projected savings for tele-endoscopy actual current endoscopy costs less: cost savings from procedures done locally cost savings from procedures not repeated cost savings of endoscopy specialist time travel missed ap

9、pointments add costs of telemedicine - equipment; line charges; endoscopist time tele-endoscopy real data six months projected savings $27,381 savings on locally done procedures $44,438 savings on single procedures $5,563 savings on travel 3 consultations $35,413 (personnel costs) vascular surgery t

10、elemedicine summary savings accrue primarily as a result of decreased need for physician travel. “break-even” for vascular surgery use of telemedicine at 2 years. surgical follow-ups do not generate additional revenue, thus savings may be more appropriate evaluation tool. alternative savings tele-di

11、alysis alternative savings tele-dialysis - real data 2 external dialysis units, 1 fahc site 9 uses in a one-month audit period educational / administrative 4 technical troubleshooting3 clinical uses2 16% of all telemedicine systems uses same real costs used in vascular surgery tele-dialysis projecti

12、ons (real data) 3 external dialysis units in rural areas extrapolated use to one-year period educational / administrative 72 technical troubleshooting54 clinical uses36 without telemedicine system, each of the above would require in-person visits to each of three sites. tele-dialysis 12 month cost a

13、nalysis real data expenses 162 uses of telemedicine (16% of total) $38,020 (telecommunications, equipment, etc.) savings $34,200 (personnel costs) tele-dialysis patient savings real data external dialysis units save patient travel 3 times weekly. savings in gas ($1.15 per gallon) is $182.85 per week

14、 or $9,508 per year. additional savings for patients accrued in lower food costs, less loss of work time. tele-dialysis telemedicine summary projected “break-even” point for tele- dialysis with three external dialysis units is 14 months. dialysis care is capitated by medicare so revenues are not gen

15、erated by in-person visits or lost by telemedicine use. telemedicine time and travel savings allow more efficient delivery of care. tele-dialysis telemedicine summary cont. provider training and support costs can be minimized through telemedicine use. in chronic disease, quality of life issues, incl

16、uding cost savings to patients, must be weighed against actual cost of telemedicine use. captive patient populations prisons nursing homes emergency rooms military prison telemedicine captive patient population contracts negotiated on: personnel, out-of-pocket, and amortized costs quality of program

17、 reasonableness of offering based on needs of contracting institution ability to garner “extra” benefits for both offering agency and contractors. nursing home telemedicine on-demand patient population support contracts negotiated on: personnel, out-of-pocket, and amortized costs often minimal staff

18、ing, technology requirements quality of program value-added reasonableness of offering based on needs of both offering and contracting institutions emergency room telemedicine on-demand, captive patient patient contracts negotiated on: personnel, out-of-pocket, and amortized costs offering based on

19、linking emergency rooms specialists to off-site patients ability to garner “extra” benefits for ems offer emergency critical care stabilize patients prior to / during transport military telemedicine captive patient population refer to prison telemedicine no contracts federally funded and directed pu

20、shing frontiers in space, under oceans, on battlefield same basic precepts provide remote patients with highest quality medical care reimbursement update categories of support cost of doing business managed care cost-shift third party payers mode of health care delivery vs. procedure image transmission hcfa guidelines for reimbursement 1997 balanced budget act 4/1/99 medicare only interactive consultations only in rural hpsas patient residency or site of consultation reimbursed at 75% of live consult 25% of amount must go to referring provider referring p