Authors: David PittmanSources: Politico, Congress.gov, UMC.edu
Mississippi, the Magnolia State, ranks at or near the bottom in most health rankings: worst infant mortality and most kids born with low birth weight; second-to-highest rate of obesity and cancer deaths; second from the last in diabetes outcomes.
But the state is a leader in one aspect of health care: telemedicine. The state’s only academic hospital has remote connections with 165 sites, providing specialized services to some of the state’s most far-flung, medically deprived cities and towns. Mississippi’s telemedicine program, ranked among the seven best in the country, has inspired neighboring Arkansas to take bigger steps in some areas of the field, and the impact of its success is making waves in Washington as well.
Mississippi’s congressional delegation is at the center of a small group of lawmakers championing telemedicine. Trent Lott of Mississippi and former Senate majority leader, is lobbying big for the technology, which could generate fat profits if Medicare starts reimbursing it in a significant way. FCC Commissioner Mignon Clyburn, in a visit last December, said the state has “solved the perennial challenge of getting broadband to its most rural areas.”
Although it’s not entirely clear what impact telemedicine has had on the state’s health, some early data show positive signs — and the technology is helping local hospitals care for more patients who might otherwise go to larger hospitals.
The state’s use of telemedicine was born out of its poor health.
Mississippi has the worst doctor shortage in the country. Massachusetts has about 2½ times more doctors per capita. That ratio jumps to about 3-to-1 for specialists. Recruiting in poor and rural areas is tough: “No doctor is going to want to live there,” one health official said.
This realization struck Kristi Henderson more than a decade ago when she was running an emergency department in Jackson, which has the state’s only trauma center and children’s hospital. Doctors there received patients from small communities across the state because providers back home simply couldn’t treat their problems.
The visits hurt small, rural facilities, which lost patients and their payments. And it hurt patients, who often drove hours to be treated in Jackson.
“There were several hospitals looking at closing because they could not afford to staff their emergency department,” said Henderson, who runs the University of Mississippi Medical Center’s Center for Telehealth.
So she helped start a pilot to connect Jackson emergency physicians with three rural hospitals through telecommunication. The program launched in October 2003.
“We didn’t have an option,” said Henderson. Its impact has been dramatic.
The Center for Telehealth now includes 35 specialties. It provides 8,000 telemedicine visits a month and 100,000 a year across the state, with services as varied as diabetes counseling and robots examining premature babies.
Small hospitals in the state saw their costs drop 25 percent because they didn’t have to rely on temporary doctors paid under contract to work in their emergency departments. At the same time, their admissions rose 20 percent because patients weren’t being shipped to larger hospitals.
Early outcome data has been positive, Henderson said: For example, patients suffering cardiac arrest in rural emergency departments with telemedicine fare as well, on average, as those treated at a larger hospital in Jackson.
Health officials in the state are now working to expand telemedicine to schools to help nurses manage chronic disease and other conditions. Preliminary results of their work with remote monitoring of diabetics show positive results in controlling their blood sugar with no hospitalizations or emergency department visits.
Baptist Memorial Hospital in New Albany, Mississippi, a town of 8,500 people, has used telemedicine for two years to connect neurologists from a private company three to five times a month, Chief Executive Walter Grace said. The hospital hopes to add a similar system for intensive care and pulmonology patients by the end of the year.
The New Albany, Mississippi, hospital connects with neonatal intensivists at North Mississippi Medical Center in Tupelo, nearly 30 miles away, who use long-distance electronics to control robots to care for newborns with special needs. The neonatologists can check vital signs, conduct a visual exam, review X-rays and listen to the baby’s heart and lungs using a stethoscope attachment.
North Sunflower Medical Center in Ruleville, Mississippi, a critical access hospital serving one of the poorest counties in the country, was on the verge of closing before increasing its services through telemedicine. It now offers emergency services, psychiatry and other treatments through the technology, and last year launched a program to remotely monitor the diabetes of 200 patients in the Mississippi Delta. Patients are given tablets through which they can report their health and feelings to clinicians.
“Ruleville is the poster child for what a critical hospital can do for a community in the United States,” said Ryan Kelly, executive director of the Mississippi Rural Health Association.
In 2012, the state Legislature passed a bill that required private insurance to pay for telemedicine services at the rate it does for in-person care, a “huge step,” Henderson said. Last year, separate legislation that covers remote patient monitoring took effect, and Medicaid also pays for a great number of services.
Mississippi’s momentum has carried to the halls on Capitol Hill.
Rep. Gregg Harper (R-Miss.) last year introduced a bill to expand telemedicine payments in a number of ways, including by allowing it for all sole community and critical access hospitals. It would allow remote monitoring in Medicare patients with some conditions such as strokes. Republican Mississippi Sens. Thad Cochran and Roger Wicker introduced a companion bill.
A separate bill Harper co-sponsored would expand Medicare payments in federally qualified health centers and rural clinics.
Harper became fascinated by telemedicine after seeing Henderson’s work in Jackson a few years ago. He leads a working group of the House Energy and Commerce Committee that is drafting telemedicine legislation to be included in the committee’s 21st Century Cures bill.
Lott, who was Senate majority leader during his home state’s early days of telemedicine growth, helped launch the telemedicine lobbying group Alliance for Connected Care early last year to push for lowering Medicare’s payment barriers.
Henderson has flown to Washington three times already this year to talk about Mississippi’s telemedicine work. She plans to come again next month and in May to talk to the Federal Communications Commission. She attributes success to health insurers paying for telemedicine but also to support from the state, from the governor’s office on down to the community level.
“Not only do we have adoption, but we’ve cleared these barriers and have a model that can be sustained,” Henderson said. “We want to showcase that so that others can replicate it … Imagine if you cleared [the barriers] at a federal level what can happen.”
Arkansas, which has telemedicine connections with every hospital emergency department in the state to share images with, has taken some principles from Mississippi’s success, said Tina Benton, who runs a program that monitors high-risk pregnant women at the University of Arkansas for Medical Sciences.
Like Mississippi, Arkansas now distributes services such as neurology, emergency care and high-risk pregnancy care to needy parts of the state.
“You have to work backwards by need,” Benton said. “You look at where your needs are and say this is where we can take our program.”
Mississippi has been an “early adopter” of telemedicine, said Ceci Connolly, managing director of PwC’s Health Research Institute, by allowing providers, consumers and regulators to grow accustomed to the virtual connection of doctors and patients.
“Cultural changes remain one of the biggest hurdles to progress,” she said.