After years of traveling from a primary home in College Park, Md., to a second home in Lewes, Betty and Dennis Leebel in 2008 decided to move permanently to the beach. But because Betty has Parkinson’s disease, they must still make the trek to Maryland to see her specialist.
“I’ve got the energy and hardly any medical problems, so I’m able to drive her,” said her husband. But traveling to doctor’s visits takes its toll on her, he added.
They’re not the only Sussex County residents who travel long distances to see specialists. Leebel founded a Parkinson’s support group in 2009 in Lewes that now has 150 members. “Most go to specialists in the Washington, D.C., Baltimore and Philadelphia,” Leebel explained. “Many of the members of our group are over 65. The roundtrip to those places plus waiting to see the doctors results in a 12-hour day.”
Telemedicine — also known as telehealth — could help alleviate some of the stress on both patients and caregivers, he said.
The service, which links patients to a specialist through teleconferencing-like equipment, could also benefit people in Sussex and Kent counties suffering from the counties’ psychiatrist shortage.
Despite the potential benefits, Delaware has been slow to implement telemedicine. In part, that’s because the state wanted to make sure the federal government will allow it as a billable service under Medicaid, the program covering low-income and disabled residents, said Dr. Gerard Gallucci, medical director for the Department of Health and Social Services.
As of July 1, that barrier is gone. The Delaware Medical Assistance Program will reimburse for telemedicine-delivered services delivered to Delaware Medicaid clients. (The federal Medicare program, which covers senior citizens, already reimburses for telemedicine in rural areas with a physician shortage or in sites participating in a federal telemedicine demonstration project.)
Now the state must ramp up to meet the demand.
More than Skype
Telemedicine is not a service or medical specialty; it’s a mechanism for providing medical care, said David Michalik, chief of policy and planning for the state Division of Medicaid and Medical Assistance.
Here’s how it works. A secure line and the technology are situated in what’s known as an “originating site provider,” such as a hospital, federally qualified health center, skilled nursing facility, mental health and substance abuse center, or a public health center.
The provider delivering the health services is at the “distant site.” The provider could be a physician, nurse practitioner, physician assistant or clinical psychologist. (Providers can reside in another state provided they comply with Delaware licensing requirements.)
To qualify for Medicaid funding, both the provider — such as specialist in Baltimore — and the originating site must be enrolled in the Delaware Medical Assistance Program or in one of the program’s managed-care organizations.
A Proven Technology
Telemedicine has been used in rural areas for decades. University of California Davis Hospital, for instance, started its program in 1996 to serve Northern California. According to the American Telemedicine Association, more than 10 million Americans now benefit from telemedicine each year.
Initial conversations about telemedicine in Delaware targeted the well-publicized shortage of mental health providers. The Earl B. Bradley sexual abuse case, which involved more than a thousand children, underscored the urgent need for child mental health specialists. (The pediatrician was indicted in February 2010.)
The Delaware Telehealth Coalition, which formed in 2011, began looking at applications other than psychiatry, said Carol Morris, a planner with the Division of Services for Aging and Adults with Physical Disabilities, a member of the coalition.
Telemedicine is not just for psychiatry or chronic conditions. UC Davis has shown it can be useful in emergency situations. A trauma physician in a hospital without an endocrinologist on staff, for example, can use it to consult a specialist when a diabetic patient comes into the emergency room.
Moving Forward
Medicaid reimbursement has opened the way for telemedicine in Delaware, but implementation is in its infancy. “There is momentum building,” said Gallucci of the Department of Health and Social Services. “Once it’s up and running, there will be more usage.”
Telemedicine at La Red Health Center
Telemedicine and La Red:
CEO Brian Olson discusses telemedicine initiatives at La Red and in Delaware.
To be sure, there has been progress. La Red Health Center in Georgetown in April received a federal Rural Health Services Outreach grant for providing telepsychiatry services with a Dover practice.
After meeting with Leebel of the Parkinson’s disease support group, La Red CEO Brian Olson met with decision-makers at Johns Hopkins Hospital to discuss how they might use telemedicine tools to serve the patients in Sussex County. The center is currently working with the hospital to iron out details.
“They are going to provide us with software to connect to them,” said Olson, who hopes to launch the system by the end of summer.
The center had previously planned to implement telepsychiatry over a three-year period. Now, to meet the growing demand, La Red plans to offer it by early next year.
Beebe Medical Center has offered telepsychiatry services since February, both in the hospital and in the emergency department. The patients are served by board-certified psychiatrists with Insight Telepsychiatry in Marlton, N.J. All of them have credentials at Beebe.
Beebe nurse manager Loretta Ostroski said the program is proving effective. “It’s just as though they came in and saw the patient at bedside,” she said. “They talk to the patient and the physician and nursing staff.” She would like to see the program expanded to primary care physicians’ offices in the area.
Beebe recently partnered with Christiana Care Health System for teleconsulting services that target trauma patients who might otherwise have to go to Wilmington for care. The service, she added, is just getting off the ground.
In a state with only a handful of health care systems, you might think the hospitals would be too competitive to cooperate. But the relationship between Beebe and Christiana Care proves that’s not the case, said Dr. Albert Rizzo, medical director of e-care at Christiana Care Health System. He said other hospitals downstate have shown some interest in a similar service.
The hospitals could use out-of-state providers, but the approach works best if physicians already know each other. “They can stay in close contact,” Rizzo said.
Christiana Care already uses telemedicine technologies to remotely monitor intensive care unit patients. The health system is exploring ways to remotely monitor patients after they’re discharged. Some existing systems can transmit patient data, but the devices may require help from nurses and technicians.
Such equipment will be useful for a population that wants to age in their own homes. “It’s an exciting area for eldercare,” Gallucci said. “And it’s particularly useful in underserved rural areas in the southern counties.”
Leebel would agree. He and his wife look forward to a doctor’s appointment that doesn’t consume so much time and energy. Until then, they often stay overnight at her sister’s house in Maryland to reduce the hardship. “Not everybody has that option,” he concludes.
