Telemedicine could help rural states like Arkansas improve overall health metrics

Most Arkansas medical industry officials say technology is changing the industry via telemedicine and virtual care, and that will continue no matter what Congress does with the Affordable Care Act in 2017.

Eric Pianalto, president of Mercy Hospital in Rogers, said electronic medical records at Mercy, an investment made in 2008, have allowed the health system to adapt virtual care models for Intensive Care patients and monitoring patients at home. He said Mercy sees virtual care as a way to augment patient treatments and overall care. Over the past two years Mercy Health System has pulled into the virtual care program its sickest patients having as many as 13 to 20 hospital admissions a year and maybe 20 or more emergency room visits. The patients in the program are monitored at home via virtual care specialists based in St. Louis.

“We don’t want them to stop seeing their local doctors, but this is a way for us to track their condition at home and perhaps fend off an issue that if let unresolved could land them in the emergency room. This added layer of oversight has allowed us to reduce hospital admissions by 50% and reduce emergency room visits more than 50%. We have reduced the total cost of their annual care by 35% and that includes the cost for the virtual care team oversight,” Pianalto said. “That’s a true cost savings in health care and money we don’t get paid for, but it’s the right thing to do.”

There are just under 400 patients in the Mercy virtual care program, but without a permanent funding source, Pianalto said the program isn’t sustainable. He said government funding restrictions around virtual care or telemedicine must be addressed by Arkansas legislators and Gov. Asa Hutchinson.

Health professionals said state law must be adapted to allow for compensation and reimbursement models before telemedicine and virtual care can become mainstream in the Natural State. That said, Little Rock-based Arkansas Children’s Hospital is actively using it in a pilot program funded by private money to provide better healthcare access in some of the poorest schools around the state.

Dr. Robert Steele, a pediatrician and chief strategy officer for ACH, believes telemedicine will be an effective way of delivering care to remote Arkansas areas. Laying the foundation for telemedicine doesn’t come cheap. Steele said ACH invested about $500,000 in 2015-2016 on telemedicine infrastructure, and in about a year the Little Rock hospital will connect to ACH Northwest when the hospital opens in Springdale in January 2018.

Steele said ACH is piloting a telemedicine program to deliver pediatric care in public schools with a higher than average level of economically disadvantaged students – referred to as a Title 1 school. The program is funded by two federal grants totaling $700,000. ACH Foundation plans to raise $300,000 in matching funds for the program that will connect 42 schools during the next three years.

Under previous Arkansas regulations, patients could not be treated virtually unless they already had an in-person visit with that doctor. In August, the Arkansas Rules and Regulations Subcommittee of the Arkansas Legislative Council approved the Arkansas State Medical Board’s amendment of Regulation 2.8. It now allows the use of real-time audiovisual technology for the first-time establishment of the doctor-patient relationship, rather than requiring the doctor and patient to first meet in person.

However, Steele said laws need more updates to better facilitate telemedicine. The American Telemedicine Association has ranked Arkansas last among all states for its telemedicine practice standards. He said the ACH pilot program can only be optimal if the necessary laws get passed by state legislature.

“We have the confidence the law will catch up,” Steele said.