KentuckyOne Health to start around-the-clock online or phone access to health-care providers for $35 a visit on Nov. 1

Hospital group KentuckyOne Health says it will launch a program on Nov. 1 that will let Kentuckians get urgent care at any time by consulting with a medical professional over the phone or web camera. The group says KentuckyOne Anywhere Care is among the first such programs in the nation.

“KentuckyOne Health’s purpose is to expand access to quality health care, no matter where you live in the Commonwealth; is one way we are doing that,” CEO Ruth W. Brinkley said. “We can provide primary care to more Kentuckians, while saving them time, hassle and expense. We can treat conditions before they become more acute, as well as prevent unnecessary and costly emergency room visits.”

The service will cost patients $35 per visit, whether or not they are covered by insurance. "The cost is less than typical urgent care and a fraction of the cost of a normal emergency room visit," KentuckyOne said in a press release. Patients will be able to request a visit online or through a toll-free phone number. They will receive a phone call or video call from a medical provider within 30 minutes, the release promises.

"Patients will have access to board-certified doctors and nurse practitioners," the release says. "If needed, the KentuckyOne Anywhere Care provider will refer patients for a follow-up clinic visit or to an emergency department," and may prescribe medications, but won't prescribe or refill prescriptions for controlled substances.

The system will be operated by Carena Inc., which has been doing such work since 2010 and serves more than 500,000 patients in corporate programs and more than 1 million for the Franciscan Health System in Tacoma, Wash. The firm says it has a 98 percent satisfaction rating among patients.

Before going public, the new service will get a shakedown cruise by serving KentuckyOne employees who live in Kentucky. The group, Kentucky's largest, comprises Jewish Hospital & St. Mary’s HealthCare in Louisville; the Lexington-based Saint Joseph Health System, which includes hospitals in Bardstown, Berea, London, Martin, Mount Sterling and Shelbyville; and the University of Louisville Hospital and James Graham Brown Cancer Center. (Read more)

Kentucky expands Medicaid reimbursement for telehealth services, but lets managed-care firms keep authority over fees

By Molly Burchett
Kentucky Health News

Recent changes in Kentucky's telehealth regulations are making it easier for providers around the state and country to deliver health-care services to Medicaid patients, thus improving access to specialty care for many patients in Kentucky's rural areas. But the amount of their reimbursement can still be determined by Medicaid managed-care companies.

Patients in rural Kentucky sometimes need the care of a specialist not in their home community, and programs like the University of Kentucky’s telehealth program and the statewide Kentucky TeleHealth Network use videoconference tools to bring these physicians to the patients.

Kentucky has been among the leading states for driving reimbursement of telehealth services. As of July 2012, it was one of the 13 states requiring some level of private insurance coverage of telehealth. It is also one of the 15 states that requires reimbursement from Medicaid for some services, which are mostly mental-health and specialty services.

The new regulation expands the types of services eligible for Medicaid reimbursement. While the Kentucky TeleHealth Network has been operating since 2000, the old regulations limited the use of this type of technology, Rob Sprang, director of Kentucky TeleCare and chair of the state's Telehealth Board, told Greg Stotelmyer of Public News Service. "The previous regulations were very restrictive on who could see a patient on television, what services they could deliver on TV, and where those services could be delivered," he said.

The new rules lift restrictions on both the type and number of services covered by Medicaid. A much longer list of providers can be reimbursed for telehealth services, "including people like social workers, speech language pathologists, physical therapists, occupational therapists, a very broad group of providers outside of just physicians," said Sprang.

The regulation also includes certain services provided by a physician, psychiatrist, nurse practitioner, psychologist, dietitian and certified nutritionist. To provide telehealth services in Kentucky, a provider has to be approved for membership in the Kentucky Telehealth Network.

Reimbursement is technically the same as the amount paid for face-to-face services, but the regulation says managed-care firms are not required to reimburse those amounts. Thus, the role that telehealth will play in Kentucky could depend on how much the companies and the state decide to pay for it.

Still, the Foundation for a Healthy Kentucky has endorsed these changes to telehealth coverage and reimbursement, saying "it has the potential to help make quality specialty health services more accessible throughout Kentucky," reports Stotelmyer.

Telehealth will play a big role in health reform, said Sprang. "It's not rocket science," he told Stotelmyer. "You know, if you look at where providers are located today, there are no nephrologists, no kidney doctors, in most of our small communities. There are no child psychiatrists, there are no psychiatrists. There's so many medical specialties that are not available in our rural communities."

A recent report by Deloitte Consulting recommends increasing reimbursement for telehealth to address the state's doctor shortage problem, and that reimbursement needs to include primary care. "Given the potential benefits of using technologies such as telehealth to reach rural areas, where Medicaid populations can be large, the lack of Medicaid reimbursement for primary care could be a barrier to the overall effectiveness of Kentucky’s current and future investments in telehealth," says the report, which was released before the new regulations were issued.

Norton Healthcare implements a mobile application that allows doctors to monitor patients, especially expectant mothers

 

Norton Healthcare is the first health-care provider in Kentucky to implement a patient monitoring system that allows obstetricians to monitor expectant mothers while they're in labor via the physician's smart phone or tablet. The real-time application uses wave-form technology and works with iPhones, Androids, BlackBerrys and a variety of Windows Mobile devices. Its use has been cleared by the U.S. Food and Drug Administration.

The implications are vast for doctors in busy urban settings as well as for those in rural areas where doctor shortages may limit a physician's personal attention to individual patients. According to Norton Healthcare press materials and their obstetrician spokesperson, Dr. Reed Netter, the application allows the doctor to view "the same patient information that he or she would see at the patient’s bedside, looking at the monitor for heartbeat, contraction patterns, or signs of distress." This could save valuable time when a fetus is in trouble or if nurses see something that worries them.

The applications of the technology are evident for use in ambulances, in intensive care units, operating and emergency rooms, said Steve Heilman, Norton's system vice president and chief medical information officer for Norton Healthcare. (Read more)

Tenn. study suggests rural residents have as much access to care as anyone, if they're insured and don't mind the drive

A health-care study in Tennessee, which started with the premise that people in rural areas have less access to care than urban dwellers, ended with a rather surprising conclusion: They don't. Not if they have health insurance. "When it comes to commercially insured patients, there’s little disparity in access to health care between residents of rural communities and urban areas in Tennessee," said Dr. Steven L. Counter, president of the BlueCross BlueShield of Tennessee Health Institute.

How can this be? The study found that almost half of rural residents pass up the hospitals closest to their homes to go to larger urban hospitals, even if the same services are available locally, writes Getahn Ward of The Tenneseean. "The conclusion we came to is that we’re living in a very mobile society, and the distance is not necessarily a determinant factor in whether people get care or not," said Coulter.

Because the survey did not include consumers, it's only a guess about why they chose to take the time and trouble to go to the big town, but experts says it's a combination of services not being available or a perception that they aren't, even if they are. This raises, again, age-old questions about the viability of rural hospitals, some of which often don’t have the money for capital-intensive technology and services. However, Coulter told the Tennessean that "a recent increase in alliances between rural hospitals and larger hospitals and urban health systems raises hopes that non-urban hospitals may be able to expand their menus of services."

Such partnerships between non-profits and for-profit chains are becoming more common, reports Ward, and some say those efforts will change the perception of those in far-flung regions that great medicine is being practiced close-by. This could be especially important, said Wes Littrell, chief strategy officer and president of Nashville-based Saint Thomas Health, in the new world of health reform. “We expect that when you get more into population management that you need to take care of the patient closer to home in the lower-cost setting,” he said. (Read more)

Online training could help rural doctors offer better mental health care

More than half of all U.S. mental health care takes place at the primary-care level, and that percentage is even higher in rural areas, where mental-health doctors are often hundreds of miles away, reports Newswise, a research-reporting service. A new online training program could help rural primary-care doctors better treat patients with mental health issues, and that could be important in Kentucky.

The Behavioral Health Education Center of Nebraska, a part of the University of Nebraska Medical Center, designed the program. Educational Director Howard Liu said primary care doctors are overwhelmed by the amount of mental health care they must provide. Newswise reports "the goal is to help primary care providers get more comfortable as they prescribe medications and refer patients to psychiatrists and therapists." The adolescent version of the program was released last fall and is being used by doctors worldwide. The adult and geriatric version will be released this spring.

Primary care doctor Angie Brennan estimates 35 percent of all visits to her practice have been mental health related. She said there are specific rural challenges to treatment, including "reluctance to see a counselor and a lack of mental health insurance coverage – combined with an intensified fear that someone in the community will find out a patient has mental health issues." (Read more)

Doctors use telemedicine to help patients with dementia, Alzheimer's

Following a nationwide trend, Kentucky doctors are turning to telemedicine to help patients with memory problems such as those associated with Alzheimer's disease and dementia, reports Allison Elliott with the University of Kentucky.

"State-of-the-art memory evaluations should not be limited to persons that are able tom ake the often long and arduous trip to Lexington," said Dr. Greg Jicha, neurologist at UK's Sanders-Brown Center on Aging. "Taking advantage of Internet technologists to bring expert care into even the smallest of rural communities is a blessing for many families across Kentucky that simply cannot bring a loved one with dementia to Lexington.

Several times a month, physicians with the Sanders-Brown Center will connect to patients in clinics throughout the state. Participating clinics include Harlan Appalachian Regional Health; the Hazard Center for Rural Health; T.J. Sampson Hospital in Glasgow; Trover Clinic in Madisonville; Western Baptist Hospital in Paducah; Owensboro Medical Center; and St. Claire Regional Medical Center in Morehead. (Read more)

Rural folks have more chronic conditions and less access to health care, and Kentucky is one of the more rural states

Though rural Americans have more chronic health conditions than those who live in urban centers, they have poorer access to health care, a working paper released last month confirms. Health experts are pointing to technology, including telemedicine, to help bridge the gap.

The paper was compiled by the UnitedHealth Center for Health & Reform Modernization, an arm of the nation's largest health insurer. It found "there are only 65 primary care physicians per 100,000 rural Americans — 40 or so less than the 105 per 100,000 urban and suburban Americans," Molly O'Toole of Reuters reports. "Already five million rural residents live in 'shortage areas' defined by the government as counties with less than 33 primary care physicians per 100,000 residents." The problem intensifies when it comes to specialists, with rural areas having fewer than half the number of surgeons and other specialists per capita.

Kentucky is one of the more rural states, with the latest U.S. Census numbers showing that about 42 percent of its population lives in rural areas.

The study incorporated results of a survey of about 3,000 patients and primary-care physicians. It found drug abuse and teen pregnancy are bigger concerns in rural areas than in cities. Rural people tend to think their local health care is lower in quality than in urban centers. In many instances, they're right. "UnitedHealth confirmed this 'equality deficit' is supported by data showing that in 70 percent of markets, rural quality of care was measurably worse than in urban areas," O'Toole reports.

To remedy the situation, the report advises expanding the role for nurse practitioners and incorporating more mobile health clinics, technology such as telemedicine and preventive care into health care. (Read more)

Kentucky looking at 'telecare' for Medicaid patients to cut costs

Kentucky is considering making tele-caregivers — off-site guardians who provide care by monitoring cameras and sensors in a patient's home — available to some disabled Medicaid patients. The move is expected to save money by requiring less onsite care, The Courier-Journal's Patrick Howington reports. Because they are being monitored remotely, such as by telecaregiver David Crowe (C-J photo by Jordan Kartholl), it also allows patients to stay in their own home, rather than go to a nursing home.

The service is offered by Rest Assured, a subsidiary of ResCare, which is based in Louisville. The Cabinet for Health and Family Services "has asked permission from federal officials to use Medicaid funds for 'telecare' services like Rest Assured, as is allowed in Indiana and at least one other state," Howington reports.

Electronic monitoring is about half as expensive as in-home care and far less than the $5,000 or more a month it costs for a Medicaid patient to live in a nursing home. Rest Assured charges about $10 an hour for its service, resulting in $2,400 a month for eight hours of daily care. Though not expected to solve the state's Medicaid budget shortfall, "anything we can save at this juncture is wonderful," said state Sen. Julie Denton, R-Louisville.

Rest Assured has about 375 clients nationwide "Depending on clients' needs, the system can provide limited services such as medication reminders and food-preparation guidance for an hour or two a day or comprehensive monitoring for up to 24 hours," Howington writes. Telecaregivers use video and sensors that monitor temperature change, carbon monoxide levels and how long a patient is in the bathroom. (Read more)

Foundation matches Social Innovation Fund money to create grants for improving health services in seven Kentucky counties

The Foundation for a Healthy Kentucky today announced four equal Social Innovation Fund grants totaling $1 million to improve access to health services, reduce health risks and disparities, and promote health equity in Jefferson, McCreary, Wolfe, Powell, Montgomery, Bath and Menifee counties. The projects are expected to serve nearly 9,000 people in the next year.

Home of the Innocents in Louisville will establish a dental clinic at the newly opened interdisciplinary Hockensmith Pediatric Assessment Center. The program will provide dental services to children in state care, children with special health care needs, and other children and families served by the Home and its partner agencies.

St. Joseph Health System, based in Lexington, will establish primary care clinics in Powell and Wolfe counties, both rural and low-income. These satellite clinics will be staffed by nurse practitioners and will utilize telemedicine to collaborate with physicians and specialists at a central location.

Cumberland Family Medical Center, based in Burkesville, will establish a nurse-managed health center and rural training program for nurse practitioners and physician assistants. Funds will be used to expand the scope of services provided in McCreary County to include x-ray and utilize health IT to connect with other CFMC sites. This will be the county's first x-ray, reducing travel for local residents who previously had to travel ouside the county for x-ray services.

The Montgomery County Health Department in Mount Sterling will establish a health education and navigation program to serve a low-income population in Montgomery, Bath and Menifee counties. Four full-time health navigators will be employed to serve the community by assessing individual needs and linking patients with services.

Each $250,000 grtant includes $125,000 from the Foundation for a Healthy Kentucky. As an endowed public charity, the foundation was able to provide the matching funds that were required to secure the Social Innovation Fund award for Kentucky. Learn more about the grants here.