Senate Commerce, Science and Transportation Subcommittee on Communications, Technology, Innovation and the Internet Hearing
Chairman Thune, Chairman Wicker, Ranking Members Nelson and Schatz and fellow panelists, it is a pleasure to appear before this subcommittee to discuss how we can work together to advance telehealth through connectivity. I thank the Subcommittee, and especially my Senator, Chairman Wicker, for the opportunity to testify and look forward to a robust discussion.
Telehealth was born out of necessity. Patients living in rural areas have always lacked access to healthcare, and, even today, those who are not able to travel often receive inadequate care, or no care at all. Many patients are not able to see a specialist or get the treatment they need without traveling long distances. Long gone are the days when each small town had its own "Jack of all trades" doctor who could deliver babies, set broken bones and check on Grandma's aching back. While patients in urban areas may be located in closer proximity to medical services, the waiting time for appointments with specialists can be several weeks, resulting in increased severity of disease equivalent to that in the rural areas.
Why is this?
The physician shortage is partially to blame.
Chronic disease is another major challenge, particularly for poor, rural Americans. A review of data provided by the
Due to limited local medical services and lack of transportation, patients are often unable to access vital primary care health services that focus on prevention and management of chronic illnesses, which leads to inadequate continuity and coordination of care. The result is inflated health care costs, poor outcomes and repeated readmissions. Telehealth is a critical tool in addressing these challenges, one that
The Telehealth Solution
In its infancy, telehealth simply connected hospital sites to rural clinical sites, linking health providers to each other and bringing much needed services to remote areas. Telehealth, however, can be used in many different settings beyond the traditional hub and spoke model. From corporations to correctional facilities, telehealth is providing access to care and reducing costs for both providers and patients.
. In the workplace - In 2011, 11% of employers with at least 5,000 employees said that they have a telehealth program in place, up from 5% in 2010, according to a study by Mercer. Participating employers are seeing productivity savings of up to three hours and an average cost savings of
. In correctional facilities - From a baseline of 94,180 transports made annually from correctional facilities to emergency departments at a cost of
. In schools - School-based telehealth provides access to healthcare for students to receive mental health, chronic disease management, and other care in schools. In an
. In nursing homes - From a baseline of 2.7 million transports made annually from nursing home facilities to emergency departments at a cost of
. Into the home - Remote patient monitoring is a form of telehealth that is being used to address chronic disease. A national home telehealth program started by the
Telehealth in
Nowhere in this great nation are health care challenges greater than in
Seventy-two of
The
Twelve years later, using a similar audio/video platform, the
As we worked to expand telemedicine services, we ran into several laws and regulations that complicated its delivery. The first obstacle we encountered was the financial disincentive to practice telemedicine. Prior to 2013, insurance companies in
In 2013, Governor
Another obstacle we encountered was connectivity. Due to the largely rural nature of our state, we could not take for granted that support for telehealth services would be available at the level we required, or frankly, at all. In order to achieve the connectivity required, we partnered with many of the telecommunications companies in the state - cable companies, wireless and broadband providers - to maximize existing resources and leverage the strength of incumbent utilities in the areas where they serve.
Thanks to support from the
In 2012, diabetic medical expenses in
Last fall,
Of the 85 patients currently enrolled in the pilot, all report that their disease is under control for the first time and that they have lost weight and are feeling better. While our goal was for 75% of patients to reduce their hemoglobin A1C levels by 1% in the first year, study results show that after only six months, the average reduction in A1C levels among participants is almost 2%. In addition, with the exception of one patient who needed to be hospitalized at the time of enrollment, none of our participants have gone to the ER or been admitted to the hospital for their diabetes.
It's important to recognize that the connectivity between UMMC and these patients would not exist but for the
Given the impressive and immediate results to date of our pilot in
The Future of Telehealth
As we look to the future, we must consider opportunities and challenges to the growth of telehealth. Right now, the greatest challenges lie in winning the federal level reimbursement parity that will make telehealth attractive in the marketplace and securing the reliable, high quality connectivity that telehealth requires. Given the jurisdiction of this committee, I urge you to consider these three issues:
1. The need for continued support of USF. Today, in rural
2. The need for a broader application of the FCC E-rate program. The sooner that children's health issues are addressed, the better, particularly when it comes to prevention of chronic disease. As such, we would like to see telehealth services into schools be allowed to take advantage of the E-rate program. Many children, particularly in rural areas, may not receive care in other settings, making school based evaluation and treatment even more important. Data shows that healthy children perform better in school, have less absenteeism and are more likely to reach higher levels of educational attainment.
3. The need for a more inclusive
The mission of the
I thank the subcommittee for the opportunity to testify today and look forward to answering any questions you may have.
ni
nii Rosenblatt, Roger A.; Chen, Frederick M.; Lishner, Denise M.; Doescher, Mark P. The Future of Family Medicine and Implications for Rural Primary Care Physician Supply.
niii Chen, F., Fordyce, M., Andes, S., & Hart, L. (2010). Which Medical Schools Produce Rural Physicians? A 15-Year Update. Academic Medicine, 594-598. Retrieved
niv
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nvi Vo, Alexander. "The Telehealth Promise: Better Health Care and Cost Savings for the 21st Century."
nvii Daniels,
nviii McConnochie KM, Wood NE, Herendeen NE, ten Hoopen CB, and Roghmann KJ. Telemedicine and e-Health.
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nxi Care Coordination/Home Telehealth: The Systematic Implementation of Health Informatics, Home Telehealth, and Disease Management to Support the Care of Veteran Patients with Chronic Conditions.
nxii US Census, 2010.
nxiii
nxiv Kaiser State Health Facts, 2009.
nxv Commonwealth Fund State Scorecard, 2014.
Read this original document at: http://www.commerce.senate.gov/public/?a=Files.Serve&File_id=466ab766-d13e-4a2b-8e1e-9b261b73a404
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