Date: 08/31/2009
Final
Telemedicine
HEALTH CARE TASK FORCE
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01:32 PM -- Discussion of Telemedicine Programs
The committee reconvened. Senator Boyd discussed a letter concerning Social Security Disability Insurance that the committee drafted.
01:35 PM -- Centura Health at Home
Ellen Caruso, from the Home Care Association of Colorado, began her presentation on home care services and telehealth/telemedicine. She described the home care industry and her organization. She distributed two handouts to the committee (Attachments G and H). Ms. Caruso introduced a film on telehealth prepared by Centura Health at Home. The video discussed a pilot telehealth program. The pilot dealt with congestive health failure and how the program can help patients become independent and maintain treatment in the home. The video demonstrated measuring blood pressure and oxygenation using the telehealth system. The video discussed reduced patient admissions and other benefits from the pilot program.
01:45 PM
Dianne Newberry, from Centura Health at Home, introduced herself and described the areas that the organization serves. She distributed a handout to the committee on the organization (Attachment I). She stated that telehealth is an effective way to address chronic diseases. Ms. Newberry stated that treating chronic heart disease accounts for a large portion of Medicare spending and that older patients with heart failure face multiple readmissions to hospitals. She described how telehealth reduces hospital readmissions. She stated the Centura Health started a pilot program to evaluate the effectiveness of telehealth, and that after the pilot ended, the program was expanded to the treat other chronic diseases including diabetes, hypertension, and other chronic conditions.
Representative Massey asked about the cost of telehealth equipment. Ms. Newberry described how new equipment costs the same as older equipment from several years ago, but has more features. Patients use the equipment and then when stabilized, the equipment can be cleaned and given to a new patient. She described how caregivers can ask questions through telehealth equipment to monitor patient's health. Senator Schwartz asked what type of internet connection patients needed in order to use telehealth. Ms. Newberry responded that the equipment can be connected to an ordinary telephone line. She spoke to which patients are good candidates for the program. Ms. Newberry discussed how the telehealth caregiver can teach patients, monitor health, and intervene when necessary, including prompting physician visits. She described how the telehealth program is staffed by nurses.
01:58 PM
Ms. Newberry discussed some lessons learned and obstacles to telehealth. For example, in order to receive services, a patient must be homebound limiting the access of the program. She stated that another problem is that some seniors have poor quality or corroded phone lines which limits access. She explained that telehealth providers and Qwest Communications are working to find solutions for the problem, including evaluating whether wireless access could increase access. Representative Frangas asked for data on cost savings. Ms. Newberry said that cost savings can be looked at in two ways: reducing hospital readmissions, and reducing nursing staff home visits. She also commented that telehealth allows nurses to spend more time with patients who have more acute needs. Representative McCann commended Centura Health and asked about whether all patients in the program were on Medicare. Ms. Newberry responded that they do not have a specific funding source for telehealth services and operate under the Medicare cap for home-based health services. She described working with United Health to provide coverage of such services.
Representative Kerr asked about the cost of hospitalizing a patient with congestive heart failure. Ms. Newberry described how the program encourages patients not to call 911 or go to the emergency room, and to call their nurse first to get evaluated and determine the best treatment.
02:09 PM
Ms Caruso concluded her presentation and spoke to SB 07-196, which established the Health Information Technology Task Force. She described the task force and its recent recommendations. She stated that the task force found that there is a conflict between a federal requirement under Medicaid that telehealth cannot substitute for a 'regular' nurse visit. She described efforts between the Department of Health Care Policy and Financing and the Centers for Medicare and Medicaid Services to resolve the conflict.
02:15 PM -- Connected Care
Beth Soberg from United Health Group described the Connected Care program, which partners with CISCO, Centura Health, and others to provide high definition video and audio telehealth services. Ms. Soberg described some obstacles to health care access in rural areas, such as distance, weather, and lack of specialists. She described the process for selecting pilot sites and collaborating with selected clinics to implement the project. She believes that the sites will be selected in September 2009 and United Health will purchase the telecommunication equipment for the four sites. The pilot will last for three years.
02:22 PM
Senator Foster asked about the type of equipment used in the system, and Ms. Soberg provided an example of how the system could be used for dermatological appointment. For example, an assistant in the clinic would take a photo using a dermoscope, and the image would be sent to the specialist. After review by a physician, the physician could submit a prescription as needed. Representative Massey commended the selection of sites. Ms. Soberg continued by describing outreach to clinics. She described how the Connected Care program integrates with the rest of the health system. She described the interaction of the program with the Colorado Regional Health Information Organization (CORHIO) and the Colorado Hospital Association. Representative Kerr asked about the process of site selection. Ms. Soberg described the criteria for site selection which included population density, existing capacity in the clinics/communities, and demographics of the communities. Ms. Soberg responded to a question from Representative Kerr regarding the costs of the system.