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KBIA’s Health & Wealth Desk covers the economy and health of rural and underserved communities in Missouri and beyond. The team produces a weekly radio segment, as well as in-depth features and regular blog posts. The reporting desk is funded by a grant from the University of Missouri, and the Missouri Foundation for Health.Contact the Health & Wealth desk.

The cost of connecting doctors with rural patients electronically

A shortage of rural health care professionals throughout the state has health systems connecting with patients in remote areas through telehealth.

At the University Hospital in Columbia, telehealth coordinator Samuel Woodard thumbs a remote which sends a camera at the far end of the room spinning around to face him. His co-workers at the Missouri Telehealth Network offices across town appear on the screen.

“Hey Katie, how’s it going? We’re just going over the equipment, showing him how the telehealth unit works.” Woodard says.

Since 1994, they have introduced over 200 sites in more than half of Missouri counties. But the start-up costs are estimated to be $10,000. Another $10,000 is needed to maintain a secure and stable high-speed broadband every year.

The Missouri Department of Health and Senior Services consider 100 of Missouri’s 114 counties rural. A Missouri Hospital Association reports says most hospitals in those counties had positive earnings in 2010, but a third of them were not hitting their bottom line.

“However, there is a great amount of grant money out there to help out physicians who want to help start up these program,” Woodard says, “You just have to apply for the grant and keep applying for them and hope for the best.”

He says the technology is getting cheaper and there is help at the state and federal level. But the problems with telehealth also extend into the pockets of its physicians.

In the University Hospital’s Dermatology Clinic, Dr. Karen Edison goes between rooms treating some patients face-to-face and others through telehealth. She served on a U.S. Senate Committee in the 1990s where she helped influences changes so that Medicare compensates doctors and nurses for telehealth procedures today. Yet Dr. Edison says physicians already have their hands full.

“These people are already so busy in their regular clinics and hospitals that they do not have a lot of extra time to do things like telehealth and there are really no incentives to do it,”Dr. Edison says.

To practice in another hospital, doctors need to be certified. To practice in another state, they need a license. Even electronically. Doctors also get higher reimbursements for in-person treatments, like surgeries and biopsies, compared to examinations done through telehealth.

But Dr. Thomas Hale, medical director for the Center of Innovative Care for the Mercy Health System, thinks treatment compensation is not the problem.

“I think that is irrelevant. I think what we need to see is the payment methodology changes from paying physicians to do things to changing to taking care of populations and keeping people well,” Dr. Hale says.

Hale suggests adopting accountable care organizations which incentivize keeping patients away from hospitals. Rather than being paid for individual treatments, physicians have to meet certain health standards for a group of patients and keep hospital expenses low. Telehealth expands this program’s reach and would lessen the need for in-person procedures.

With the release of federal guidelines for accountable care last year, so far three Missouri health systems plan to adopt this method. But that addresses only a fraction of the need in the state.

To find out more about how the implementation of telehealth can solve the growing need for rural health care, listen to the first part of this two part series on our website.

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