Reimbursement issues loom as Maine holds its first telehealth summit

Maine healthcare providers launched their first official telehealth summit on Tuesday with a message to the rest of the country: The first state to see the sun rise each day also aims to be one of the leaders in this rapidly growing healthcare delivery philosophy.

"Telemedicine really does promise to improve and enhance the health of all of us," said Charles Dwyer, director of the Maine Center for Disease Control's Office of Rural Health and Primary Care, which organized the one-day gathering of roughly 150 healthcare providers at the University of Maine's Orono campus.

Dwyer pointed out that the state has had interest in telemedicine and telehealth for several years, and organized a telemedicine workgroup in 2006 to guide both state and local efforts. The group has launched a Web site (www.mainetelehealth.org) and plans to make the summit an annual event.

Summit organizers attracted one of the nation's leading experts on telehealth for a keynote speaker: Dale C. Alverson, MD, medical director of the Center for Telehealth and Cybernetics Research at the University of New Mexico's Health Sciences Center and president of the American Telemedicine Association. Alverson noted that Maine was one of the first state's to receive a federal grant for telemedicine in 2003, and is one of only a few to mandate reimbursement by private payers for telehealth services.

"We are in an amazing time in our country, an amazing time of transformation," he said.

Neither Dwyer nor Alverson – nor the many panelists who spoke on Tuesday – predicted an easy road for telehealth. Barriers include credentialing and privileging, healthcare providers who are resistant to change or too overworked to consider something new, broadband availability, sustainability and reimbursement.

"What's hindering the development of telemedicine? What's hindering the sustainability of it?" asked Dwyer. "Obviously, the big barrier is reimbursement."

"How do we equitably pay providers?" added Alverson.

Conference attendees heard several examples of telehealth projects underway in Maine. Among them:

• The Maine Sea Coast Mission, a Bar Harbor-based program that provides telehealth services to several islands – currently through a 72-foot ship equipped with telemedicine technology, though the mission is working with inhabitants on the islands now to build health centers;

• The MaineHealth vitalnetwork, based in Portland, which has operated an electronic intensive care unit (eICU) since 2005, linking hospitals and healthcare providers throughout Southern Maine;

• The teletrauma unit at Eastern Maine Medical Center in Bangor, overseen by Dr. Rafael Grossman, which covers an area of about 26,000 miles – roughly two-thirds of the state – offering emergency trauma services to people who are often 200 miles away from the nearest trauma center;

• HomeHealth Visiting Nurses, which has provided telehealth services to home-bound patients since 2001; and

• The tele-speech pathology program at Waldo County General Hospital in Belfast, coordinated by Dr. Michael Towey, who has treated people with speech and swallowing disorders from as fart away as Taiwan.
  
  

Workshops held throughout the day focused on updates on state and federal legislative efforts to regulate telehealth services, guidelines for launching a telehealth project, and tips on measuring the return on investment and looking to sustain a project once grant funding has run out.

State Rep. Ann Perry, from Calais, drew praise from Alverson for her efforts to pass legislation in 2008 requiring Maine's private health insurers to reimburse providers for telehealth services. She pointed out the language in the law is deliberately open-ended, so that state officials, providers and payers can work together to define what services will be paid and how.

"You ask for the sky so that you can get what you want," she said of her efforts to introduce the bill. "And that's a foot in the door."

Shaun Alfreds, chief operating officer of HealthInfoNet – the state's health information exchange – said the nation has to adopt a more broad-based approach to healthcare, aligning health information exchange with telemedicine.

"Telehealth is health information exchange and electronic medical records," he said. "We're not talking about these tools together, and we should be."

Alverson said healthcare reform should influence how well telehealth succeeds throughout the country. Aside from connecting patient to providers and specialists over long distances – and sometimes bringing together competing healthcare interests to work side-by-side – the use of telemedicine technology can improve the quality of healthcare and significantly reduce the cost of healthcare delivery.

"We're looking at a fundamental shift in the way healthcare is delivered," he said.