Updates from the Commission on Rural Resources

Rural Commission Sponsors Roundtable to Discuss Telemedicine/Telehealth
News from the New York State Legislative Commission on Rural Resources
January 9, 2012

ALBANY – Access to healthcare can be life-changing, especially for individuals who may live in rural or isolated areas. The bipartisan Legislative Commission on Rural Resources and the Senate and Assembly Committees on Health and Insurance met with over a dozen healthcare providers and leaders, to discuss the benefits and barriers to expanding the use of telehealth at a roundtable discussion, "Telemedicine and Telehealth: Putting the Pieces Together.”

Assemblywoman Aileen Gunther, Vice-Chair of the Commission on Rural Resources, and a Nurse who has worked in rural health settings noted that, “Telehealth and telemedicine are invaluable tools for practitioners and patients, alike. It is not only a cost-effective tool, but it gives patients in more rural areas or those with limited ability to travel access to specialized medical care, which can often mean the difference between life and death.”

“With telemedicine and telehealth programs, that much-needed access becomes a reality, providing access to world-renowned experts and improving quality standards while alleviating the isolation of rural providers. The possibilities are endless, from literally saving lives to allowing disabled and frail elderly to stay in their homes,” said Senator Catharine Young, Chair of the Commission.

The Commission on Rural Resources is working on legislation based on input received at the roundtable to create a Telehealth Program in the State Health Dept., provide guidance for the granting of hospital privileges for telemedicine physicians and ensure insurance coverage for telehealth services

Dr. Kenneth L. Oakley, chief executive director for Western New York Area Health Education Center and Lake Plains Community Health Network, Inc., spoke at the January roundtable. He said he is “personally and professionally invested” in telehealth and telemedicine because he has watched it change lives.

“My grandson was born with severe birth defects, and he had it pretty rough. Along the way, he’s also had some issues with psychosis and emotional issues. For the first five or six years of his life, he was institutionalized. It wasn’t until we had a consultation with Columbia University that his diagnosis and treatment changed. Since that time, he’s only been hospitalized for 20 days in three years. Before, he was averaging 40 days (in the hospital) a year,” Dr. Oakley said.

He added, "If telehealth and telemedicine weren’t available, we wouldn’t be in the same place. We need to embrace this in our state. We need to make a concerted effort to say, ‘Let’s mobilize and think of a comprehensive strategy,’”.

While New York State has been at the forefront of telehealth/telemedicine, focused on providing increased access to health care services and avoiding unnecessary travel and hospitalizations, there is still more work to be done.

Thomas Holt, Chief Executive Officer of Lutheran Social Services, noted, “The senior population in our rural community is rapidly growing, and they need coordinated services now to remain healthy and safe in their homes. This can more easily be accomplished with the use of technology, which is less costly and less invasive than the utilization of hospitals and nursing homes.

Alexis Silver, Vice President for Clinical Policy of the Home Care Association of New York State (HCA), said: “Health providers throughout New York State have been model innovators in the use of telehealth and telemedicine. This important technology extends the clinician’s reach to patients beyond the traditional face-to-face encounter, allowing for critical interventions that save lives and reduce the need for higher-cost services. In rural areas of New York, where patients may face barriers in obtaining preventive health care or chronic disease management, these technologies are especially vital, bringing individuals closer to services that help them better control and improve their health. New York’s health care community looks forward to working with the Legislature on a plan that can further utilize these important life-saving technologies to enhance care delivery and service integration for citizens throughout the state.”

Presenter Profiles for the NYS Commission on Rural Resources Telehealth/Telemedicine Roundtable, January 9, 2012

Rachel Block, Deputy Commissioner, Office of Health Information Technology Transformation, NYS Department of Health

Rachel Block is Deputy Commissioner for Health Information Technology Transformation in the NYS Department of Health, where she has overseen development and implementation of New York’s statewide health information technology strategy since May 2009. She was the founding executive director for the New York eHealth Collaborative (NYeC), a statewide multi-stakeholder organization committed to advancing health information technology adoption and use in New York from 2006-2009. Previously, Rachel was the project director for the United Hospital Fund's Quality Strategies Initiative where she developed several initiatives to coordinate improvements in health care delivery and outcomes across the health care system in New York, including the planning process which led to creating NYeC. She also held several senior management positions at the Centers for Medicare & Medicaid Services (previously Health Care Financing Administration) where she directed policy development and operations of Medicaid, State Children's Health Insurance, and Federal Survey and Certification Programs, with particular emphasis on quality improvement, data and systems issues. Rachel worked for Vermont Governor Howard Dean on health reform from 1992-94. She also worked for the New York State Legislature from 1978-92 focusing on health policy and financing. Rachel is a past president of the board for the eHealth Initiative and currently serves on its Leadership Council.

Gregory S. Allen, MSW, Director, Financial Planning and Policy, Office of Health Insurance Programs, NYS Department of Health

As Director of the Division of Financial Planning and Policy, Mr. Allen is responsible for managing Medicaid’s clinic and physician reimbursement, pharmacy finance and operations and fee-for-service payment policy for all healthcare clinic services. In addition, Mr. Allen’s portfolio includes payment policy review for mental health, chemical dependence and mental retardation and developmental disabilities services.

Beginning his career as a front line service professional in the chemical dependence field, Mr. Allen has over 20 years of government operations and management experience. Working at both the State Office of Alcoholism and Substance Abuse Services and at the Department of Health, most of his work has focused on the nexus between program development and reimbursement with a particular focus on payment policy, new service development, data management and rate setting.

Stewart Gabel, M.D., Medical Director, Office of Children and Families, NYS Office of Mental Health

Stewart Gabel, M.D., has been the Medical Director of the Division of Children and Family Services in the New York State Office of Mental Health since 2007. Dr. Gabel is a general and child and adolescent psychiatrist, who also is a board certified pediatrician. After completing an internship and residency in pediatrics, he became the director of a child development clinic in Virginia. Dr. Gabel then trained in psychiatry at Western Psychiatric Institute and Clinic in Pittsburgh and subsequently worked as the director of a children's day hospital at New York Hospital/ Cornell Medical Center, Westchester, New York. Dr. Gabel moved to Colorado to become a Professor of Psychiatry at the University of Colorado Medical School and Chair of the Department of Psychiatry and Behavioral Sciences at the Children's Hospital, Denver, a position he held for 10 years through 2002. While at the Children's Hospital, Dr. Gabel became heavily involved in integrative efforts between academic psychiatry, a private children's hospital and community mental health programs. He subsequently lectured, wrote on organizational issues and practiced in a community mental health clinic and a university health center. Dr. Gabel has edited or authored numerous books and articles, a number of which deal with conduct problems in youth, children of incarcerated parents and substance abusing parents and leadership in medical organizations.

Kenneth L. Oakley, Chief Executive Director, Western New York Area Health Education Center and Lake Plains Community Health Network, Inc.

Kenneth Oakley is Chief Executive Officer of the Western New York Rural Area Health Education Center (R-AHEC) and the Lake Plains Community Health Network, Inc. Dr. Oakley became interested in telemedicine while working as the Chief Executive Officer of a rural hospital in 1996. In his current positions, Dr. Oakley has received numerous telemedicine awards from the U.S. Health Resources and Services Administration’s Office for the Advancement of Telehealth and the USDA’s Rural Development Distance Learning and Telemedicine Program. Dr. Oakley also secured a $5.9 million grant through the Federal Communications Commission in 2007 to create a dedicated broadband healthcare network in Western New York, which has since connected more than 25 facilities and expects to have an additional 14 facilities “go live” by early March of 2012. R-AHEC recently announced that was provided with a high-speed IP-network through PAETEC to support the Western New York Rural Broadband Healthcare Network (WNYRBHN). This work is part of a 60-month contract valued at $6 million that will serve 38 facilities with advanced Internet and MPLS-based VPN services over PAETEC's fiber optic network. The overriding mission of the Western New York Rural Broadband Network is to bring rural patients the same health care opportunities that are available in urban areas - "to connect those who have with those who need."

Frederick Heigel, Vice President for Regulatory Affairs, Rural Health and Workforce, Healthcare Association of New York State

Frederick Heigel is Vice President for Regulatory Affairs, Rural Health and Workforce for the Health Care Association of New York State (HANYS), a statewide organization representing some 500 member non-profit and public hospitals, health care systems, nursing homes, home care agencies and other health care providers. A strong supporter of the use of telemedicine in New York State, HANYS has made a recommendation to the Medicaid Redesign Team (MRT) in this regard. HANYS regularly showcases to its members examples of innovative approaches to offering telemedicine services that have proven successful and can be replicated. In addition, HANYS has worked successfully with the Department of Health (DOH) to expand Medicaid payment policy to include reimbursement for telemedicine consultations. HANYS fully supports the tele-stroke initiative implemented by DOH and has also worked with DOH to address duplicative New York State physician credentialing requirements to make them more consistent with federal requirements/national standards. As barriers to the wide implementation of telemedicine in New York State are identified, HANYS continues to work together with state and legislative officials to address them.

Alexis Silver, Vice President for Policy, Home Care Association of New York State

Alexis Silver is the Vice President for Policy at the Home Care Association of New York State (HCA). HCA has been on the forefront of the advancement of home telehealth since 2003, first collaborating with state legislative and regulatory bodies in 2004 to secure $7 million in grant funding to support capital investment in telehealth. By 2006, there was clear evidence that the use of home telehealth reduced unplanned hospitalizations of high-risk patients. During the 2007 legislative session, HCA worked closely with the legislature to create a Medicaid reimbursed home Telehealth program under Chapter 58, L. 2007. HCA followed up by providing consultation and technical assistance to the New York State Department of Health to develop the framework and reimbursement structure for the telehealth program. Most recently, HCA has been collaborating with the legislature to further promote the development of a coordinated accessible telehealth and telemedicine program. As HCA’s point person on telehealth policy, Alexis Silver has worked extensively to support New York home care providers in their telehealth program development, which has led to her being named Chair of the American Telemedicine Association Home Telehealth and Remote Monitoring Group. She also serves as the American Telemedicine Association’s representative to the Joint Commission for Telehealth Policy.

Frank Dubeck, Vice President and Chief Medical Officer, Excellus Blue Cross and Blue Shield

Dr. Frank Dubeck is Vice President and Chief Medical Officer for Excellus Blue Cross and Blue Shield, headquartered in Rochester, New York. Excellus is part of a $5 billion family of companies that finances and delivers health care services across upstate New York and long term care insurance nationwide. Collectively, the enterprise provides health insurance to more than 1.8 million members. Excellus BlueCross BlueShield maintains a strong local presence through four regional headquarters and additional field offices in the Central New York Region, based in Syracuse with an additional office in Watertown; Central New York Southern Tier Region, based in Elmira with an additional office in Binghamton; Rochester Region, based in Rochester; and Utica Region, based in Utica with additional offices in Oneonta and Plattsburgh. Upon corporate review, Excellus anticipates opening all of their commercial policies to reimburse for telehealth, based on the Medicare reimbursement model. If adopted, this new policy will represent a major shift in the state’s reimbursement for telehealth.

Cynthia Gordon, Director of Telehealth Services, Rochester General Health System and InterVol – Via Teleconference

Cynthia Gordon is the Director of Telehealth at the Rochester General Health System. Cynthia was one of the original co-founders of the telehealth program at Rochester General Health System in 2006 and has been one of the primary founders of two international telehealth programs in Haiti and Belize through InterVol, a local Rochester non-profit organization. She has presented at many national, state and local conferences on telehealth and its multitude of applications in healthcare. Rochester General Hospital's telehealth program is the first of its kind in the region and one of only two in the United States which offers telehealth consults for multiple physician specialties, providing healthcare and consultative services to individual patients by using telecommunications technology. Rochester General's program offers specialty consults for highly specialized physicians, and utilizes two main types of technological systems - static and dynamic. Static technology uses still images or one-way transmission to forward and store still frame images, while dynamic technology uses interactive video through broadband internet connections primarily for teleconferencing between physicians, staff and patients in two locations. With a newly formed Department of Telehealth, offering services in both the inpatient and outpatient arenas, Rochester General and Newark-Wayne Community Hospital provide leading edge telehealth services.

Victoria G. Hines, President and Chief Executive Officer, Visiting Nurse Service of Rochester and Monroe County, Inc.

Victoria G. Hines is President and Chief Executive Officer of the Visiting Nurse Service of Rochester and Monroe Counties, Inc., which has been at the forefront of telehealth for two decades. In the 1990s, VNS worked with American TeleCare, piloting one of the early telehealth devices in home care that involved use of a video phone and a number of peripheral devices that were not at the time integrated, nor did they have a central monitoring portal. VNS also worked with Kodak’s research and development division when they were considering getting into the telehealth market, but at that time, the costs were prohibitive and there was no payment stream. VNS has been actively monitoring patients since 2006. Initially limited in their ability to serve needed patients due to cost outlay, they converted to a new system in 2011 that is lease-based, allowing VNS to serve more clients. Currently, VNS is nearing 200 patients in Monroe County alone, with the most common diagnoses including: heart failure, COPD, diabetes and hypertension. VNS is also working with Finger Lakes Visiting Nurse Service (FLVNS), a rural home care agency, and has received grants from Greater Rochester Health Foundation in 2008 and 2011 to expand their telehealth program. It is projected that VNS will serve more than 1,500 patients whose medical conditions put them at high risk for hospitalization, reducing emergency department use and inpatient admissions for local savings of more than $3 million over a two year period.

Thomas Holt, Chief Executive Officer, Lutheran Social Services

Thomas Holt is Chief Executive Officer of Lutheran Social Services (LSS), which provides a wide range of telemedicine senior services and state of the art senior housing to adults who need help in finding solutions as they age. Their programs include a medical adult day care, medical rehabilitation, assisted living and skilled nursing in a nursing home setting and housing that includes independent living apartments and duplexes with both HUD-subsidized and market rate options. Through New York State HEAL 20 grant monies. Lutheran Social Services was able to initiate “Smartment Building” and “Project Independence” – two projects which provide monitoring technologies into individuals’ homes to improve health outcomes and reduce unnecessary medical costs and hospital readmissions.

Michelle Mazzacco, Vice President and Director, Eddy Visiting Nurse Association/St. Peter’s Health Partners

Michelle Mazzacco is the Vice President and Director of Eddy Visiting Nurse Association/St. Peter’s Health Partners, which began in 2000. Over the last 12 years, improvements in patient outcomes have led to the gradual expansion of the program. Recently, the organization conducted a study with 30 of their Long Term Home Health Care Program patients which demonstrated a 37% reduction in readmissions, as well as a 57-patient study with a local health plan which demonstrated $1.1 million in overall healthcare cost savings over a year. The Eddy’s five county service area (Albany, Rensselaer, Saratoga, Columbia and Greene) includes two counties which are primarily rural (Columbia and Greene) and three counties with large rural populations. Based upon the research results above, the Eddy VNA considers its use of telehomecare as evidence-based best practice for patient care.

Laurie Neander, Chief Executive Officer, Bassett Healthcare Network: At Home Care, Inc.

Laurie Neander is Chief Executive Officer of At Home Care, Inc., located within the Bassett Healthcare Network in Central New York. At Home Care, Inc. is among the 23% of U.S. home health care agencies that have invested in telehealth technology, a monitoring system that allows nurses in At Home Care’s Oneonta office to keep tabs on more than 100 patients from their homes in Otsego, Delaware, Chenango and Herkimer counties. All patients receive training on the user-friendly telehealth unit, which allows them to send key data – such as their weight, blood pressure, oxygen level, ECG reading and glucose levels – to At Home Care daily through the phone line. At the telehealth “nerve center” in the Oneonta office, two registered nurses monitor the data stream, watching for red flags.

Mary Ann Zelazny, Chief Executive Officer, Finger Lakes Community Migrant Health

Mary Ann Zelazny in the Chief Executive Officer of Finger Lakes Community Migrant Health. She has been the team leader in the development of the Migrant Voucher Program, which provides farm workers in 42 New York counties access to health care. Her job responsibilities included the opening of three full service health centers and five part time clinics. In 2008, Ms. Zelazny secured funding for the agency to become a Community Health Center, and in 2009, Finger Lakes Community Migrant Health brought a four-county Title X Family Planning program on board, with an additional four sites. Ms. Zelazny has led in the development of the Finger Lakes Community Migrant Health Telehealth Program and the NYS Farm Worker Telehealth Network, bringing together 28 agencies in pursuit of better collaborations to provide access health care for patients. In 2010, Finger Lakes founded the National Farmworker Telehealth Network, a health center controlled network to expand telehealth services to migrant and community health centers in the U.S. Ms. Zelazny has had several years of IT training and certification, as well as experience in providing culturally appropriate health services to the communities of the Finger Lakes region.

Denise K. Young, Executive Director, Fort Drum Regional Planning Organization

Denise Young is the Executive Director of the Fort Drum Regional Planning Organization. Under her direction, the North Country Telemedicine Project began as a regional initiative to create a fiber optic telecommunications and telemedicine network to connect healthcare sites operating in Jefferson, Lewis and St. Lawrence Counties and in four urban facilities located in Syracuse and Utica. The network provides consultation and specialty care through the use of electronic medical records and telemedicine applications. This large network continues to increase access to primary and specialty healthcare for the 160,000 residents of the Fort Drum Region.

Deborah Robbins, Director of Clinical and Sales Support, Advantage Home Telehealth, Inc

Deborah Robbins is the Director of Clinical and Sales Support for Advantage Home Telehealth at the downtown Buffalo Niagara Medical Campus, partnering with home health-care providers by offering remote patient monitoring services with wireless devices. Advantage Home Telehealth has signed a number of contracts that add potentially hundreds of new patients to its telehealth monitoring system, while bringing in at least $400,000 in revenue. The company’s technology allows physicians to better monitor even small changes in the health status of their clients electronically, allowing quicker interventions when necessary to keep patient conditions from declining. Home care with remote monitoring also gives patients the ability to age in place, remaining in their own environment instead of being placed in a nursing facility. Patient telehealth services include diabetes, hypertension, medication compliance, obesity, COPD (chronic obstructive pulmonary disease), chronic heart failure and other conditions for both private pay and referral-based service models.