Telemedicine Improves Access in SC

Imagine a world where you no longer have to travel to the doctor for an earache or other routine illness; where you can simply pull out your smartphone and be connected with a physician ready to treat what ails you. That world is rapidly approaching.

Although it has been around for quite some time, telemedicine has become one of the biggest digital health trends in 2015. By allowing for the treatment and diagnosis of patients via remote telecommunications, health care providers have the opportunity to access populations that would normally go unserved. Coverage and reimbursement standards for telemedicine vary across the US, with 50 states that have virtually 50 different policies. Some provisions are more widespread, like cooperation with state Medicaid programs, where 48 states (including SC) have some type of Medicaid coverage for telemedicine. But for the most part, there is no “one-size-fits-all” model for implementing telehealth services.

The primary goal for most telemedicine advocates is to enact state parity laws that require private insurers to reimburse telemedicine-provided services like in-person services. According to the American Telemedicine Association, 24 states have telemedicine parity laws for private insurance, while many other states center their telemedicine coverage on specific services and underserved areas. South Carolina falls into the latter category.

Dr. James McElligot is the Medical Director for Telehealth at MUSC. MUSC has been a major benefactor of state funding to advance telemedicine in South Carolina, thanks in part to the advocacy of Dr. McElligot. A practicing pediatrician, he gained an interest in health disparities among children and a passion for serving the underserved. This passion led him to the forefront of a grassroots movement to help increase access in rural areas fueled by a grant from the Duke Endowment.

One of the results of that movement was the establishment of a school-based telehealth program that reaches approximately 20 schools today, with more in the pipeline. By partnering with school nurses on site, physicians can utilize telehealth devices to help diagnose and treat students without them ever leaving campus. Moreover, it provides students who may not have access the opportunity to be treated by a physician.

“You may be going in to see a sore throat and catch a dental abscess,” says Dr. McElligot. And while he recognizes the benefit of reimbursement parity laws for telemedicine, he is more focused on using it to target population health, highly-utilized services, and underserved areas.

The tele-psychiatry program at the SC Department of Mental Health (DMH) is a great example of how telehealth services can be used to increase access and save health care dollars. Now in 23 hospital emergency rooms across the state, DMH is celebrating 25,000 consultations since the inception of the program in 2009. Another successful product of grant funding from the Duke Endowment, the state’s tele-psychiatry program has resulted in a 53% reduction in emergency department lengths of stay and a 61% reduction in overall hospital length of stay for impacted patients according to the USC School of Medicine.

“Patients who used to sit in ERs without a psychiatrist can now be seen via tele-psychiatry,” says Dr. Bob Bank, DMH Medical Director. Dr. Bank has been with DMH for more than 20 years, and calls tele-psychiatry one of the most effective mental health intervention programs he has ever been a part of. “It’s an amazing tool for rural and underserved areas where you don’t even have to lay your hands on the patient, and you can still get an assessment and recommend a treatment plan,” Dr. Bank says.

Through their network of 23 hospitals and 12 mental health centers, SCDMH is able to remotely treat patients, resulting in overall medical service savings of $3,006 per individual episode of care. 

Dr. Bank and Dr. McElligot agree that we are only scratching the surface of what telemedicine can do to improve efficiency and health outcomes in South Carolina. Between the schools, hospitals, and clinics, more than 150 sites are currently engaged in telemedicine in the state, and more sites are expected to come in the next few years thanks to support from the Duke Endowment and the General Assembly. Private health insurers are also getting in on the act as they begin to cover more telemedicine services.

For Dr. McElligot, the future of telemedicine in South Carolina is bright, as the state’s telemedicine network continues to expand with more technology and service sites. “Over the next two years, a whole lot more telehealth will be occurring equitably across the state,” says McElligot. “Eventually, you may stop calling it telemedicine, and just call it healthcare.”