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TeleMedicine
The newsletter for the Midwest Rural Telemedicine Consortium - July/August, 1997

News on the wire:

In the news...In a recent issue of the Des Moines - based Business Record, North Iowa Mercy and its Women's Health Center in Mason City were noted as being one of the 10 best women's hospitals in America by Self magazine. The magazine studied health care organizations across the country. North Iowa Mercy was the smallest of the 10 hospitals named. Congratulations!

MRTC expands to 38 sites...In June, the MRTC installed the last of 20 additional locations in Iowa where telemedicine services can be accessed, bringing the total number of sites to 38. In addition to the original 18 sites, Dr. SMITH now resides at Adair County Hospital, Greenfield; Belmond Community Hospital, Belmond; Eldora Regional Medical Center, Eldora; Ellsworth Municipal Hospital, Iowa Falls; Hancock County Memorial Hospital, Britt; Manning General Hospital, Manning; Marshalltown Medical and Surgical Center, Marshalltown; Mary Greeley Medical Center, Ames; Mitchell County Regional Health Center, Osage and Story County Hospital, Nevada.

Bishop Drumm Retirement Center, Johnston; Chatauqua Guest Homes, Charles City; Graettinger Clinic, Graettinger; Forest City Regional Medical Center, Forest City; Madrid Home for the Aging, Madrid and Mercy Family Care Clinic, Spencer have all acquired single monitor units. In addition, Mason City Clinic, Mason City; Mercy Mayo Family Practice Residency Program, Des Moines and the emergency rooms at Mercy Hospital, Des Moines, and North Iowa Mercy, Mason City, have been equipped with single monitor specialty consultation units.

DHS approves Medicaid reimbursement for telemedicine services

On May 23, Governor Terry Branstad signed into law a supplemental appropriations bill which will enable health care providers to be reimbursed for services delivered via telemedicine to Medicaid recipients. Based on projections of teleconsultation volumes provided by MRTC staff, the Iowa Department of Human Services (DHS) expects to spend about $60,000 during the first 12 months following implementation of the pilot program. Additional funding will be provided by the Medicare program in the form of federal matching dollars. Rules will be drafted to provide more specific directions as to types of services eligible for reimbursement, conditions of eligibility and other administrative policies and procedures.

The importance of establishing a pilot program at the state level was brought to the attention of lawmakers in 1996. At the MRTC's request, Rep. Bob Brunkhorst (R-Waverly) introduced and rallied support for an amendment requiring DHS to prepare a report on the feasibility of payment for telemedicine services provided to Medicaid beneficiaries. The report, which was submitted to the Iowa Legislature by DHS earlier this year, recommended establishing a pilot program based on fee-for-service payment to both referring and consulting providers.

Uncertainty about the budgetary implications of the pilot program diminished DHS's support in the early stages of the 77th General Assembly. Following phone calls from MRTC members and presentations relating to utilization at committee meetings by MRTC staff, key legislators provided enthusiastic support for an amendment to initiate the pilot program. The amendment was passed by the House and Senate in the final days of the session.

Passage of this legislation is important not only because it will enable physicians and other providers to be paid for services, but also because low-income Iowans will be better able to obtain needed health care services in a more timely and efficient manner than would otherwise be possible. The MRTC believes that the use of telemedicine to provide services promptly in the most appropriate setting can have a favorable effect on Medicaid program costs. Our efforts now will focus on assisting DHS staff in developing methods of measuring these effects.

Although the list of supporting legislators is long, we would like to extend special thanks to Reps. Brunkhorst, Blodgett (R-Mason City), Houser (R-Carson), Hansen (R-Council Bluffs) and Frevert (D-Emmetsburg), whose committee-level support propelled passage of the amendment. Thanks also to Senators Bartz (R-Grafton) and Hammond (D-Ames) for their leadership on the other side of the Rotunda. Finally, the MRTC wishes to express appreciation of the efforts of Steve Roberts (Davis Brown Law Firm, Des Moines), Kirk Norris (Iowa Hospitals and Health Systems) and Paul Bishop (Iowa Medical Society), who kept the issue of telemedicine reimbursement on the legislative radar screen.

MRTC names medical directors

Burt Bottjen, M.D., and Joseph Latella, D.O., have been named Medical Directors for the northern and southern regions of the Midwest Rural Telemedicine Consortium, respectively. Dr. Bottjen is on the hospital medical staff at Kossuth Regional Hospital in Algona. Dr. Latella, who has participated in more telemedicine sessions than any other physician in Iowa, is on the hospital medical staff at Hamilton Hospital in Webster City.

Telemedicine entails using live, two-way audio-video links to provide patients and primary care doctors like Dr. Bottjen and Dr. Latella with access to specialists in Mason City or Des Moines. Drs. Bottjen and Latella have used the telemedicine system for consultations in cardiology, oncology, pulmonology, orthopedics and several other specialties.

The doctors' responsibilities as Medical Directors will include acting as liaisons between the program's administrative staff, specialists and primary care providers practicing in and around the communities that have hospitals that are members of the MRTC.

In addition to clinical uses of the system, Drs. Bottjen and Latella also will be investigating educational opportunities for doctors and other health professionals as a means of keeping people well. By working with other members of the MRTC, the medical directors' can better understand the health education needs of our communities and how to use telemedicine technology to meet those needs. Drs. Bottjen and Latella agree, "Then, when a member of our community becomes ill, we are able to use this technology to take care of the patient locally in the most efficient and effective way possible.

Dr. SMITH debuts as a "Semi-Sensation"

Dr. SMITH made his Franklin County debut as a part of the Hampton Chamber of Commerce "Semi-Sensations" . The May 14th "Semi-Sensations" was a progressive supper highlighting Hampton's two ICN classrooms and Franklin General Hospital's telemedicine room. Arriving by semi at their third stop, seventy people were introduced to Dr. SMITH at Franklin General Hospital. The guests had an opportunity to view Dr. SMITH's auxiliary camera mounted on a swiveling, extendable arm. This new technology in conjunction with the remote camera control capability allows the consulting physician greater viewing flexibility during a telemedicine consultation. Displays detailing a brief history of the MRTC and the advantages of telemedicine technology for the patient, physician and community were also available. Franklin General Hospital, one of the original sites established through the Midwest Rural Telemedicine Consortium in 1995, was retrofitted with the mobile Dr. SMITH cart just a week prior to the "Semi-Sensations" event. Cable drops for the Dr. SMITH cart to the emergency room, board room, and conference room were also included as part of the retrofit. An additional cable drop to Franklin General Hospital's new clinic addition this summer, will be an added convenience for both patients and physicians.

Telepathology links rural Iowa hospital laboratories to references laboratories
by Steven P. Goetz, M.D., Pathologist, North Iowa Mercy Health Center

Ongoing Educational Opportunities

Grand Rounds
First and third Tuesday of each month
Various topics and speakers
7:30 - 8:30 a.m.
1 hour CME Category 1
1 hour AOA Category 2A
0.1 CEUs (1 contact hour)
Offered by Mercy Hospital Medical Center, Des Moines
There is no charge for these programs.

Lunch Lecture
Every Thursday
Various topics and speakers
12:00 - 1:00 p.m.
1 hour CME Category 1
1 hour AOA Category 2A
0.1 CEUs (1 contact hour)
Offered by Mercy Hospital Medical Center, Des Moines
There is no charge for these programs.

Trauma Conference
First Wednesday of each month
7:00 - 8:00 a.m.
1 hour CME Category 1
1 hour AOA Category 2A
0.1 CEUs (1 contact hour)
Offered by Mercy Hospital Medical Center, Des Moines
There is no charge for this program.


To submit an article or for more information, please contact Tina Collins at 800/637-2994 ext. 8750 or 515/643-8750 or Brenda Epsteen at 800/433-3883 ext. 7875 or 515/422-7875.

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