Why you should care
Because rural health care is in the pits, but this could connect doctors to faraway patients.
Willie Reeves sags into his couch in the house he rebuilt himself after it burned down two decades ago. The 71-year-old has worn many hats in the tiny town of Lexington in rural Mississippi, serving as a small-business owner, an award-winning youth football coach and a community activist trying to aid a faltering school district.
Now, though, Reeves is simply another diabetic trying to manage his disease, one that has contributed to five heart attacks and seven stents in his chest. He opens a large cardboard box and picks up an iPad in a green case. He sticks his arm. His sugar levels are low. Reeves knows that if they get too low, he will be hearing from Jackson, an hour south, where nurses with the University of Mississippi Medical Center’s telehealth program are watching day and night. “If the numbers don’t look right, they’ll give me a call,” he says.
I haven’t been to the hospital for diabetes since I’ve been on the [telehealth] program.
Willie Reeves, diabetes patient
Mississippi trails only West Virginia and Alabama as a diabetes epicenter among America’s states. Nearly 14 percent of its residents suffer from the condition. It ranked last overall in the 2017 America’s Health Rankings, its high prevalence of cardiovascular deaths and obesity in keeping with the broader health patterns of the American South. Yet Mississippi has also emerged a leader in remote health care and is betting on the sector like few other states are. In 2016, it was one of only eight states that received an “A” rating from the American Telemedicine Association — New Mexico and Delaware were among the high achievers. And in October, the UMMC was named one of only two “Telehealth Centers of Excellence” by the federal Health Resources and Services Administration, a designation that credits the state for using remote video calls and remote tracking tools to provide services — and comes with a potential $2.6 million in funding to boot.
The next step in its vision? Mississippi-style telehealth coming to a hospital near you, no matter what state you live in. Earlier this year, Mississippi Sen. Roger Wicker co-sponsored a bill with Hawaii Sen. Brian Schatz to give discounts to nonrural hospitals that provide telehealth services. Within the state, telehealth has expanded to include ICU bed oversight and asthma care. Monitoring of hypertension is next. And the Center of Excellence designation will allow the UMMC to add a research division, tapping into daily, real-time diabetes data that will one day help prevent the disease, says Michael Adcock, executive director of the medical center’s telehealth program. “The CDC has a playbook on how to create a diabetes prevention program,” Adcock says, speaking of the Centers for Disease Control and Prevention. “What nobody has done is scale that to a place where you can push that directly to your phone.”
Mississippi’s need for telehealth is unique. According to the Association of American Medical Colleges, the state had the lowest doctor-to-patient ratio in the nation in 2017 — with 186 doctors for every 100,000 people, less than half that of Massachusetts, which leads with close to 450. Starting with a “telemergency program” in 2003 that included audio and video feeds set up in three rural hospitals, the initiative grew to six hospitals in 2008 — when the state added mental counseling to the program — and then 17 hospitals soon after. A diabetes pilot test showed that the 140 participants didn’t have a single ER or doctor visit during the first six months, saving a potential $339,000 in Medicaid spending as a result. Those results led to the Mississippi state Legislature passing reimbursement laws in 2012, a crucial step that allowed telehealth providers to get paid for health services in the same way that doctors usually were reimbursed by insurance providers. Today, UMMC telehealth has 44 employees, works with 200-plus satellite hospitals and clinics statewide and has outfitted hundreds of the university network’s doctors with technology to be able to provide remote guidance to patients. The program enables rural hospitals to use the expertise of nurses there, instead of relying on temporary staffing companies that often supplied family medicine doctors who “weren’t used to a heart attack or a stroke,” explains Adcock.
The state now plans to expand telehealth coverage to nearly 1.5 million potential asthma and hypertension patients, and to expand services to neighboring states, where border towns distant from city centers could benefit from a cross-state relationship.
Significant obstacles remain. Some private insurers, such as Blue Shield, have declined to cover the programs despite the state law. UMMC has a rolling enrollment of 120 patients being monitored for diabetes, with most patients staying on less than a year. “I could accept 10 times that,” Adcock says, but some local physicians and family practitioners refuse to participate, skeptical that they’ll lose patients (and thus money) to telehealth services. Nationally, the Wicker bill and others like it have yet to make it out of Senate committees.
But the gains from telehealth can be lifesaving. In Lexington, Reeves remembers one night before being enrolled, when his sugar levels suddenly dropped, and he woke up at 4 a.m. with no feeling in his legs. It took him three hours before he was able to go to the hospital and receive treatment.
If that were to happen today, he knows doctors would be able to check his readings, and see something wrong almost immediately. It’s a safer situation than that of his brother, who lives with him and who receives monthly treatment an hour away at the VA hospital. “I haven’t been to the hospital for diabetes since I’ve been on the program,” Reeves says. “It helps a lot.”
- True Story
In the heart of the blues highway, the music is hanging on … by a thread.