Could telehealth ease Miss. doctor shortage?
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Mississippi has one of the worst doctor shortages in the United States. With doctors in short supply, specialists like Lee Greer, M.D.  have found a new way to meet patient needs through telehealth.
He is the only geriatrician practicing in northeast Mississippi and works at the North Mississippi Medical Center in Tupelo. 

Over the past several years, Greer says he has given up his nursing home practice because of the time it takes to travel from community to community. But with computers, high-speed internet connections and advanced technologies, he’s able to see and treat nursing home patients again. 
 
“With telehealth, just this morning I saw patients in Iuka, Pontotoc, and I didn't have to travel anywhere but just to my office here,” said Greer.
 
One of his patients is 90-year-old Melba Pugh. She lives at the Pontotoc Nursing Home about 30 miles away from Greer’s office. Greer, along with the assistance of registered nurse Donna Wiggins who is at the patient’s side, can exam Pugh. Pugh’s daughter-in-law Denise Pugh remembers how a telehealth visit was described by her mother-in-law’s primary care doctor.
 
“It is a video interactive system so that he's on one end of the camera, your mother-in-law's on the other end of the camera,” said Pugh.  “And he can take care of her, examine her, talk to her, interact with her, and make medical decisions.”

That visit was also available by the video interactive, so that was very beneficial for her and for us.”

Nurse Wiggins is following Greer’s orders during Pugh’s exam. Pugh is seated in front of a large monitor with a high-resolution web camera mounted to the top. Just like Skype or FaceTime, the two can hear and see each other. Pugh says access to a specialist through interactive audio and video provides the care her mother-in-law needs.
 
“He was able to make medication changes, (and) change some of her therapies,” said Pugh.  “(Greer) made a referral to one of our psychiatrists, so that she can seek additional care for her dementia.” 
 
That visit was also available by the video interactive, so that was very beneficial for her and for us.”
 
Telehealth, also known as telemedicine, is a tool health care providers have used for decades to connect to one another and to patients. Technological advances have created more access points for patients to see providers using cameras and live, interactive video.
 
“Anything that you can think of doing in person, we can do from telehealth,” said Michael Adcock, director of the Center for Telehealth, University of Mississippi Medical Center (UMMC). “Telehealth is the delivery of health care using technology in the simplest forms.” 

In Mississippi, telemedicine has to be both audio and video. When the legislature set up the reimbursement rules and changed the codes in Mississippi to allow for telemedicine, they set it up as a live audio-video interaction.”
 
UMMC, led by Robert Galli, MD and Kristi Henderson, NP, started a telehealth program to support rural emergency rooms in 2003.  It now offers 218 telehealth service locations with 35 medical specialties. Other health systems in Mississippi and telehealth companies are expanding care and access options in the state. For instance, rural clinics may connect to larger health care facilities for specialty care. And for basic urgent care, telehealth is used in corporate health programs and discount pharmacies. Mississippians can independently access a health care provider for basic ailments or mental health counseling services, who may be located anywhere in the country, by using a website or app.
 
“Telehealth is the best thing since bread and butter at BankPlus,” said Dianne Pepper, Human Resources Director, BankPlus which uses UMMC as its telehealth health plan provider.  “It's a way that our employees can get health care right here at work and not have to leave the office. They can go for a quick appointment in about 15 minutes and get back on the job and not miss a beat.

It makes a big difference for the expense on the bank. It's a win-win. It's great for the employee; it's great for the bank.”
 
Several corporations operating in Mississippi, like Nissan and Ingalls Shipbuilding, have a telehealth employee benefit. These companies contract with telehealth providers like UMMC, MDLIVE, Doctor on Demand, and Teladoc. A telehealth benefit for the state health plan is scheduled for rollout in March 2017. Basic urgent care is also available at telehealth walk-in clinics at some fred’s dollar store pharmacies in Mississippi.

Doctors or nurse practitioners providing healthcare services via telehealth can be physically located anywhere in the United States, but must be licensed to practice in the state of Mississippi. 

In the 2016, a licensure compact law signed by Gov. Phil Bryant allows a streamlined process for medical doctors whose primary practice is not in Mississippi to obtain a license and practice in Mississippi.

You’ll hear a lot of talk about interstate licensure,” said Adcock. “Right now, to provide telehealth in Mississippi, you have to be licensed in Mississippi, which is a good thing.”

Adcock said the new law will allow UMMC and other health systems and telehealth companies in Mississippi to offer its health care services outside of the state, and the compact will allow for more providers to become licensed to see and treat Mississippi residents.

Access, cost savings, and profit potential are why policymakers in telehealth businesses are behind supportive telehealth laws. Critics say some uses of telehealth will fragment patient care, but electronic house calls offer promise. 
 
Leroy Henderson of Mound Bayou was diagnosed with diabetes 21 years ago. 
“I wasn't able to handle it well because I didn't know much about it at the time when I was first diagnosed,” said Henderson. “The seriousness of it didn't seem important to me at the time.”
 
Henderson was one of 200 Delta resident who participated in the 18-month-long Diabetes Telehealth Network study run by UMMC. High-speed Internet connection and an iPad with a monitoring software allowed health care practitioners from UMMC to watch Henderson’s blood glucose levels in real time. 
 
“Video conference is very helpful,” said Henderson. “It seems as if you are sitting right in the office with your care provider.”

Adcock says these electronic house calls helped meet the cost savings and patient care goals of the study.

“In the first 100 patients, first six months, there were zero ER visits, zero hospital admissions for diabetes…that is unheard of,” said Adcock.

“I would tell anyone that has a problem with diabetes to try to get involved with the telehealth network,” said Henderson.  “It's awfully helpful, and it keeps you up on your diabetes. It reminds you every day what you need to do to keep going and to keep your blood glucose level that you could live with.”
 
Patients like Henderson and Pugh have health care access that as of a couple of years ago didn't exist in their rural areas. Experts say telehealth is positioned to grow, and like other industries accessed online, health care online will become commonplace.