Telehealth and Tele-Hurdles in a Rural Health Clinic:A School Board Collaborative Partnership

2018 Louisiana Rural Health Association ConferenceBaton Rouge

Randy McKinney, RHC Administrator Bienville Family Clinic

1175 Pine StreetArcadia, LA 71001(318) 263-7970 (o)

Admin@BienvilleFamilyClinic.Com

Tara Haskins, DNP, RNAssociate Professor of Nursing

thaskins@latech.edu(318) 257-3033

About Bienville Family Clinic

Rural North Louisiana Along I-20 about half-way between Jackson, Mississippi and

Dallas, Texas in the center of North Louisiana Rural Health Clinic Public Entity

Governed by Hospital Service District Board

How did this all get started?

Board had some surplus funds available. Board desired to accomplish something significant

with funds related to community health. The concept of School-Based Health Center

Development was brought to the table.

We wanted a sustainable model

We knew that putting a provider in all six Bienville Parish Schools was the very best thing to do, but we also knew that this was NOT sustainable.

TELEHEALTH DELIVERY

The concept of TELEHEALTH DELIVERY was brought to the forefront in discussions.

We Developed a Model.

CLINIC

GIBSLAND CAMPUS

RN

ARCADIA CAMPUS

RN

RINGGOLD CAMPUS

RN

CASTOR CAMPUS

RN

SALINE CAMPUS

RN

BIENVILLE CAMPUS

RN

RNs in Schools

Six school campuses in Bienville Parish. School Board employed three RNs that rotated

from school-to-school. The most appropriate foundation for TELEHEALTH

DELIVERY required an RN to support our providers at each school campus.

. . . What We Did

The Hospital Service District (through the clinic) provided:

• funding for three ADDITIONAL RNs• telehealth equipment (clinic and all six school campuses)

• cloud infrastructure• durable and nondurable health supplies

. . . Telehealth Competency

We knew that our staff should be “TELEHEALTH COMPETENT.” (And the LA State Board of Nursing requires it)

All clinical staff have completed an online course of study “Certified Telemedicine Clinical Presenter”

National School of Applied TelehealthContact: Rena Brewer, RN, MA

Rena.Brewer@gatelehealth.org888-738-7210

Service Delivery Elements

Child must be registered by parent or guardian (Consent) Child presents with problem RN triages child to see if medical visit could benefit the child If RN determines that child can benefit from visit with provider, RN places the visit on the

Bienville Family Clinic Schedule in the BFC eClinicalWorks system. After RN enters vitals and other information, RN “flags” the child as “ready for provider,” just as we do in our office for an in-person visit.

RN attempts to contact parent/guardian Parents can be present during the visit:

At the School At the Clinic or Via Speakerphone at School

Bienville Family Clinic phone system is extended to all parish schools.

Service Delivery Elements

Live Audio/Video connection is made between school and clinic. RN Acts as Presenter

Using appropriate equipment to assist Provider with Exam Specialized camera with lenses

General Viewing Lens For large areas of the body Mouth, tongue and throat areas

Specialized Derm Lens Close views of skin, lesions, etc

Otoscope Electronic Stethescope

Transmits heart and lung sounds

Service Delivery Elements

RN then assists Provider with carrying out treatment plan. Provider sends electronic prescription to pharmacy of choice, if

warranted. Visit summary to Primary Care Provider is sent (if our clinic is

not PCP) for continuity of care. This is a very important Program Element!

Louisiana RHC Medicaid Guidelines state this about billing Medical/Behavioral Encounters:

If a covered service is provided via an interactive audio and video telecommunications system (telemedicine), it must be identified on the claims form by appending the Health Insurance Portability and Accountability Act (HIPAA) 1996 complaint modifier “GT” to the appropriate procedure code.

Getting Paid???

We worked with a Practice Management Consultant in the Bureau of Primary Care and Rural Health of the Department of Health and Hospitals to make an inquiry to the Director of the Louisiana Medicaid Program about RHCs getting paid for Telehealth Services.

PRIOR TO PURCHASING TELEHEALTH EQUIPMENT

We included all important elements in the information that we sent to Medicaid Contractors:

Standards from Louisiana Medicaid Provider Manual Medically Necessary Encounter NP Provider in RHC RN at School as Presenter and to Support Provider Actual Live Audio/Video Connection with Specialized Exam

Equipment Visit Summary Transmitted to Primary Care Provider following

Visit for Continuity of Care

We went to the Medicaid Contractors.

All five (5) Medicaid contractor’s stated that they would pay for the encounters, as RHC Encounters.

Some sent this statement to us, in writing.

What the Medicaid Contractors Told Us

A Nurse-Practitioner/Physician Collaborative Practice Agreement was designed around our program of Telehealth Delivery.

Telehealth Equipment to be used was included in proposed agreement.

That agreement has been approved by the Louisiana State Board of Nursing and is currently in place.

Collaborative Practice Agreement

Student Population Chronic Illnesses 2016-2017

Enhancement of the school health program

Years 2015/16 2016/17 Change

School nurse encounters

9,662 13,934 Increase of 4,272 (30.65%)

Getting consents……. % of school population

School 2016/17 2017/18 Change

Arcadia 62% 70% +8%

Bienville 81% 90% +9%

Castor 36% 65% +29%

Gibsland 65% 76% +12%

Ringgold 69.5% 78% +8.5%

Saline 72% 90% +18%

Telehealth visits

2016/17Academic Year # of Telehealth visits

2016/17 627

2017/18 662 (April 30th)

Telehealth Visits by Month 2016/17

0 20 40 60 80 100 120

May

April

March

February

January

December

November

October

September

August

Faculty/Staff

Student

Parent Satisfaction Survey results 2016/17

School # of respondents Are you aware of telehealth services ? Yes

If your child used telehealth, were you satisfied?

Arcadia 35 80% 100%

Bienville 17 76.5% 100%

Castor 84 84.% 100%

Gibsland 17 66.6% 100%

Ringgold 105 86% 100%

Saline 61 89% 100%

Benefits to Teachers/staff

• Telehealth is helping them maintain their monthly incentive bonus for having no absences.

•Prescriptions are picked up on their way home.

•Allows them to better manage their time for work and their family.

CONTACT INFORMATION

Randy McKinney, RHC Administrator Bienville Family Clinic

(318) 263-7970Admin@BienvilleFamilyClinic.Com

Tara Haskins, DNP, RNAssociate Professor of Nursing

(318) 257-3033thaskins@latech.edu

Questions/Comments??