The Clinton Herald, Clinton, Iowa

March 12, 2014

Iowa Code vague on Telemedicine

Health professionals attempt to spell out important language in growing field

By Brenden West Assistant Editor
The Clinton Herald

---- — CLINTON — A doctor patrols the halls at Clinton’s Mercy Medical Center, talking to stroke patients, monitoring their vitals. A nurse helps gather information for prognoses. The doctor processes the data and refers treatment.

Half an hour later, the same doctor might see a patient in Marshalltown. Or perhaps in Council Bluffs, on the other side of the state.

Yet he never leaves his Iowa City office. In his clutch is a joystick, not a clipboard.

Administrators at Mercy’s Clinton branch uphold their stroke robot as a gem for forward-thinking treatment. Its makeup isn’t flesh and blood but wires, circuits and a powerful processor using fiber optics to allow instantaneous flow of patient records. Behind the bot are the brains of the best stroke doctors the state has to offer.

Physicians at University of Iowa Hospitals and Clinics control this device — known locally as “the doctor with hands in its pockets” — from miles away. And they “see” patients thanks to cameras on the robot.

“Once you’re done with one site, you’re pulling up another one,” said Rod Tokheim, Mercy-Clinton’s VP of Business Development. “You’re moving from Carroll to Fort Dodge to someplace else, very fast. It’s just like making a phone call.”

Technology like this falls under the telemedicine umbrella and it exists throughout hundreds of Iowa hospitals. The Clinton branch can put people in touch with renowned psychiatrists and neurologists. In Mason City, patients can receive the best nephrology (kidney) treatment from practitioners in Des Moines.

Telemedicine is viewed as a way to combat a wave of health care demand expected after passage of the Affordable Care Act. Technology has advanced in ways that connect some doctors to patients from home.

“In a perfect world, where we have specialists everywhere, we don’t need things like tele-nephrology,” said Dave Hickman, regional director of the Mercy Health Network in Des Moines. “But unfortunately there’s a shortage of a lot of specialists.”

In a rural state like Iowa, treatment could span hundreds of miles for specialists. Telemedicine is one way hospitals bridge those miles and bring doctors to more patients.

Like anything health related, there’s a cost. Tokheim said typical hospital insurance reimbursements in psychiatry, for example, run about $250,000 annually.

“The current (telemedicine) reimbursements don’t come close to covering the actual cost,” he said.

And when it comes to those all-important reimbursements, Tokheim said Iowa Code is pretty vague.

That’s why he has joined other professionals throughout the state to urge legislators to become more aware of the telemedicine field. They have, in part, with state Reps. Deborah Berry and Pat Murphy introducing House File 2160. It’s the first bill to define telemedical licensure, insurance coverage and reimbursement under Iowa’s medical assistance program.

“We don’t really have anything that states what professional licensure should be for telemedicine in Iowa,” said Fred Eastman, Midwest Telemedicine Consortium representative. “This bill is to spell out what the parameters are for using telemedicine.

“The bill was written fairly broadly to look at a number of areas that would support telemedicine use in the state and would recommend how insurance companies should handle reimbursement.”

Health officials aren’t optimistic for legislation anytime soon. The bill is still too far up the funnel to make it onto this year’s floor. Tokheim cited a shorter-than-usual session in Des Moines and legislators leery to touch anything resembling major reform in an election year.

Getting a bill penned was the first step toward fleshing out policy by next year.

“We feel the time has come that providers and the state need to come together and start defining some things so we can at least facilitate the implementation of telemedicine faster than it’s been in the past,” Tokheim said.

He was among a group of Clinton County dignitaries to attend the Capitol last month, where he addressed telemedicine needs with top leaders in the Legislature. Health officials contend that as more people become aware of the issues it will bring about more support for definitions at the state level.

The telemedicine umbrella is growing, Eastman said, with multiple studies — pharmaceutical, radiology, cardiology — finding new ways to enhance patient care. By addressing Iowa Code now, he hopes the health community is heading up the issue rather than letting it grow.

“When I think of telemedicine, I think of providing better patient care,” Eastman said. “Right now, it’s a consciousness-building thing.”