Developing a Sustainable Program for Tele-Echocardiograms in Rural Pediatrics by SupremeLord

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									Developing a Sustainable Program
   for Tele-Echocardiograms
       in Rural Pediatrics



   Thomas K. Chin, MD and Richard Kuebler, BBA
       University of Tennessee College of Medicine
        and LeBonheur Children’s Medical Center
                   Goals:


 Demonstrate that a Telehealth Program is
  beneficial for providing Pediatric
  Cardiology services in rural Tennessee
 Show that the Telehealth Program is
  sustainable, and potentially profitable for
  regional sites and the tertiary care center
Why is Telemedicine particularly effective
 for treating Congenital Heart Disease?
 Background:
  For every 1000 infants born in the United States,
   between 5-8 have heart defects.
  Over 85% of these infants are expected to reach
   adulthood if they receive appropriate medical
   attention.
  It has only been possible in the past 60 years to
   treat congenital heart disease in infants and
   children (surgery and interventional cath).
  To achieve current standards for outcomes, it is
   necessary to obtain treatment at a specialized
   medical center with the expertise, facilities and
   equipment to provide care (tertiary care center).
Why is Telemedicine particularly effective
for treating Congenital Heart Disease?


  Manpower/Resources:
   There are 1,521 (total) board certified pediatric
    cardiologists
   There are 244 practicing pediatric cardiovascular
    surgeons in the United States
   110 pediatric cardiology fellows complete training
    each year.
  (2006 AHA census)
Uncomplicated
Heart Defect
Interventional Heart Catherization:


                     Interventional procedures:
                          balloon septostomy and
                           valvuloplasty (PS, AS,
                           Coarctation)
                          coil embolization (PDA,
                           collaterals)
                          Stents
                          ASD& VSD closure
“Stage I”
Norwood
Procedure
Arrhythmias:
Ventricular Tachycardia
Arrhythmia Treatment Using
     Catheter Ablation


                Mapping
                Ablations
                     Cardiac Institute




                                                  A C U I T Y
              Research Center

 High Risk       Ventricular
 Surgeries/        Assist        Transplants
   ECMO           Devices
             Cardiac             Medium Risk
CVICU




                                                  P A T I E N T
            Anesthesia         Surgery & Hybrid
                                  Procedures
Interventional             Electrophysiologist
 Cardiologist
              Low risk surgery
         Diagnostic Catheterization
         Echocardiography expert
              Fetal Echos
        Non-Invasive Diagnostics
     EKG, ECHO, MRI, Stress Testing
           Clinical Cardiologists
           Telehealth Program
     at the University of Tennessee

 The University of Tennessee Telehealth Program
  was initially developed and maintained using
  Federal and State grants.
 The program is associated with the University of
  Tennessee Health Science Center (Colleges of
  Medicine, Pharmacy and Nursing)
 Located in Memphis, TN (population of 1.3
  million)
 Serves a 3 state region: West Tennessee, Eastern
  Arkansas and Northern Mississippi
  The University of Tennessee
  College of Medicine
Affiliated Hospitals:
     Methodist University
       Hospital
     The MED and MEDPLEX
       (Shelby County Hospital
       system, trauma center)
     Veteran’s Administration
       Hospital
     LeBonheur Children’s
       Medical Center
     St. Jude Children’s
       Research Hospital
LeBonheur Children’s Medical Center
Clinic & Tele-Echo Sites




                           = clinic +
                           tele-echo

                           = tele-echo


                           = clinic
Benefits of Telemedicine
in Pediatric Cardiology

 Allows the detection of patients with
  congenital heart disease (particularly important in
  the neonatal period)
 Allows access for regional hospitals and their
  patients the expertise of a major medical
  center (services would otherwise be unavailable to
  these patients).
Benefits of Telemedicine
in Pediatric Cardiology

 Allows efficient use of valuable resources:
    Decreased need for hospital to hospital
     transports (some patients can stay locally)
    Minimizes duplication of services
    Subspecialty physicians can simultaneously
     serve patients in metropolitan area and
     underserved regions
Echocardiograms:
Memphis Metropolitan Area


4000     3718
                                  Le Bonheur
3500
3000
2500                              St. Jude
2000
1500         2000
                                  UTMG
1000                              Germantown

500
                   549 517        The Med
   0
              7/1/07 to 6/30/08
Echocardiograms performed in rural sites
using telehealth
1000
       904
 900
                                   Jackson TN
 800
 700                               Tupelo MS
 600                               Savannah
 500         450                   TN
 400                               Martin TN
 300                               Corinth MS
 200
                   90              Crittenden
 100                    45 38 23
   0
         7/1/07 to 6/30/08
Sustainability of Telemedicine
in Pediatric Cardiology
 Expenses for set-up and maintenance:
     Set-up fee: $15,000. per site (work-station,
      software, line installation).
     Line fee: $9,500. per site/year--can be shared
     Referring institutions can bill for the technical
      component of charges and additional
      telemedicine charge
     Service institution can bill for professional
      component of charges
Sustainability of Telemedicine
in Pediatric Cardiology

Charges and Collections for Telehealth Echos:
     750 studies/yr.
     Charges/yr. referring institutions $2,250,000.
        (collections=$900,000.)
     Charges/yr. serving institution    $ 750,000.
        (collections=$300,000.)
Conclusions:
Benefits:
 Allows the detection of patients from rural
  sites with congenital heart disease
 Allows access for rural hospitals and their
  patients to the expertise of a tertiary care
  center
 Allows efficient use of valuable resources
  (fewer transports, less duplication of services,
  efficient use of subspecialty physicians)
Conclusions:

Sustainability and Profit:
 Direct revenue from rural tele-echocardiograms at a
  moderate size tertiary care center
      is extremely beneficial for rural sites
      is adequate within a single year to offset set-up costs
       for 6 rural sites, costs for line maintenance for all sites,
       as well as to generate a profit!
 Additional Indirect revenue from surgical and
  interventional cath referrals is likely to be significant.
Thank You
(opening in Fall 2010)

								
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