Wednesday, July 13, 2011

Caring for Safety Net Patients

The California Statewide “Specialty Care Safety Net Initiative” (SCSNI), a Center for Connected Health Policy (CCHP) sponsored telehealth demonstration project, connects 40 safety net clinics in medically underserved communities across California with medical specialists located at five University of California Schools of Medicine. SCSNI serves as a laboratory to find ways to establish permanent relationships between UC medical schools and California’s safety net providers.

The SCSNI currently uses existing telehealth networks and will eventually use the California Telehealth Network funded by the FCC, the California Emerging Technology Fund, and United-Health/PacificCare. The plan is to connect to more than 850 California healthcare organization and then to a statewide and nationwide broadband network


• Purchases medical specialty clinic time from the UC Schools of Medicine in dermatology, psychiatry, orthopedics, endocrinology, and neurology using telehealth technologies

• Reserves specialty telemedicine clinics for patients of SCSNI partners regardless of insurance status

• Provides education services to SCSNI clinic providers through UC physician-assisted patient consults and continuing medical education presentations

• Provides limited financial support for SCSNI clinic and UC Medical School partners

• Contracts with a telehealth technology consultant to provide support for each participating clinic.

One of the community clinics “Share Our Selves” (SOS) in Costa Mesa, California is testing e-consults in a program funded by “Access OC” a nonprofit program that addresses specialty care for the county’s uninsured population. E-consults can fill the bill for the type of referrals that don’t require real-time patient-to-doctor contact, such as neurology, dermatology, and cardiology. Currently 12 specialists participate in the program, assessing cases and returning their recommendations to the SOS doctors within 48 hours.

SOS Medical Director. Dr. Patrick Chen recently did a neurology e-consult for a 38 year old pregnant patient with a history of seizures. She was taking two anti-seizure medications, and Chen wanted to be sure they wouldn’t adversely affect the pregnancy. He documented her case, then sent it via e-consult to a neurologist and learned that both medications were safe to use during pregnancy.

Although teleconferencing systems are providing great results, but they still are expensive to use according to Hector Para who coordinated UCI’s participation in the SCSNI and helped develop the “Telepresence Interactive Operating System” (TELIOS) that is being used at the SOS clinic. TELIOS is completely software-based, free, and offers a very low barrier to entry but with a web browser and a webcam you can get some of the same features.

The University of California San Francisco is working with La Clinica a federally-qualified health center participating in the CCHP demonstration. Twenty six offices in Alameda Contra, Costa, and Solano counties are using store & forward technologies to make initial assessments on dermatology cases with the information going to UCSF.

UCSF dermatologists study the cases and then refer the cases back to La Clinca’s primary care providers with a diagnosis and treatment plans. They also treat complex cases in person via monthly specialty clinics at a La Clinica office in Oakland.

La Clinica can bill for the in-person dermatology consults that UCSF dermatologists provide at its clinics, however, La Clinica is not yet billing for the UCSF teledermatology triage consults. While Medi-Cal covers standard store & forward teledermatology consults, La Clinica is still working with Medi-Cal officials to clarify whether La Clinica can bill for these teledermatology triage consults.

“We didn’t think of this program as a moneymaker, we just want to break even,” says Nermeen Iskander, Projects Planner at La Clinica. “There are multiple benefits to patients and providers that go beyond cost. We are removing a burden on the safety net healthcare system overall, and we are creating a system where the patients who really need dermatology care can get that care.”

Iskander says the ability to bill for the UCSF telederamatology triage consults is key to getting close to the break-even point. She is hopeful that La Clinica and Medi-Cal can agree on terms for reimbursement.