Testimony by KU health, technology outreach director at rural health hearing

HAYS -- David Cook, director of the Health and Technology Outreach Department at the University of Kansas Medical Center, presented the following testimony at a congressional hearing in Hays on rural health care. Barbara Atkinson, executive dean and vice chancellor for clinical affairs for the KU School of Medicine, also testified.

U.S. Rep. Jerry Moran, R-Kan., and U.S. Rep. Earl Pomeroy, D-N.D., hosted the hearing this morning at the Hays Medical Center. Moran and Pomeroy are co-chairs of the Rural Health Care Coalition. Thomas Scully, administrator of the federal Centers for Medicare and Medicaid, attended the hearing after touring the Rush County Memorial Hospital in LaCrosse.

Also attending the tour and hearing were Jack Fincham, dean of the KU School of Pharmacy; Jon Jackson, senior vice president forÊsystems integration atÊKU Med; and Janet Murguia, KU executive vice chancellor for university relations.

The KU School of Medicine is the primary supplier of physicians and continuing education for physicians for the state of Kansas.

Testimony presented to
Centers for Medicare and Medicaid Services Administrator Tom Scully, Congressman Jerry Moran (R-KS), Congressman Earl Pomeroy (D-ND)
By David Cook, Director of the Health and Technology Outreach Department, The University of Kansas Medical Center
Rural Health Care Forum
Tuesday, May 27, 2003
Hays Medical Center

It is a great honor and privilege to speak with you all today. I would like to thank Congressman Jerry Moran, Congressman Earl Pomeroy, Administrator Thomas Skulley of the Center for Medicare and Medicaid Services, Executive Vice Chancellor Don Hagen of the Kansas University Medical Center (KUMC), the Hays Medical Center and all those individuals involved in giving me the opportunity to provide testimony today. It is my great pleasure to provide an overview of KUMC's outreach efforts, in addition to those provided by Dean Atkinson earlier, including highlights of the Center for Telemedicine & Telehealth's efforts to impact the health care of rural Kansans.

Overview of KUMC Outreach Efforts

In December 2002, KUMC established the Health and Technology Outreach (HTO) department, formally aligning several of the long-standing outreach entities of the institution. The establishment of this outreach arm highlights KUMC's commitment to serve the health care needs of Kansans across the state. The entities include the Center for Telemedicine & Telehealth and the Continuing Education office both housed in Kansas City, the Rural Health Services department located on the School of Medicine campus in Wichita, and the three Area Health Education Center's based in Garden City, Hays and Pittsburg. Collectively, these departments provide services that span the entire state, with activities that reach, literally, into each of Kansas' 105 counties.

Health and Technology Outreach's mission is to þimprove the health of Kansans through communication, collaboration, and statewide partnerships.ú Evidence of the department's influence is highlighted in a variety of health related services provided.

 • KUMC is the largest provider of Continuing Education for physicians, nurses and allied health providers in Kansas, with over 12,000 registrations in FY 2002.
 • KUMC is the only nationally accredited provider of Continuing Nursing Education in Kansas. Advance practice nurses must have 50% of their hours from nationally accredited providers.
 • In FY 2002, KUMC faculty and residents provided 390 days of locum tenens coverage for 46 counties.
 • Since the establishment of the Kansas Bridging Plan in 1991, a program that provides incentives for medical residents to practice in rural communities, 163 residents have enrolled, and 82% have remained in Kansas.
 • In FY 2002, 3,219 telemedicine consults with over 40 communities linked KUMC specialists to rural and medically underserved communities.
 • Since 1998, over $3 million in extramural telemedicine funding has been received to provide specialty clinical services to rural and medically underserved communities.

The above initiatives are a mere snapshot of the various services provided. As HTO begins to take shape, several objectives are guiding the array of services aimed at:

1. Improving access to health services for underserved communities;
2. Enhancing public health and emergency preparedness capacity across the state;
3. Enhancing community education on pressing health topics statewide; and
4. Improving workforce development capabilities of rural health providers in Kansas.

Notably, each of the objectives are uniquely grounded in addressing the challenges facing the rural health care provider and enhancing the delivery of services to the underserved. To achieve these goals, efforts to examine the costs of doing business as a state agency to find ways to be more efficient and effective are paramount. Consideration of new innovations and specifically, the potential role of technology in delivering services are equally central to these strategic outreach efforts. As a result, the role of telemedicine and distance learning will continue to expand its reach across the state.

Telemedicine in Kansas

The future of telemedicine in Kansas' is predicated on a formidable history of activity over the past decade. Telemedicine began in the early nineties when a KUMC pediatric cardiologist in Kansas City utilized telemedicine to connect with a patient 300 miles away in Hays to initiate the first tele-consult in the state. By 1995, approximately 500 consults had occurred. Today, over 10,000 clinical consults have occurred connecting KUMC providers with citizens in rural and medically underserved areas around the state. Clearly this number can be magnified considerably when adding telemedicine connections between communities such as Hays and St. Francis or Garden City and Great Bend, or Cedar Vale and Wichita. In the past year, KUMC services ranged from providing acute pediatric care for children in elementary schools to routine clinical care for oncology patients in hospitals to palliative care for elderly patients in home-based hospice care. The diversity of services highlights the even greater potential of telemedicine to serve various populations in years to come.

In Kansas over 40 communities have telemedicine technical capabilities and this number continues to grow. In fact, with systems becoming easier to use and the associated costs continuing to decrease, it is becoming more and more difficult to compile system utilization data. The promise of continued growth is further assured by the Kansas Board of Regent's Kan-Ed initiative which is developing a statewide communication network and information highway for schools, libraries and hospitals. Funding for the initiative includes $25,000,000 over four years for KAN-ED operating expenses from the Kansas Universal Service Fund. With a Kan-Ed architecture in place, interoperability challenges and cost concerns for telemedicine may more easily be overcome. But even more importantly, a user community across constituencies is likely to collaborate in new and innovative ways to solve interdisciplinary challenges including those relating to health care. To this end, policies that further expand Medicare reimbursement for telemedicine to a broader constituency of telemedicine providers and which also expand originating site criteria to a broader range of facilities and locations have the potential to significantly benefit such efforts. These include the addition of interdisciplinary providers such as Occupational Therapists, Speech and Language Pathologists and Physical Therapists to those able to provide telemedicine services; and the inclusion of locations such as mental health facilities, schools and long-term care facilities to the list of qualified originating sites for telemedicine reimbursement.

Federally Funded Telemedicine Projects

Since 1998, the Center for Telemedicine & Telehealth has received federal grant support for projects aimed at providing telemedicine services in rural and medically underserved areas of Kansas. Federal agencies providing funding have included the Department of Commerce, the Department of Health and Human Services, the Health Resources and Services Administration, and the National Institute of Health. Programs range from $954,000 of DHHS support for direct clinical services in eight rural communities to $424,785 of support, including matching dollars from the DOC, to augment homebound palliative care for hospice patients in urban and rural areas.

These various funding opportunities have provided an immediate benefit to rural Kansans, and in many cases, have provided a springboard for ongoing support and resources to make a lasting impression on the communities served. For example, a school-based telemedicine project receiving $424,925 in two-year funding, including matching dollars, from the Department of Commerce in 1998 has led to well over $1 million dollars of support from various funding sources. One of the contributors, the Ewing Marion Kauffman Foundation, provided $218,740 of support that was instrumental in the development of a Kansas Medicaid policy for telemedicine reimbursement. A second contributor is the Kansas Children's Initiative Fund that provides $250,000 in annual funding, beginning in FY2001, to replicate the program across the state. Other supporters include the Prime Health Foundation, the SBC Foundation and the Wyandotte Health Foundation.

Conclusion

As in the case with the school-based telemedicine project, federal grant support has made a significant impact through funding direct clinical services to rural and medically underserved Kansans. This funding has provided a foundation for even broader resources to be made available to these communities, and in the case with the reimbursement, has made a significant impact on policy guiding health delivery in the state. For these reasons, and more, we are grateful for federal funding opportunities directed at telemedicine and rural health care because we have seen first hand how they make a difference in our community. Congressman Moran's unwavering support for these efforts is appreciated by those of us on the front line, working to make a difference in the delivery of health services in the state of Kansas.

Again, I would like to thank Congressman Jerry Moran and Congressman Pomeroy, Administrator Thomas Skulley of the Center for Medicare and Medicaid Services, Executive Vice Chancellor Don Hagen of the Kansas University Medical Center (KUMC), the Hays Medical Center and all those individuals involved in giving me the opportunity to present today. It is indeed an honor and a privilege to be given an opportunity to overview KUMC's outreach and telemedicine activities with all of you.

Thank you,

David J. Cook, PhD
Director
Health & Technology Outreach
Kansas University Medical Centr