A first of its kind rural medicine program at Marshall University has received initial accreditation.
A first of its kind rural medicine program at Marshall University has received initial accreditation.
The new joint rural surgery residency program at the Marshall University Joan C. Edwards School of Medicine and Logan Regional Medical Center earned initial accreditation from the Accreditation Council for Graduate Medical Education.
The new residency pioneers a training model designed to address specific benchmarks unique to surgeons practicing in a rural setting. It was developed in part with a $750,000 grant from the U.S. Department of Health and Human Services.
The Marshall Community Health Consortium partnered with Logan Regional Medical Center to develop curriculum, recruit faculty and address the clinical and learning environment needs required to obtain accreditation.
As a rural program, residents have to spend at least 50 percent of their five-year program in Logan.
The Association of American Medical Colleges expects a shortage of between 23,100 and 31,600 general surgeons by 2025.
The rural surgery residency program will officially launch and welcome its first residents in July 2023.
Medical experts have spent years promoting telehealth as an option for rural areas with little access to in-person care.
Now, after West Virginia Gov. Jim Justice issued a “stay home” order that took effect on Tuesday, March 24, some medical providers are offering telehealth as a way to keep more people healthy at home during the coronavirus.
Dr. Jennifer Mallow at WVU Medicine describes telehealth as “the use of communication and information technology to share information.”
“We can provide clinical care,” Mallow said. “We can provide education, we can provide public health, we can provide administrative services at a distance.”
Telehealth spans several methods and types of technology, most prominently phone and video conferencing.
Mallow and Dr. Steve Davis, a WVU associate professor, are working on a pilot to provide telehealth options to patients with traumatic brain injuries, disabilities and the elderly.
Davis said he foresees elements of the project helping those who are particularly vulnerable to the coronavirus.
“The patient can [stay] at home, because we don’t want them to come in and be exposed, or expose other people, to COVID-19,” Davis said.
Virtual Urgent Care Visits, Free Of Charge
WVU Medicine is offering video urgent care appointments at no cost, for anyone more than five years old who is experiencing symptoms potentially related to the coronavirus. The WVU-owned Ruby Memorial Hospital in Morgantown also has been operating a 24-hour phone line, at 304-598-6000, option 4, since mid-March.
On Thursday, March 26, WVU reported going from six to 538 video visits in the course of three weeks. Their phone appointments experienced a similar spike, from 20 to 671 in the same length of time.
In Kanawha County, the Charleston Area Medical Center is opening up its 24/7 Care app for urgent video appointments to the public.
“As a nation, as a world actually, you’re trying to flatten the curve and get ahead of this virus,” said Rebecca Harless with CAMC’s ambulatory services.
Normally, Harless said an urgent care visit at CAMC would cost $49 out of pocket. Right now, anyone who may be displaying coronavirus symptoms can use a “COVID” coupon to get a free appointment.
“They’re able to speak to a provider, one of our employee providers, and understand where they fall, where their symptoms fall in that algorithm of, you know, ‘Am I okay to stay home?’” Harless said. “A lot of people are really scared out there right now.
Rather than everyone flood the hospitals and clinics at once, West Virginia Commissioner for Public Health Dr. Cathy Slemp recommends people stay at home if they are experiencing symptoms at a non-life-threatening level.
“If you are waiting for test results, or you are thinking you might have this, or you know you have it, you want to treat it as if you do,” Slemp said at the governor’s March 24 press briefing. “So what you do is, first, you want to stay home. If you need to go to the grocery story, someone else goes for you. At the pharmacy, you don’t want to be around other folks.”
Efforts To Loosen Federal Restrictions On Reimbursement
Slemp told the press on Wednesday she and the West Virginia Department of Health and Human Resources are working on educating providers throughout the state about telehealth, and what options providers have for implementation.
Traditionally, getting paid for telehealth has been a challenge. Regulations from the federal Department of Health and Human Services, which regulates Medicare for people 65 years old and up, only reimburse telehealth services when there’s an available video option.
This makes it difficult for most providers to offer phone-only services, which could aid elderly patients living in rural areas without reliable broadband access.
The West Virginia Bureau for Medical Services, which oversees Medicaid for low-income people and families, normally enforces the same requirement for telehealth.
According to Commissioner Cindy Beane, the state already allows Medicaid to reimburse phone and audio-only appointments, to keep more people at home.
“Truly, we’re in an emergency. We’re waiving all your normal things that you have to worry about, as providers,” Beane said. “Especially when we know that the person’s sick, we don’t want them going to the ER. We want you to call, and route them the appropriate way.”
The coronavirus response bill that passed the Senate on Thursday, March 26, gives federal officials the authority to waive the video-only requirement.
The U.S. Center for Medicare and Medicaid Services already announced on March 17 it temporarily waiving certain HIPAA requirements, such as restrictions that forbidding patients and providers from using “everyday communications technologies” such as Skype and Facetime, and other restrictions barring certain patients from taking their calls in-home, versus an approved facility.
The Struggle With Broadband
“Broadband, I mean, is an issue, pandemic or no pandemic for us,” said Williamson Health and Wellness chronic care director Amy Reed.
The Williamson Health and Wellness Center in Mingo County is a federally qualified health center that offers patients a range of services including behavioral, dental and pediatric. It recently began offering and promoting video and phone appointments to its patients who are technologically able, as Medicare and Medicaid allow.
Reed said she and others at Williamson Health have noticed the development making a difference for some.
“We know that our population, the patients that we serve, are more vulnerable, they’re more at risk,” she said.
The U.S. Census estimated in 2018 almost 19 percent of the Mingo County population was over 65 years old. That same year, the U.S. Census estimated almost 20 percent of the entire state was over 65.
The Centers for Disease Control and Prevention reports people older than 65, and those with pre-existing health conditions like HIV and asthma, are at a higher risk for catching the coronavirus than others.
“So, it’s made a huge difference in being able to provide them what they need, and not send them to the hospital, not send them to the emergency rooms,” Reed said. “We’re actually able to look at them and have those conversations.”
Reed says she wishes telemedicine was something she could offer to every patient year-round, due to the age, health needs and lack of transportation of the population they serve. But she’s worried the waivers won’t remain in place after the pandemic ends, and that these services won’t be allowed to continue.
Reed also said the health center would have more requirements to meet, as a federally qualified health center offering several types of practice, than other primary care providers in the state.
“There’s a huge risk just because, you know, you get your patients dependent on that, they see that it’s there. ‘Oh, you’re doing it now, why can’t you do it later?’” Reed said.
Davis at WVU said he hopes once the pandemic subsides, some of the changes in federal regulations will remain in place.
“As we look at sustainability,” Davis said, “one of my hopes is that, one of the good things about the COVID-19 is that we’ll come out of it and will realize, ‘ah, we can use telehealth for all of these things, and we ought to be paying for it.’”
Marshall Health through Marshall University is partnering with the Mountain Health Network in Cabell County to develop telehealth options for residents there.
Mon Health in and around Monongalia County is collaborating on services with CAMC. As of Friday, March 27, Mon Health announced that entails virtual video visits for primary care, psychiatry, behavioral health and urology with plans to expand into neurology, obstetrics and cardiology appointments.
This service requires reliable internet access and is for patients with minor medical conditions. Mon Health said Friday they are waiving associated patient fees for this service.
If policymakers use market-based approaches to solve healthcare access problems, they need a better understanding of how rural markets work, says one researcher.
A lack of competition among health insurers in rural areas has reduced the ability of market-based approaches to increase insurance enrollment, a new study says.
The Affordable Care Act of 2010 sought to improve the health-insurance access in part through fostering more competition among insurers. But rural markets have less competition than metropolitan ones, so the impact of market-focused strategies is diminished, according to a study by the Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis.
The study looked at insurer participation data across three market-based health insurance programs — the Federal Employees Health Benefits Program (FEHBP), Medicare Advantage (MA) and Health Insurance Marketplaces (HIMs – which were created under the Affordable Care Act). Researchers aimed to see whether the competition within an insurance market affected an individual’s decision to purchase health insurance.
That information is key in determining whether market-based health-insurance helps increase enrollment rates in rural areas where population is less dense.
The study found that, in areas that had been dominated by a smaller number of insurers in the past, the Affordable Care Act’s health-insurance marketplaces for individual policies had lower enrollment.
“This finding suggests that an underlying level of competition, based upon historic and/or institutional factors, plays a role in [the Affordable Care Act health-insurance marketplace’s] success or lack thereof in rural places,” the study said.
The study also indicates that a lack of population density doesn’t lower health-insurance enrollment. Rather, the region’s previous lack of competition predicted the lower enrollment rates.
The study used data from the three health insurance programs, as well as the “Herfindahl Index,” which measures market concentration.
Data showed that insurer participation began to decrease in 2017, across the country, but most especially in rural counties and in states that did not expand Medicaid.
Focusing on counties with population densities below 100 people per square mile, the study found that counties that continued to attract insurers tended to have lower prior-year Herfindahl indexes, meaning the counties previously had market competition.
“Over the first four years of [health-insurance marketplace] operation, 2014-17, there was significant entry and exit of insurers in both urban and rural counties,” the study found. “In 2017, data began to show signs of weakening insurer participation, especially in rural counties and in states that did not implement Medicaid expansion.”
The study concluded that a complex set of factors, not just population density, made rural areas less competitive.
“Years of evidence across three market-based health insurance programs clearly indicate that rural places are less competitive,” the study found. “Our findings suggest that while this is due in part to the limitations of small populations, low population density, and fewer available providers, other factors are also at work.”
Those other factors can include things like “the presence and type of hospital systems, the policy environment at the state level, the entrenchment of certain insurers who were early entrants to the private market, the payer mix and even the specific geography in terms of terrain and infrastructure.”
Abby Barker, with RUPRI, said in an email to the Daily Yonder that the study points to the need for a re-evaluation of how rural areas are different than urban areas.
“I think you could say that population density, and some of those other population-related measures… are expected to be significant. But what we added is this measure of competition that shows that another explanatory factor is how concentrated the market is and has been over time. The methods don’t really identify which is MORE important, but the contribution of this work is to say that prior market concentration matters. In my view, it suggests that policies that rely on competition to achieve certain access/affordability goals, really have to be intentional about overcoming this sort of inertia that tends to exist. Once certain insurance issuers are established in a particular geographic region, it’s a little harder for new ones to come in.”
Policies should address the specific needs of rural areas in the future, she said.
“This brief didn’t really examine the urban county data, but I think implicitly our message is that rural places DO have the potential to be different in terms of how much we can rely upon the market model to work well, at least in certain rural places, at least without recognition that rural places may require something explicit in a market-based policy to mitigate these types of issues,” she said.
This article was originally published by the Daily Yonder.
Kelly Browning doesn’t wait for Lyle Marcum to come to the door. She knocks and then pushes the glass door open, like she’s been there many times before.
Lyle stays where he is, sitting on a brown love seat, the TV on, and he calls for his dog, Lyla. “Get over here!” She’s running, excited, back and forth, her collar jingling until Kelly finds a leash, connects it to Lyla and slides the rope’s handle over a closet door knob.
“New plan for you,” Kelly laughs. She’s wearing scrubs, but her outfit only describes a portion of the tasks she regularly has to do. As a community health worker for Williamson Health & Wellness Center in Mingo County, West Virginia, Kelly is assigned to 29 of the primary care center’s sickest patients. Most of her patients have more than one chronic disease, or comorbidity, and almost all of them have diabetes.
For two years now, Kelly has been working with Lyle, a former truck driver who hauled coal and mine equipment for most of his life. Since he was diagnosed in 1996, Lyle has spent the better part of two decades with uncontrolled diabetes. For a long time, he didn’t take the drugs doctors prescribed, and he didn’t eat the way they told him to, but he didn’t see any immediate consequences. So he carried on the same way he always had, working until he retired in 2007.
But Lyle’s luck ran out. “Eventually, stuff starts falling apart,” Kelly said. Lyle lost sight in his right eye. He’s now considered legally blind. And he had to have the top quarter of his right foot amputated, losing his toes. But with Kelly’s encouragement and consistent accountability, Lyle’s checking his blood sugar regularly and he’s taking his medications at least most of them.
“They’re death on diabetes,” Lyle said of Kelly and her team. She’s hoping he’s right.
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Kelly’s a certified nursing assistant, but if you ask her advisor, Jerome Cline, her most important qualification is that’s she’s called the hills and hollers of Mingo County home her entire life. Kelly has known many of her patients for years. She knows how hard it’s been to find work since the coal industry’s decline in the region, she’s been touched by the opioid epidemic just like too many of her neighbors, and she cares about what happens to her patients.
Diabetes is just one of the many battles her patients face. Type 2 diabetes is considered a public health epidemic throughout the United States, but the disease is especially prevalent throughout lower-income communities in central and southern Appalachia, especially in states like West Virginia, Mississippi and Alabama, which currently lead the nation (1 – 3) in rate of occurrence. One in two West Virginians, for example, have abnormal glucose levels.
The community health worker program, the reason Kelly’s knocking on Lyle’s door every week, is one of the ways that the region is trying to fight back. It’s a new version of a well-known, widely used model that employs community members, without requiring a medical background, to support the health of others. The Department of Family and Community Health at the Joan C. Edwards School of Medicine at Marshall University, located in Huntington, West Virginia, is leading the program’s implementation. The program targets high-risk patients that have diabetes, cardiovascular disease, and/or chronic obstructive pulmonary disease (COPD) in rural areas throughout Appalachia. Rather than relying on regular doctor’s visits to treat diseases like diabetes, which are largely impacted by a patient’s daily decisions, the model moves care upstream into the homes of patients to create opportunities for intervention on a weekly basis.
Community health workers have been working across the world, especially in rural, underserved areas, for decades, said Dr. Richard Crespo, researcher and professor at Marshall’s Department of Family and Community Health. Crespo and his team worked with Duke University to secure grant funding to launch an initial pilot program in 2012 at four health centers, which included Williamson Health & Wellness Center.
Credit Paul Sancya / AP photo
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AP photo
Dr. Christopher “Dino” Beckett, CEO of Williamson Health and Wellness Center, left, walks with Democratic presidential candidate Hillary Clinton during a tour of the facility in Williamson, W.V., in May 2016.
The pilot at Williamson focused on 130 high-risk diabetes patients. Within a six-month period, patients reduced their hemoglobin A1C levels by an average of 2.5 percentage points. Rather than using daily glucose readings to track a patient’s sugar management, A1C monitoring offers a much more accurate snapshot by showing average blood sugar level over the previous two to three months.
“If you were a drug company and you dropped hemoglobin A1C by .6 percent, you’d have a multibillion dollar drug,” Dr. Dino Beckett said in a 2018 interview. He’s a physician of osteopathic medicine and the CEO of Williamson Health & Wellness Center.
Due to Williamson’s initial success, Crespo has continued working to secure grant funding through public and private sources to expand the program across the region. The program currently includes 29 community health workers across 13 primary-care centers that are helping to treat 650 high-risk patients living in 27 counties across West Virginia, eastern Kentucky and southeastern Ohio. And based on early results, the majority of patients have been able to make significant improvements to their health.
Crespo’s hopeful this model can offer an alternative, effective path forward for a region that is becoming increasingly sick.
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When Craig Robinson started working in Appalachia in the ‘60s and ‘70s to help coal miners with black lung receive medical care, diabetes was around, but it didn’t stand out as a serious public health problem, Robinson said. He’s now the executive director of a primary-care provider in West Virginia.
A lot has changed since then.
Today, more than 30 million Americans, 9.4 percent, have diabetes, according to the American Diabetes Association, with nearly 95 percent experiencing type 2 diabetes, with a disproportionate number living in Appalachia. Diabetes is a slow building disease largely influenced by lifestyle choices over a long period of time — diet, exercise, stress management and so on. Genetic variations also combine with diet and exercise habits to contribute to a person’s overall risk.
If there’s too much glucose in the blood due to a high-glycemic diet — eating large quantities of food with high frequency that cause blood sugar levels to rise like carbohydrates and sugar — the body eventually develops insulin resistance, according to the National Institute of Diabetes and Digestive and Kidney Diseases. And when the body becomes resistant to insulin, it then needs more of it to help glucose enter cells and to keep blood glucose levels down.
“The American diet has become very high in sugar, of course sugary drinks contribute to this,” Robinson said. “We have a very high glycemic diet, which means that our diet tends to make our blood sugar rise and that’s what causes diabetes.”
The Center for Disease Control and Prevention tracks diabetes rates per county throughout the U.S. In 2011, the CDC labeled a 644-county area in the southeast as the “Diabetes Belt.”
To qualify within the belt, counties located in the southeast had to have at least an 11 percent or greater prevalence rate, higher than the national average. Comparing the Diabetes Belt with the map of Appalachia — which spans 420 counties in 13 states from southern New York to northern Mississippi — 232 counties are located within the Diabetes Belt, according to a 2014 report released by the CDC. Every Appalachian county in Mississippi qualified. West Virginia, the only state fully located in Appalachia, had 48 of its 55 counties qualify. It currently leads the nation in rate of occurrence with 15 percent of its population considered diabetic and another 35 percent qualifying as prediabetic.
Residents living in rural, distressed counties throughout Appalachia are 1.4 times more likely to have diabetes than residents of non-Appalachian counties, according to a 2010 report published by the CDC. To identify “distressed” counties, the Appalachian Regional Commission, a partnering federal organization, examines poverty rate, the rate of unemployment and per capita market income over a three-year period of time.
In rural settings, there are many factors that create barriers to healthcare, ranging from geographic isolation, lack of transportation, and decreased health literacy, according to to a 2016 report in the West Virginia Medical Journal.
“There’s an association between poor health and low income,” Crespo said. “And for many of the people whose condition is out of control, it’s because of what’s happening in the community.”
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When Kelly Browning receives a new patient, before she can start setting health goals, she has to do two things: first, assess her patient’s needs. And second, earn his or her trust.
Cline, the clinical lead for Williamson’s community health worker program, often comes along for the initial home visit. He’s a nurse practitioner and certified diabetes educator, but said there’s no reason to start spouting off how many carbohydrates a diabetic can have with each meal if he enters a patient’s home and sees only a can of stewed tomatoes in the cupboard.
“The thing we have to do when we find it, is address it,” Cline said of food insecurity issues that patients may be experiencing “Because if we don’t address the food shortages, it’s not going to matter.”
Credit Tyler Evert / AP photo
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This Thursday, Nov. 29, 2018 photo shows Williamson, W.Va., seen across the border from Kentucky.
In Mingo County, where the coal industry once supported a booming economy, a quarter of residents live in poverty, and the life expectancy rate is one of worst in the nation, according to the Institute for Health Metrics and Evaluation.
Because Kelly is a longtime member of the community, she knows the nearby churches and food pantries to call to get her patients connected to more reliable food sources. She also works with a rural bus service to ensure they have transportation to and from their doctor’s appointments. And because she knows that healthier options are often more expensive, rather than asking patients to overhaul their entire diet, Kelly often works with them on portion control to decrease their carbohydrate and sugar intake.
Across the 13 healthcare providers currently active in the program, community health workers have done everything from helping a patient who was sleeping on the floor obtain a bed to organizing the construction of a wheelchair ramp to help another patient easily enter and leave his home.
“When it comes to somebody’s well being, what is too much?” Kelly said.
To ensure comprehensive care, Kelly and her fellow community health worker, Aletta Hatfield, meet with Cline and the program’s overseeing RN, Melissa Justice, once a week to discuss patient care. It’s one of the aspects that makes this community health worker model unique, Crespo said. By placing community health workers on a care coordination team, they don’t have to be experts in medicine to be able to offer comprehensive care. And even on days that they don’t meet, Kelly can call Cline or Justice to ask small questions she doesn’t know the answer to.
“What the community health worker needs to know in our model,” Crespo said, “is what the patient needs to know. So if a patient needs to know how to do their own glucose monitoring, then the community health worker needs to know that.”
Out of the 650 high-risk patients currently enrolled in a community health worker program throughout central Appalachia, 323 of those patients have diabetes. And so far, Crespo said, 54 percent of diabetic patients have been able to lower their A1C levels by an average of two percentage points, which is very significant in clinical terms.
But it’s going to take more than lowering A1C levels to ensure that this kind of work can continue and grow.
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Currently, grant funding is the make or break between having or not having community health workers, Crespo said. Some health centers, after seeing initial results, have made their own investment to expand their number of community health workers beyond their grant’s support.
Since 2017, Crespo and his team at Marshall have led quarterly meetings with insurance providers to share results of the programs. Three payers have signed on with select health centers, including Williamson Health & Wellness Center, to develop a model for payment during a temporary test period.
“All payers will say ‘Yeah, primary prevention saves us money, but what they look at is their bottom line at 5 o’clock. And it’s the [reduction in] ED [emergency department] and hospital visits that bring the cost down,” Crespo said.
The American Diabetes Association released research in 2018 reporting the total cost for treating diagnosed diabetes patients rose from $245 billion in 2012 to $327 billion in 2017.
During Williamson’s pilot program, emergency room visits decreased for diabetes patients by 44 percent and overall hospital stays were reduced by more than 30 percent, according to Crespo. They haven’t averaged, yet, how much money community health workers are already saving payers by reducing hospital visits, but Crespo is hopeful that if these trends continue, and if more payers sign on to the model, community health workers like Kelly Browning won’t ever have to worry about job security.
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Credit Anna Patrick / 100 Days in Appalachia
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100 Days in Appalachia
Kelly Browning checks Lyle Marcum’s blood pressure during her weekly visit to his apartment in Matewan, West Virginia on May 14, 2019. Because Browning checks Marcum’s vitals during every visit, she was able to respond immediately when she found his blood pressure to be higher than normal.
Shortly after Lyle Marcum became one of Kelly’s patients, he peeled a piece of tape off of the bottom of his left foot. Except it wasn’t tape. It was skin.
For months, Kelly treated the wound. But it kept spreading and growing, until eventually he was forced to have the leg amputated slightly below his left knee. Because her patient load requires her to travel throughout Mingo County, Logan County and even crossing the border into Kentucky, Kelly couldn’t make it to Matewan every day to check on Lyle, who lives alone, during his recovery process.
To help with the days she couldn’t visit, Kelly walked into the Matewan Sheriff’s department to ask that someone check on Lyle regularly. She made friends with a young woman that works at the town’s water department to get her to bring food to him. She had the senior center, just a few hundred yards away from his apartment, provide him meals. She even had her own mother stopping by to bring food and offer company.
“You just become whatever they need from you,” Kelly said. For Lyle, that often looks like gentle and sometimes not so gentle encouragement to keep going.
“Me and him have been in some knock down drag outs,” Kelly said.
“I won’t let him give up.”
This story was co-published with Spotlight for Poverty and Opportunity, a nonprofit, nonpartisan site featuring commentaries and original journalism about poverty and mobility. Follow us on Twitter @povertynews. Read the story on their site here.
Anna Patrick is a journalist based in Thomas, West Virginia. A former reporter for the Charleston Gazette-Mail, her work has appeared in the New York Times and CNN’s Parts Unknown. Raised in Appalachia, her work explores the lives of folks who call these mountains home.
A CDC study released earlier this month found that rural Americans are dying at a higher rate from potentially preventable diseases than their urban counterpoints.
The Centers for Disease Control and Prevention study looked at the five leading causes of death from potentially preventable diseases. They are heart disease, cancer, unintentional injuries, chronic lower respiratory disease and stroke. The study found that the percentages of deaths from these five diseases were higher in rural areas than urban areas.
The gap between rural and urban life expectancy and mortality has been growing in recent years. And the CDC report points to several factors to explain it. Rural Americans tend to be older and sicker than urban Americans. They also have higher rates of cigarette smoking, high blood pressure, and obesity. Additionally, rural Americans face higher rates of poverty, less access to healthcare, and are less likely to have health insurance.
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation, Charleston Area Medical Center and WVU Medicine.
Telemedicine has been touted as a way to fill in some gaps in health care for rural residents. But telemedicine relies on broadband service, which parts of Appalachia still don’t have.
“Without broadband, you don’t have telemedicine,” said nurse practitioner Lindsey Kennedy. Kennedy manages the telemedicine program at Bland County Medical Center in southwestern Virginia.
The clinic is located at that tip of Virginia that curves down between West Virginia, North Carolina, Tennessee and Kentucky. Kennedy said patients from all of those states utilize the clinic’s telemedicine services.
The Bland clinic is a federally qualified health center, which means that many of the clinic’s patients are uninsured or underinsured. Without telemedicine, patients needing specialty care have to drive to a hospital that offers financial assistance, which could be hours away.
“But it’s just not feasible for our patients to drive that far and to provide the finances for transportation and the time for that,” said Kennedy.
Telemedicine offers a way to bridge that gap. People drive to the clinic, which is centrally located, and then have consults with doctors at the University of Virginia Medical Center in Charlottesville.
“I think there’s been a clear communication in this country that rural people need access to resources,” said David G. Cattell, director of telemedicine for UVA. UVA works with 150 rural clinics like the one in Bland County. West Virginia University also has a telemedicine program as does the University of Kentucky.
However, much of the region lacks adequate broadband access, which is defined as download speeds of 25 megabits per second and upload speeds of 3 megabits per second. Even in areas that have some access to broadband, like the Bland Clinic, it isn’t always enough.
“We are working with Carillion to do cardiology clinics,” said Kennedy, “because a lot of our patients have heart attacks. They’re flown out to Roanoke and are expected to follow up in Roanoke,… [but] a two hour drive for a 90-year-old, elderly woman is not feasible.”
The clinic had to add an additional IP address to be able to electronically connect to the hospital system. But there’s only one internet provider in Bland, and they weren’t in rush to get the project done.
Installation “took six months. It was something that could have been done in a day,” she said. “But because we only have the one carrier in the area, they took their time with it. …They knew we didn’t have anyone else to go to.”
Now UVA is expanding telemedicine into the local school system, yet Kennedy said everyone’s pretty nervous about whether the school’s internet will be fast enough to manage the task.
“I mean a lot of people don’t think about it, but that’s your fundamental for telemedicine – you have to have that connection so you have that flawless face-to-face encounter,” she said.
Telemedicine uses videoconferencing to create face-to-face encounters between a patient and provider – think Skype or Facetime on steroids.
“We have accessories that you can plug into… If you have to listen to heart or lung sounds, they have a stethoscope you can plug in,” said Kennedy.”Then on my end, I’ll hold it up to the patient, just as if I was doing an assessment and on their end they’ll be able to hear those sounds.”
Recently the federal government has taken steps to expand broadband in rural America. In April, the U.S. Department of Agriculture announced grants of nearly $12 million to help establish broadband access in rural areas.
Some states, however, have declined to add their tax money to the cause. Last January, West Virginia legislators proposed a bill to create a $72 million state-run broadband network. But the bill was never put to a vote in the House in the absence of support from some Republican members.
Both Kennedy and Gordon-Cattell emphasize that without broadband you can’t have telemedicine.
“We as a nation need to commit to full-scale broadband. Broadband is that place where education, economic development and health are interdigitated,” said Gordon-Cattell.
Gordon-Cattell said in the end rural broadband isn’t just about healthcare – although that’s desperately needed. He said broadband can bolster rural economies by helping rural hospitals stay open and creating technology jobs.
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.
