Developing a Sustainable Program Developing a Sustainable Program for Tele-Echocardiograms for Tele-Echocardiograms

in Rural Pediatrics in Rural Pediatrics

Thomas K. Chin, MD and Richard Kuebler, BBAThomas K. Chin, MD and Richard Kuebler, BBA

University of Tennessee College of Medicine University of Tennessee College of Medicine and LeBonheur Children’s Medical Centerand 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 Why is Telemedicine particularly effective for treating Congenital Heart Disease?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 Why is Telemedicine particularly effective for treating Congenital Heart Disease?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)

UncomplicatedHeart Defect

Interventional Heart Catherization:Interventional Heart Catherization:

Interventional procedures: balloon septostomy and

valvuloplasty (PS, AS, Coarctation)

coil embolization (PDA, collaterals)

Stents ASD& VSD closure

““Stage I” Stage I” NorwoodNorwoodProcedureProcedure

Arrhythmias: Arrhythmias: Ventricular TachycardiaVentricular Tachycardia

Arrhythmia Treatment Using Arrhythmia Treatment Using Catheter AblationCatheter Ablation

Mapping Ablations

Clinical Cardiologists

Non-Invasive DiagnosticsEKG, ECHO, MRI, Stress Testing

Echocardiography expertFetal Echos

Diagnostic Catheterization

Low risk surgery

InterventionalCardiologist

Electrophysiologist

CVICUCardiac

AnesthesiaMedium Risk

Surgery & HybridProcedures

High RiskSurgeries/

ECMO

VentricularAssist

DevicesTransplants

Research Center

Cardiac Institute

PA

TI

EN

T

AC

UI

TY

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 Benefits of Telemedicine in Pediatric Cardiologyin 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 Benefits of Telemedicine in Pediatric Cardiologyin 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:Echocardiograms: Memphis Metropolitan AreaMemphis Metropolitan Area

3718

2000

549 5170

500

1000

1500

2000

2500

3000

3500

4000

7/1/07 to 6/30/08

Le Bonheur

St. Jude

UTMGGermantown

The Med

Echocardiograms performed in rural sites Echocardiograms performed in rural sites using telehealthusing telehealth

904

450

9045 38

230

100200300400500600700800900

1000

7/1/07 to 6/30/08

Jackson TN

Tupelo MS

SavannahTNMartin TN

Corinth MS

Crittenden

Sustainability of Telemedicine Sustainability of Telemedicine in Pediatric Cardiologyin 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 Sustainability of Telemedicine in Pediatric Cardiologyin 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 YouThank You(opening in Fall 2010)(opening in Fall 2010)