Kansas Health Institute | Information For Policy Makers. Health for Kansans.

SEDAN — The last thing Margie McKenna, 58, wanted to do last week was drive two hours to Wichita to have a pain specialist look at her shoulder.

“I broke it in two places about a year ago and now they’re talking about maybe doing shoulder-replacement surgery,” said McKenna, who lives in Sedan.

She didn’t go to Wichita. Instead, McKenna drove three blocks to the Sedan City Hospital for a telemedicine conference with her doctor. She was in and out in about 40 minutes.

“I’ve done it before,” McKenna said. “It feels very hands-on; I can see the doctor and she can see me. We’re able to hear each other. There’s a nurse in the room with you, taking notes and answering questions.”

Telemedicine — a doctor at one site using interactive video to see patients at another site — is giving the state’s small-town residents access to big-city specialists.

“It’s wonderful not having to take off work and spending all that time driving,” McKenna said. “I’d recommend it to anybody.”

Money's "the issue"

Today, about one-third the state’s rural hospitals offer telemedicine.

There should be more, said Dale White, who runs the hospital in Horton.

“The technology is there — that’s not the issue,” he said. “The issue is revenue.”

Medicare and Medicaid, he said, both pay for telemedicine as do three of the state’s five largest insurers — Blue Cross Blue Shield of Kansas, Blue Cross Blue Shield of Kansas City, and Preferred Health Systems.

The other two major insurers — United Health Care and Preferred Health Systems Humana — do not.

“The thing to remember it that a lot of this technology is relatively new,” said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, a lobbying group that represents the health insurance industry. “A lot of companies are covering various parts of it so the issue then becomes: How do you define what telemedicine is and what would fall under the various categories?”

Insurers that don’t cover telemedicine, Zirkelbach said, are still assessing its effect on quality of care.

“It’s not that they’re against new technology or telemedicine,” he said.

Rep. Tom Sloan, R-Lawrence, in 2007 introduced a bill that would have required insurers to cover telemedicine. It didn’t pass.

“What happened was (Kansas Insurance Commissioner) Sandy Praeger indicated she would convene a telemedicine task force to see what the issues were and what could be done,” Sloan said.

The task force survey found that about 20 percent of the insurance companies doing business in the state covered telemedicine, but included in those 20 percent were three of the five largest insurers. That meant most Kansans with health insurance are covered for telemedicine.

“A definite majority of Kansas policies regulated by the Kansas Insurance Department currently cover telemedicine services," said Bob Hanson, a spokesman for the Kansas Insurance Department.

The task force met twice. It has not scheduled a third meeting.

Sloan said he’s likely to introduce a similar bill next year.

“This is one of the few times I think the federal government is on the right path. Medicare and Medicaid both cover telemedicine in hospital-to-hospital settings; in fact, they’re getting ready to expand those settings to include nursing homes and mental health centers,” he said. “The state should do the same.”

If all the state’s insurers covered telemedicine, more small hospitals would likely offer it, said Chad Austin, vice president of the Kansas Hospital Association. Still, he said, some would not.

Other concerns

“There are some other issues going on,” Austin said. “Health care providers and their patients need to be comfortable with the technology and with its usage. There’s a lot of education that needs to take place; a lot of people don’t know what it is or that it’s available.”

Many of the state’s smaller hospitals, he said, either can’t afford telemedicine’s start-up costs or struggle to see how it would pay for itself.

“We have it and we think it’s great,” said Kris Ochs, administrator at Grisell Memorial Hospital in Ransom. “We’d like to use it more, but Hays is just an hour away and some people, you know, would just rather get in their cars and go.”

Basic videoconferencing equipment costs between $5,000 and $10,000. The broadband connection fee costs about $500 a month.

Digital house calls?

But as the state’s population continues to age, fuel costs increase, and rural physicians retire, it’s only a matter of time before telemedicine is seen as a basic service, said Horton Community Hospital’s White.

“With all the new drugs that are being developed and all the procedures becoming less and less invasive, the practice of medicine is something that, more and more, is deliverable outside a tertiary setting,” White said. “Telemedicine is going to transform access to and the delivery of health care.”

"I can only imagine what it's going to be like for my children," said Dr. Gary Doolittle, a physician at the University of Kansas Medical Center who has been involved with telemedicine for 15 years. "Facebook, sending pictures back and forth to each other. It wouldn't surprise me if a lot of doctor visits were replaced by home visits."