Health

If it hadn’t been for telemedicine, Mary Horsley isn’t sure her mother-in-law could have stayed in her rural town after being diagnosed with Alzheimer’s disease.

Horsley drove her mother-in-law – also named Mary – to a rural health clinic in eastern Kentucky every three months to see an Alzheimer’s specialist. The specialist would appear on a computer screen and remotely manage Mary’s Alzheimer’s symptoms. They did this for seven years until Mary died.

“What was nice about it was that we weren’t coming to Lexington,” Horsley said. “She was opposed to that. We said, ‘you’re going to your local clinic and we’re going to connect to a specialist in Lexington.’”

Telemedicine is similar to a face-to-face health care visit but instead, patients interact with health providers remotely, usually via computer screen. Currently, the practice is limited to doctors and higher-level practitioners, and the patient has to be in a clinic setting for the visit.

But that will change starting in July 2019 because of a new law signed by Gov. Matt Bevin last week, which broadens telemedicine. Under the new law, Medicaid and commercial insurance companies will have to pay for telehealth visits in a patient’s home. And insurers will have to pay mid-level providers, such as psychologists, family therapists and physician assistants for telehealth visits.

Horsley said her family was lucky her mother-in-law already had a doctor in town that she trusted.

“I’m hoping this legislation will open up the opportunity to see these specialists from their homes,” Horsley said. “For people with Alzheimer’s, it is difficult for them to go places that are unfamiliar to them but a lot of times they’re familiar in their home.”

Rob Sprang, director of Kentucky TeleCare at the University of Kentucky, said being able to reach patients inside their homes will impact many areas of health care. Sprang said while psychiatrists and psychiatric nurse practitioners have been able to practice telehealth,  psychologists and licensed social workers were left out prior to the new law.

That’s important because in Kentucky, there are not enough mental health providers to start with. In 2013, Kentucky faced a shortage of 1,638 mental health providers to keep up with demand, according to a state report. The report also said that rural counties were most in need of mental health providers, and that there were more clinical social workers and psychologists than any other mental health professionals in the state.

“[Rural] medical clinics are more likely to bring on some mental health specialists, and in most cases they can’t justify a psychiatrist. But it does make good sense for them to hire a family therapist and they can leverage that person using telehealth to reach anywhere in the state,” Sprang said. “We need every clinician we can find to meet the problems of underserved patients in our state.”

What About Access?

Psychiatrist Robert Caudill is already able to see patients via telemedicine. He helped start a program at the University of Louisville to reach patients in parts of Kentucky that are far from the medical hubs of Louisville and Lexington.

“These rural mental health centers have had a bit of a challenge in terms of recruiting and retaining medical staff,” Caudill said, “we’re able to go in with video connection.”

But he’s excited by the prospect of reaching more patients in their own homes.

“The end game is the recognition that making house calls with technology is where this winds up,” Caudill said. “The new legislation allows us to do that.”

Caudill uses BlueJeans video conferencing to connect with patients for telehealth visits. BlueJeans is a web-based video platform, much like any other video conferencing platform, but includes special health privacy protections.

In July 2019, when the new telemedicine law takes effect, Kentuckians can pull up the website on their phone or computer and get connected for a mental health checkup.

Of course, patients will have to have internet access at home, which could present problems.

Though 85 percent of Kentuckians have access to high-speed Internet, there are still 524,000 people who don’t, and 187,000 people don’t have any internet providers where they live.

Still, Mary Horsely said it’s good to have the option for telemedicine at home. She said many people in eastern Kentucky, where her mother-in-law lived, now have a smartphone.

“The tech has gotten so easy over the years that it’s not really an obstacle anymore,” Horsely said. “If they’ve got a grandchild that’s tech-savvy that can help them with those connections.”

Back To Frankfort

Sprang with Kentucky TeleCare said the next year advocates will push for additional telemedicine technology. They want insurance companies to pay for remote patient monitoring. People with congestive heart failure, for instance, usually have warning signs that precede an emergency room visit.

“Many cardiologists will tell you, ‘if I knew every morning what that patient weighed, I could predict when they trend poorly,’” Sprang said. “Because if they eat too much salt, or forget to take their diuretic, they will begin to gather fluid around their heart and lungs and before you know it, they can’t breathe.”

Legislation passed a few years ago mandated the state Medicaid program create a remote-monitoring pilot project, but lack of funding stalled the project. Sprang said advocates will ask lawmakers for money for that project.

“That technology, and paying for that technology, I think that could be the most impactful thing we’ve done,” Sprang said.

Lisa Gillespie is WFPL's Health and Innovation Reporter.