Video streaming for consultation with doctors expands and becomes more popular; 2 Ky. insurers use it and another plans to

In the past, people had to go to the emergency room to receive medical attention if they required it outside the usual hours for doctors. Now telemedicine programs such as KentuckyOne Health's "Anywhere Care" and Anthem BlueCross BlueShield's "LiveHealth Online," Kentuckians can access a doctor 24/7 through a computer or mobile device.

Photo from The Lane Report

"Patients like telemedicine because it's fast and easy to use and cheaper because it's a low-overhead service," Esther Zunker writes for The Lane Report, a Lexington-based business magazine.

UnitedHealthCare, a Minnesota-based health benefits provider for many people in Kentucky, plans to cover Skype-based doctor visits through "NowClinic," "Doctor on Demand" and "American Well." Anywhere Care and Live Health Online give clients a list of certified doctors they can chat with through video on a computer or a mobile device. The doctors can provide diagnosis and treatment and even write a prescription. They can direct patients to an emergency department if necessary.

It's affordable, too. A LiveHealth Online appointment costs the same as an office visit for eligible members. LiveHealth doctors usually charge $49 per online "visit." Anywhere Care costs $35 per visit, even if patients don't have insurance.

"As we know, care can be limited and is based on being able to get someplace when [a doctor] has an opening," said John Jesser, Anthem's vice president of provider engagement strategy. "They only have certain hours, and that doesn't always work for when people don't feel well. [Telemedicine] expands access to care for the consumers, making it much more friendly to their schedule and lifestyles."

Telemedicine is also convenient for doctors. It saves money for hospitals and allows one doctor in one location to help patients in a variety of locations. Patients can receive help with chronic conditions over periods of time without having to travel to the doctor's office.

"We've had amazingly positive feedback from patients who have tried this service," said Kathy Love, director of strategy and business development for KentuckyOne Health's Central East Kentucky Market. "People have told me they've used it multiple times when they've needed it . . . either late at night or over the weekend."

She also said people who use telemedicine still need a primary-care physician: "It's something you can access 24 hours a day with a very minimal wait and very professional providers, but it shouldn't replace your very important relationship with your primary-care doctor." (Read more)

UK HealthCare offers help to primary-care clinics; university's top health official calls it 'a game changer' for rural health providers

The Kentucky Primary Care Association and the University of Kentucky have announced a new partnership to provide support services to primary care providers throughout Kentucky.

This "groundbreaking partnership" will provide KPCA, which includes more than 800 patient care providers, access to UK HealthCare's support services, such as supply chain contracts, medical professional placement services, practice transformation support and training, and an after-hours pediatric call triage center, according to press release.

The most notable feature of the partnership is that KPCA members will have access to UK's group purchasing contracts, giving them access to services at heavily discounted rates at no charge to the facilities. This is expected to create "significant" savings for more than 250 clinics throughout the state. UK's top health official called it "a game changer."

“Primary care physicians, especially those in rural areas, have the extra burden of high patient volume, limited staff, and stretched resources,” Dr. Michael Karpf, UK's executive vice president for health, said in the release. “By partnering, UK HealthCare and KPCA members can grow important programs and services for their patients while also controlling and reducing operating costs.”

KPCA Executive Director Joe Smith said, "By addressing some of these issues related to costs, clinics with already scarce resources can instead focus on improving the quality of care.We’ve had a longstanding association with the university and UK HealthCare, and this partnership elevates that relationship by adding a strong commitment to assisting rural doctors, nurses and practice managers, who face some of the toughest transitions taking place in medicine today.”

The partnership will also allow KPCA members access to staffing services that link candidates to vacancies across the state; to Patient Centered Medical Home consultants, who help practices transition to quality and value-based models of care; and to UK HealthCare's after-hours pediatric call triage service.

Doctors of osteopathy are an increasing answer to the doctor shortage, as more osteopathic medical schools open

Doctors of osteopathy could be part of the solution to Kentucky's well-documented primary care doctor shortage, Laurel Black reports for The Paducah Sun.

"The American Association of Medical Colleges predicts that a growing population of aging people, health insurance expansion, and a freeze on Medicare funding for residency training positions will lead to a physician shortage of more than 90,000 by 2020," Black reports.

Rural areas are expected to be most affected by the shortage of physicians, especially in the area of primary care, Black writes. Kentucky is already experiencing this problem. A presentation at the 2013 Kentucky Rural Medical Educators Conference said Kentucky had a 1,287:1 primary care physician-to-citizen ratio, 557 short of the national average.

Despite this "looming doctor shortage," little attention has been given to osteopathic medicine as a possible solution, Black writes. But enrollment in osteopathic medicine, "which puts a focus on primary care and works to place its doctors in under-served regions," is growing.

"There are a lot of osteopathic schools. It's definitely a growing field," Griffin Bicking, a doctor of osteopathy and a vascular surgeon at Baptist Health Paducah, told Black.

"Graduates in osteopathic medicine have increased by more than 250 percent between 1980 and 2005, according to a study by the medical colleges' association. In 1980, there were 14 schools with fewer than 5,000 students in America; there are now 30 schools with more than 30,000 students," Black reports. "It's estimated that today nearly 30 percent of all medical school graduates are estimated to be doctors of osteopathy," or D.O.s.

The University of Pikeville's Kentucky College of Osteopathic Medicine has graduated more than 800 physicians since its inception in 1997, with 60 percent of these graduates serving primarily in rural healthcare facilities in Eastern Kentucky and other regions of Appalachia, according to its website.

New or relatively new osteopathic medical schools near Kentucky are in Harrogate, Tenn.; Lewisburg, West Virginia; and Blacksburg, Va.  Other adjoining states with such schools include Ohio, Illinois, Indiana and Missouri.

Black reports that the stigma associated with D.O.s is fading as people seek a more holistic approach to their health. She also notes that the most notable difference between D.O.s and a doctor with traditional training is a required 300 to 500 hours of training in osteopathic manipulative treatment. This training, known as OMT, involves the movement of patient's bones and muscles to treat illness and injury and is part of the controversy surrounding D.O.s, Black reports.

However, more than half of D.O.s "used OMT on less than 5 percent of their patients," according to a study reported in Academic Medicine, the journal of the medical colleges' association, Black writes.

"Curriculum-wise, it's pretty much the same," Bradley Albertson, an internist and pediatrician at Mercy Primary Care in Benton, told Black of osteopathic medicine, which also requires four years of training followed by an internship and a residency. "The differences are more political and social."

Albertson opted for a non-osteopathic residency after attending a college of osteopathy for medical school, telling Black it "would add legitimacy to his practice."

And while osteopathic schools try to push primary care, D.O.s can go into any field a traditional doctor can, and it usually pays more to specialize, Black writes.

Albertson told Black that he is not sure that osteopathic schools will be the solution to the predicted patient-doctor gap and suggest it will take a "variety of solutions," including giving nurse practitioners more privileges.

Hospitals say too many of the newly insured are using emergency rooms for primary care; state says it's working on the problem

By Melissa Patrick
Kentucky Health News

More people with health insurance, a shortage of primary-care physicians and a steep learning curve for the newly insured all add up to more patients than ever using emergency rooms for non-emergency purposes.

More than 413,000 Kentuckians are newly enrolled in health care coverage under the Patient Protection and Affordable Care Act, and nearly three out of four of those enrolled under the Medicaid expansion, which covers residents earning up to 138 percent of the federal poverty line.

Because many of these newly insured are using the emergency room for non-emergency reasons, emergency rooms are feeling the strain, Don Weber reports for cn|2's "Pure Politics," a service of TimeWarner Cable.

"In the past three months, we are seeing about a 12 percent increase per month in our emergency room visits," Sheila Currans, CEO of Harrison Memorial Hospital in Cynthiana, told Weber in a broadcast.

“Many of the patients that come have multiple chronic conditions that have been undeserved," Currans said in the broadcast. "Diabetic. Obesity. Vascular disease. And so they come with chronic conditions and they don’t really have a primary-care physician. And so the ability to get them into a primary-care setting, into specialty-care settings, becomes more difficult without that primary-care person to refer and to kind of coordinate and manage that care."

Currans added, “Primary-care physicians have got to lead this transformation in health care, because  … they can take care of the whole patient. We have to reform the payment system so that the primary-care physician can spend 30 minutes with you and/or can spend 15 minutes with you, but can hand you off to a professional within their office that can help educate, continue to educate, re-mediate.”

Norton Hospital in Louisville has also seen a 12 percent spike in the number of patients, many for non-emergency reasons, Laura Ungar reported in The Courier-Journal. Weber reports that the 12 percent increase in emergency room visits is "pretty consistent with the state average."

This is not a new problem, according to Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services.

“Kentuckians suffer poorer health than many other Americans, and have traditionally utilized emergency rooms at a higher rate. This is not a new phenomenon," Midkiff said in an e-mail. She said Kentucky is working on the problem, focusing on so-called "super-utilizers" who use ERs at least 10 times in a year.

"Last summer, Kentucky was one of seven states chosen to participate in the National Governors Association Policy Academy on emergency-room utilization, with particular focus on managing super-utilizers," Midkiff said.

People who have never had insurance often don't know how to use their benefits, which also adds to the number of people using the emergency room instead of seeking a primary care physician, Midkiff said. "There is a steep learning curve to navigating the healthcare system and all providers and the insurance companies must help educate the newly insured," she said.

Part of that effort is being handled by the companies that manage the care of Medicaid patients under contracts with the state that reward them when expenses are less than expected.

The Kentucky Health Benefits Exchange, branded as Kynect, "is developing some very basic 'Insurance 101' materials to help educate the newly insured about how to find a primary care physician, when to seek health care services, when to visit the ER, how to use pharmacy benefits, as well as providing a glossary of commonly used insurance terms," Midkiff said. "We think this fills a real need and will help consumers more appropriately and efficiently use their health-care coverage."

Midkiff said emergency rooms have long been considered the "de facto primary care center," with some hospitals even advertising the average wait times on websites and remote-controlled billboards. "This provides a confusing message to those who are newly covered," she said. "Many hospitals across the country have revised their health-care delivery model to include both emergency services and immediate care to adapt to the increased and changing demand for services."

Many hospitals around the country have done that, and are profiting. "Hospital chains and insurers are making more money, more patients using ERs are paying for their care, and the country as a whole is enjoying slower growth in its health-care spending," Alex Wayne and Shannon Pettypiece of Bloomberg News report, on the basis of public filings by hospital chains.