Tuesday, March 1, 2016

Should telemedicine serve doctors or serve patients in Mississippi?

Disruption is the new buzzword in corporate America as old business models are blown up and new ones created on an almost daily basis with the advent of the smartphone. Few things are immune to the technology tidal wave that is sweeping across the economy and the practice of medicine is no exception. Meanwhile, government is often ill-suited to handle such disruption and often does not know what to do. Mississippi is no exception as shown in the fight over telemedicine. It is a fight that is little understood or covered by the press but may impact what healthcare options are available to Mississippians.

The practice of telemedicine is a relatively new phenomenon as private companies began providing telemedicine nationwide over the last ten years. Some offer it directly to consumers while others offer it through employers and their health insurance plans.  However, one problem facing the medical profession is determining an actual definition of telemedicine. The entrenched doctors and their state medical associations want to define it as the use of video conferencing in a doctor’s office to evaluate and treat the patient.  They see the technology as a supplement to the standard office visit. The forward-thinking disruptors instead argue that the use of the smartphone and modern technology can bring more health-care options directly to the patient, especially those who live in rural areas or the poor.  They see the medical associations in much the same way as Billy Mitchell saw the 1920’s Army generals who said planes would never sink ships, much less aircraft carriers. The time of the day, the day of the week, or the location of the patient will mean little as he will be able to obtain a physician’s care almost immediately.

Several companies offer telemedicine services in Mississippi to subscribers and employers. The physicians are licensed in Mississippi. No mistaking their voices for those one hears when using an AT&T call center. The patient can talk to a doctor over the phone or through video conference. The patient can, gasp, use an app on a smartphone – a boon to those who live in rural areas and have poor broadband service or the poor who don’t’ have internet service at all.  The use of these telemedicine tools can help employers lower their healthcare costs and deliver more on-site medical care instead of losing the employee to an office visit for the rest of the day.  The app is HIPAA-compliant.   The patient can take a picture of a rash or other visual symptoms and send it to the doctor. The cost is only $40 per month.

Keep in mind Mississippi suffers from a severe doctor shortage . However, the growth in telemedicine means government- and competitors- can’t wait to regulate it. It's an old story- regulators like to control and competitors like to use the government to drive out more competition.   The Mississippi Board of Medical Licensure has been embroiled in a fight with telemedicine providers over the last year. Smartphone app? Forget about using one if the Board has its way. The Board wants to limit telemedicine to using videoconferencing only at a doctor’s office. So much for the poor and rural folks who suffer from the doctor shortage. Sick with the flu or a stomach bug at 3:00 AM? Sick baby on a Sunday evening and all the clinics are closed? Tough luck.  Go to the ER and whip out the credit card. 

Surprised at the growth of telemedicine, the Board served notice in March 2015 that is was proposing an “amendment” to its current rules on telemedicine.  The proposed change would indeed force patients to use telemedicine only if they were in a doctor’s office.  The telemedicine doctor would also have to sign a contract with a local primary-care physician.  Got to give the local medical mafioso the vig.  Telemedicine would in effect be limited in its scope and transformed into a referral service for the Mississippi Medical Association and its doctors. If the patient is in an area that is suffering from the doctor shortage, well that is just too bad. 

The board also said no economic impact statement was required as well since it was merely filing an amendment.  However,  government agencies can’t just make up rules and change policies on the fly while wreaking havoc on entire industries and companies. They have to follow a rule book for making rules. The agency must determine how much cost and benefit will arise from a proposed rule. To put it simply, will the new rule help or hurt?  The Board held a public hearing in May.  The doctors, telemedicine companies, and groups such as the Mississippi Medical Association all appeared at the hearing to chip their two cents into the discussion. The Board decided to send the proposed rule back to its Telemedicine Committee for further review. However, the fight over defining telemedicine was just beginning.

The Board channeled its inner John Roberts and “clarified” its telemedicine regulations in October. The "clarification" stated that the practice of telemedicine could not include mere phone calls or use smart phone apps but instead conformed to the  new rules proposed back in March. So much for the rulebook for making rules. Why go through the hassle of hearing public comments and determining how a decision by some bureaucrats affects an industry when a "clarification" will do?  MMLB Staff Officer Sherry Pilgrim told a fellow employee in an internal email that telemedicine was only legal

if the examination of the patient provided the same information as if this examination were conducted face to face. Thus audio only or filling out a health inquiry is not acceptable for the practice of telemedicine in Mississippi. An interviewing licensed health care professional who is on-site with the patient may convey this information to the physician practicing telemedicine.

The telemedicine providers fought back and demanded the Board perform a cost and benefit analysis as required by law. The Board acceded to the request and assigned the task to a committee of doctors. The Board still has not produced an economic impact statement even though Board members said in emails that the statement would be available by January.

It is perhaps no coincidence that the Board’s position on telemedicine just happens to match the telemedicine program offered by UMMC. Dr. Kristi Henderson founded the UMMC telemedicine program in 2003. The program only uses video conferencing between physicians. The patient must be in a doctor’s office before it can be used. There are no smartphone apps and it is not available 24/7 to patients.   It is focused on the use of telemedicine by doctors to work with other doctors while the disruptors are focused on providing telemedicine directly to the patients.   Keep in mind there is nothing stopping a local medical clinic or hospital from offering its own telemedicine service directly to patients.  A local health care provider can hire doctors, create an app, and offer telemedicine directly to patients as UMMC's competitors do.  Competition can indeed be a wonderful thing. 

It should be noted that UMMC physician Dr. Claude Brunson is the chairman of the Board’s telemedicine committee. Make no mistake, UMMC is a direct competitor of the telemedicine providers.  It invested heavily in its telemedicine program and obtained several grants for the program as well.  In other words, it has a vested interest in the outcome of this fight.  The Mississippi Medical Association supports the Medical Board's position as well.  It is an interesting battle to watch in one respect.  UMMC created a beautiful telemedicine program that is the envy of many states but it is getting leapfrogged by the disruptors while it is receiving its accolades. 

However, UMMC, the Mississippi Board of Medical Licensure, and the Mississippi Medical Association may not like what the courts have to say about their efforts to constrict the practice of telemedicine in Mississippi.  A federal judge ruled in Texas that Teladoc could practice its brand of telemedicine after medical licensing board in Texas imposed similar restrictions.  The court ruled that the presence of competitors on the board meant that the board was subject to the antitrust laws.  The court cited a 2013  U.S. Supreme Court case that held the North Carolina Board of Dental Examiners were subject to antitrust laws when a "controlling number of the decision makers on a state licensing board are active participants in the occupation the board regulates."  The board members of the Mississippi Board of Medical Licensure are all physicians and probably face the same antitrust issue in court as their Texas counterparts faced.  There is not doubt that Teladoc will fight the Board in federal court if the Board has its way.

However, the fight has now moved from Lakeland Drive to downtown at the state capitol. Several telemedicine bills were introduced in the current legislative session.  One bill is alive and trying to survive political dodgeball.  HB #1187 passed the House and awaits referral in the Senate.  The bill is patient-friendly as there is no requirement for the patient to travel to a doctor's office.  The patient can use his smartphone app as well as talk to a doctor either on the phone or through videoconferencing. The doctor must be licensed to practice medicine in Mississippi and can be disciplined by the Board if he violates the law.

The fact that Mississippi is in last place when it comes to health care is no great secret. The poor and rural character of much of the state means too many people lack access to basic health care.  However, health care access is often limited due to anti-competitive laws that shrink the supply of health care providers while driving up the cost.  Certificate of need laws restrict the supply of hospitals and medical services.  Other laws restrict the use of nurse practitioners and physician's assistants.  The fight over telemedicine is a fight over whether telemedicine should be used to bring health care to the patients who need it most at an affordable price. The good ole boy network is still alive and well in the 21st century. The disruptors seek to break up the good ole boy rules while  government tries to adapt to the 21st century and modern technology.  Which way will Mississippi go? 

*Dr. Henderson recently left UMMC for a position with Seton Healthcare in Texas.


Anonymous said...

MS Board of Medical Licensure -- looking out of each other since formation.

Anonymous said...

Funny how republicans who believe in free market support the BML that squeezes out competition. So much for conservative leadership.

Anonymous said...

Ms State Medical Association - one hand in their pocket and one hand in our pocket. (since formation)

Anonymous said...

How are members of the Board of Medical Licensufe selected?

Anonymous said...

From a 5th generation Mississippian, it is frustrating that we can't ever move forward with Heath care in this state. We will always be number 50 with the good old boy system we have running things.

Anonymous said...

This is why we can't have nice things l

Anonymous said...

Same group that is fighting nurses to provide
Primary care -- shocker.

MS Physician said...

I am a Mississippi physician and I support this bill. My Association does not speak for me. We are afraid to speak out in support of the legislation because the Board of Medical Licensure will come after our practice. I've seen many friends become part of a witch hunt by the BML who speaks out against them.

Anonymous said...

Check your ‘facts’. Your analysis is okay for a high school research paper on telemedicine. Are you sure those are the only services offered by telemedicine companies in this State?

Check section 1 part (9) of the bill as passed by the House (starting with line 70):
House Bill 1178

The Chairman of the committee expressed that the intention of part (9) was to provide patients with the choice “of any telehealth medium they want”. It has good intentions but is just a badly written bill. Not to mention it mandates the cost of telemedicine regardless of the communication method in this same section (9). This would be similar to a patient requesting which diagnostic test or procedure they want done, and then for that diagnostic test or procedure to cost the same regardless of type.

Take Dermatology for example, there is great evidence-based-medicine out there showing that close to 80% of Dermatologic conditions can be resolved through Store and Forward consultations (primary care provider sends pictures to dermatology specialist linked through cheap technology, specialist resolves the issue).

NIH Article on TeleDermatology Store and Forward Impact

With this bill, a patient could ‘choose’ not have Store and Forward consults, and request a “live video conference.” This would completely ruin the established innovation in escalation through telemedicine (patient presents at primary care, if unresolved, primary care seeks specialty consult through telemedicine to specialist via store and forward; if unresolved, therefore appropriate patients are presenting for live consult to derm specialist) that will hopefully allow patients everywhere access to specialists.

Not only that, but the Bill would make the much cheaper Store and Forward consult would now have to be offered at a higher price than necessary since the Bill mandates that the cost must be the same regardless of communication method. How’s that for stifling innovation.

And this example is specific to only this specialty. There are specialty specific implications that are all differently impacted by this legislation.

I would encourage you to learn more about telemedicine, and form a more in-depth, intelligent opinion.

Anonymous said...

@11:14 - ruin the established , i.e. Good old boys pockets. Thanks for proving KF's points.

Anonymous said...


If the word "established" is the only operative information you gathered from the post, you clearly have no understanding for how medicine, healthcare, or even science works.

When a new tool or procedure is developed in surgical medicine, for example,there is a process for validating the procedure based on outcomes. Surgeons don't just hack away like sculptors. There are established procedures with hard science behind them. This is why you can have heart surgery in Mississippi or Wyoming. Established simply means that there is good data and science to back up the approach.

This isn't some House of Cards episode or Chris McDaniel conspiracy. This is about using science and evidence to figure out the right way to implement technology into healthcare so that we improve outcomes, reduce cost, and increase access. We need to get this right.

Commenters like you make me glad we have a representative democracy.

Anonymous said...

HB 1178 lowers the standard of care for the practice of telemedicine in Mississippi. While Mississippi does lag behind in many areas, Telehealth is an area where we lead the nation. This has been accomplished by the very people and organizations who are being bashed in this article. Do not believe for one minute that HB 1178 will increase access for people who are in areas with limited wireless connectivity or those with limited financial resources. The company sponsoring this bill is interested in one thing...profit. They will not improve access to healthcare for the people that need it most, they will continue to provide it to those who can afford it. Please take the time to educate yourself about this bill and why being able to "see and be seen" by a provider is so important. There are several companies besides UMMC who are working in our state to improve access. We don't need additional legislation requested by a for profit company from Texas.

Anonymous said...

Well, I see Dr. Easterling (de facto leader and wanna-be politician) is posting on here again.

Anonymous said...

Thank you for bringing forward this topic. It is important for the public to know the facts. It is also important that we don't compare apples to oranges. Telephone medicine and telehealth/telemedicine are two different things and should be not be compared nor regulated as one in the same. Telephone medicine has been in existence since phones and doctors existed. Physicians talk to their patients all the time- adjusting medicine, prescribing medicines and educating patients on their condition. Telephone management of patients is done safely in established patient-provider relationships for management of known conditions. This is much different than telemedicine which seeks to recreate an in-person exam using technology to replicate the patient assessment. An audio-visual interaction with devices allows the physician to listen to the heart and lungs, look at the skin and much much more. Without telemedicine technology, the physicians lose one of their most powerful tools- the visual assessment and physical exam. The telemedicine interaction often establishes a patient-provider relationship unlike a phone call.

There are over 2,000 evaluative research studies demonstrating the impact of telemedicine. I encourage the public to review some of these to understand the benefits of telemedicine when done safely and securely.

I will end with providing some more detail to the statements in the article that describe telemedicine activity in Mississippi. I know first hand that the UMMC program offers their telehealth technology to physicians and other systems without the expectation that UMMC physicians will provide the services so their model offers physicians access to telemedicine tools for their patients. The UMMC program does in fact operate 24/7 and they do offer the services in locations that do not require the patient to go to a clinic or hospital. They offer their services in workplaces, schools, colleges, nursing homes and even in homes. There are multiple health systems and practices in addition to UMMC that are also providing telemedicine services in Mississippi all using video. Mississippi physicians want the technology that allows for a audio and video interaction to improve their ability for a complete assessment. I agree it is important for the public to be educated on this as legislation and regulations progress so I hope this provided additional details and a better picture of telemedicine in Mississippi. Thank you for bringing the topic forward.

Anonymous said...

So, did UMMC's F grading include their telemedicine services?

Anonymous said...

UMMC does not require telemedicine to be used exclusively in a physician's office. There is a multi-year pilot program in Sunflower County that puts diagnostic services directly into patient's homes. Get your facts straight.

Anonymous said...

UMMV shouldn't provide telemedicine with its F rating. F F F F, don't a D, but a F grade. F is for FAILING.

Anonymous said...

UMMC is the only state funded institution of learning in Mississippi that gets away year after year with a F grade.

Anonymous said...

The UMMC Center for Telehealth has received an A from the American Telemedicine Association. UMMC's Center for Telehealth is leading the nation in it's efforts.

Anonymous said...

Let's ask ourselves why the push back by UMMC, Dr. Easterling and the Board of Medical Licensure? Is it about the competition? Why would they be against a proven method of patient interaction? Especially when we are the sickest state in the nation?

Telemedicine is not new and was not started by UMMC/Dr. Henderson. During the 1990's, national groups, including physicians and private companies, worked on telemedicine of many different forms. This bill requires Mississippi licensed physicians - that's why the Board of Medical Licensure should exist - licensure. It should not be up to a few to continue to keep Mississippi down - many companies and physicians are using telephone and other telemedicine products with great success.

Let's start thinking about health care policy for the year 2016 instead of 30 or 40 years ago.

Anonymous said...

I dropped my membership to the AMA for endorsing Obamacare. I have not dropped my membership to MSMA for opposing this bill. Our associations are anti free market.

Anonymous said...

@1:12 - I believe it is UMMC not UMMV. You are correct about the F grade.

Anonymous said...

*I have dropped my membership to MSMA... Not have not

Kingfish said...

UMMC has a very good telemedicine program. However, why does their system have to be the only way allowed? There can be different models. There is nothing stopping local networks such as St. Dominic and MBMC from creating their own programs and building apps.

However, what I suspect will happen is the private sector providers will be able to move more quickly than UMMC. They can raise capital much more quickly, aren't subject to bid laws and other features of government, and can make decisions much more quickly.

Anonymous said...

I am not Dr. Easterling.

The issue and goal is not to stifle competition. 2:03’s statement is true and I agree with it, however, 2:03 is failing to address policy issues specific to this bill.

1)The bill’s adverse effects of stipulating that patients, not qualified health professionals, drive the choice of telemedicine technology [Section 1, Part 9]

2) The bill’s adverse effects of mandating that cost of services be the same regardless of communication method [Section 1, Part 9]

These two issues have the possibility to be harmful to the innovation we all want and dangerous from a health outcomes perspective.

Even more harmful is Section 1 Part (3) of the bill.

***It tries to specifically classify the physician-patient relationship in the context of telehealth. Lines 26-28 state that this physician-patient relationship can be terminated when

“the physician agreed to treat or diagnose only a specific condition or agreed to diagnose or treat only at a specific time or place and that condition diagnosis or treatment has ended”

**Based on this language, I can over the phone only consent to treat you for only one specific visit and treat your headache based only over what symptoms you describe to me in that specific visit. If you think the issue resolved and later something much more serious happens, well our physician-patient relationship was established and terminated only in the very specific context described above. I am not liable.

I am not trying to fear monger. I am simply pointing out a terrible flaw in the proposed language that should be addressed. Teladoc is indeed disrupting the way healthcare is delivered and that is a good thing. But they too understand their limitations of voice only consultations and are moving in 2016 towards partnerships with companies like Kinsa (thermometer that connects to your phone) to provide a much needed level of interaction in order to begin to address the issue of the level of care being the same as in-person.

And this directly ties into the fact 2:03 also does not address the difference between phone medicine and the definition of telehealth.

-As earlier stated, phones are great tools currently employed by virtually all physicians in existing provider-patient relationships for management of known conditions. Using them to strictly diagnose is much different.

-Telehealth uses an audio-visual connection that includes otoscopes and stethoscopes that allows a physician to simulate everything involved in a physical examination except for smell. This is crucial for quality of care and diagnosing appropriately.

I’m for TelaDoc trying to innovate a way to deliver care through phone only. It is a noble effort, and there are many partnering companies like Kinsa above helping in this endeavor. However, if they are going to do so in this State, they should not be absolved of liability and responsibility through an arguably bad specific definition of the physician-patient relationship.

Anonymous said...

This has nothing to do with UMMC being the only competition. There’s a reason why many large private hospital systems in Jackson and all throughout the State (over 200 locations) are partnering with UMMC to provide complex telehealth services as appropriate. It’s not as simple as just “building your own program” or “making an app.” It is not an issue of raising capital much more quickly. There are very complex clinical protocols and mechanisms required for some of these services offered. This is all very expensive and has taken years to figure out and implement. It’s about building a network and system that does not cut corners and truly maintains the same standard of care as in-person.

I am talking about Stroke evaluations, Emergency Room to Emergency Room consultations, ICU monitoring and much more complex interactions than a phone call from a doctor to a patient via an iPhone for a sore throat.

Again, Kingfish, I would encourage you to check your facts. See how the Center for Telehealth is organized within the UMMC structure. You may be surprised that it is much more agile than typical ‘state institutions’. Research who its nationally recognized technology partners are for Remote Patient Monitoring. Learn about the history of the physician-patient relationship and its legal ramifications in telemedicine.

I’m for expanding access to care. I’m for TelaDoc figuring out how to increase access to care (to at least those with enough money for a smartphone that has access to internet). I'm for TelaDoc providing this care at the same level of quality as in-person and bearing the full responsibility for that physician-patient relationship.

I’m for innovation. This is just a bad bill.

Kingfish said...

No one is talking about using a phone app to diagnose a stroke, heart attack, or other serious medical condition. However, for typical "bugs" such as the flu, colds, or something similar, I've yet convinced that the UMMC model of telemedicine is the only way. I've never said UMMC had a bad system. Quite the opposite. I've just said it is not the only model as well.

If anything, Dr. Brunson should remove himself from the committee so as to remove any hint of a conflict of interest.

Anonymous said...

The Mississippi State Medical Association and the Board of Medical Licensure speak with, as Tonto said, "forked tongues." The are there to assure the quality of care by requiring a medical license in Mississippi for telemedicine and for any derivatives like it.

Of course, that is not always the case with all specialties. The State Board and the Mississippi State Medcial Association have no problem with pathologists from out of state (and not licensed by the State of Mississippi) examining and rendering diagnoses for patients seen in Mississippi physician's offices. Gastroenterologists, dermatologists, and many others are free to send their tissue samples out of state (to non-Mississippi licensed physicians) and this has the "A-OK" from the Board and the Association.

Forked tongues.

Anonymous said...

@1:53 - thanks Kristi -- I think you meant F

Anonymous said...

A good takeaway from this is Please let this application develop now, let people who want to use it go with it and the small kinks will get worked out with the who and whats. With modern technology so much of medical care is still held up by bottlenecks in systems. Not enough of one resource or another. Find those bottlenecks and remove them. Medical associations are more interested in keeping Doctors Incomes and power at an archaic level than getting this system to work.

We also need a Truth In Billing Law nationwide whereby all charges are the same for cash payers, insurance companies and government pay. This would give the effect of removing the fear of medical bills, lower insurance rates and people would be more likely to pay when the charges are not the rip off rates that hospitals charge without the help of third party payers.

Anonymous said...

Dear Med students in Mississippi at the public institution; you attend a "Center of Excellence" that received a F. People around the country make fun of your Med school. Tell your leadership to raise their standards.

Anonymous said...


Anonymous said...

Teladoc is the Oxford House of telemedicine: a litigious out-of-state company whose survival depends on half-truths, threats of litigation, aggressive PR, and special treatment from the government...

William Carey Student said...

@9:59- UMMC is at bottom of the list. Does that mean it's telemedicine program is bottom of the list as well? #smokeandmirrors #F

Heddy-Dale Matthias, MD said...

I am very much in favor of telemedicine, with some stipulations. Although there are many "specifics" to work out at this time, it IS the wave of the future, and there is no reason why MS shouldn't embrace it AT ITS BEST. However, there are many things that must happen to make it BEST.

There are many things telemedicine can do simply over the phone without face-to-face contact as are done by most physician offices today: 1. durable medical equipment ordering, such as braces and splints, etc. 2. simple URI calls (which usually don't require an office visit at all. (most of the time the patient should go to the pharmacy and get symptomatic relief over the counter.) 3. Advice over the phone of WHEN to go to the emergency room . (Most of the time late night phone calls are about whether someone SHOULD go to the ER.)

I am a touchy-feely type of physician, and, I believe that, in most circumstances, a "look is worth a thousand words." I want to SEE the patient, because my 35 years of practice tell me when someone is sick. However, playing "devil's advocate," when was the last time a physician actually EXAMINED YOU by "laying hands" on you? I've found that most physicians never touch their patients. And often, with the HORRORS of electronic medical records, never even LOOK at their patients.

Instead of being obstructionistic, I would like to see MS embrace telemedicine, and find the best solutions to make telemedicine in MS the best for all patients. With most cellphones, a face-to-face may occur between a doc and a patient. What cellphone doesn't have Skype or FaceTime? "Fit-Bit" types of monitors can do this already, almost. Telemedicine stethoscopes? They already exist.

Let's move forward on having patients with automatic blood pressure cuffs, pulse recorders, face-to-face interfaces, temperature probes, etc. that are uploaded to a physician for a consultation. Let's have scales and oxygen saturation apps that can be uploaded.

In fact, why doesn't our Governor bring together the "best and the brightest" in our state and start a business incubator for all of this? There is NOTHING this state couldn't do to bring telemedicine to EVERYONE in MS and sell this technology to the rest of the world.

There are many large hospital systems that employ physicians like me to sit in a room that monitors 20 -30 ICU beds from many different hospitals on cameras, and IMPROVES care immensely with peer-reviewed literature.

I challenge this state, and the state's medical community, to find answers to existing problems with telemedicine, and to bring this EXTRAORDINARY technology to all our patients.

BTW, I am personally knowledgeable about TelADoc. They have EXCELLENT credentialing and all their "practicing" physicians are licensed in the states in which they treat patients.

Anonymous said...

@ 7:07pm and @ 7:13am. As previously stated, the UMMC Center for Telehealth has received an A grade from the American Telemedicine Association.


(reference page 9)

Anonymous said...

7:07 PM

You may be some type of medical professional considering your specific comments on Pathology, but you clearly have no understanding of the Specialty. Go back and do a rotation in Pathology.

It is not an issue of forked tongues. It is an issue of understanding medicine at a level you clearly do not.

Second opinion diagnoses and sub-specialty expert diagnoses (renal pathology, neuro pathology, dermatopathology) are sometimes absolutely essential in order to determine the correct diagnosis for a tissue sample. Sending a sample to an expert in a certain diagnoses is a great quality control tool to validate a diagnosis determined locally.

Some of these expert sub-specialty pathologists are located throughout the country.

For example, we have 3 or so dermatopathologists in the State.

Your example of Pathology and Dermatology to try and prove your point just does not make any sense.

Anonymous said...

To the William Carey Student at 7:13-

Clearly you have no understanding of what these quality surveys measure. While their results have been disputed considering that the baseline is not based off the patient population and types of procedures that happen at UMMC, that is not the issue.

Most of the quality measures rated are not at all related to anything that would happen over telemedicine.

I suggest for you to learn more about how quality is determined for hospital systems and to then learn a lot more about telehealth.

Assuming you are a medical student, best of luck in your pursuit of your D.O. degree. We need more primary care physicians in this state.

Kingfish said...

I don't think anyone is saying UMMC has a bad system at all when it comes to telehealth. Its been innovative. However, the disagreement I think is over whether it is the only system or model that should be used.

Jason Seager said...

KF- agreed, UMMC has a great telemedicine program. They just want to control the entire market. What do you expect from a state run system? Government run industry does not welcome competition.

Anonymous said...

Heddy-Dale Matthias, MD, I encourage you to reach out and visit and learn more about UMMC’s Center for Teleheatlh.

They are currently doing everything that you speak of including the eICU with amazing results. They are also using the technology you speak of to simulate all aspects of the physical examination for the patient visit, although not with Skype and FaceTime as they are not HIPAA compliant. They are also helping other health systems do this for themselves. The Governor is also a huge proponent as you say, and he is bringing the “best and brightest” in the State to both UMMC and many private telehealth companies.

Kingfish, again, I think you are partially missing the point. There are currently 20 telemedicine companies practicing in Mississippi:

•24 7 Dr. Help
•American Well
•Doctor on Demand
•First Stop Health
•InSight Telepsychiatry
•LiveHealth Online
•Memorial Hospital at Gulfport
•My Dr. Now
•North Mississippi Medical Center
•Specialists on Call
•St. Dominic Hospital
•University of Mississippi Medical Center (UMMC) – Center for Telehealth

This has nothing to do with protecting only 'one system', and that one system being UMMC. It has very much to do with understanding the clinical implications of phone-only medicine (as the doctor at 9:07 AM and others have talked about above), and much more to do with implications of language in the bill itself.

You, nor anyone else have yet to directly address among others, the three huge glaring issues with the language in this legislation:

1) mandated patient-driven choice of technology even if this technology may not be appropriate;
(I want to start a taxi cab company, but I have to have an SUV, a convertible, and a truck to start it. Much more expensive to start this service now. A patient wants me to take them to the cold frozen mountains. I have a taxi vehicle that is 4 wheel drive and warm, but the patient insists it has to be in a top-down convertible. I now have to figure out how make my two wheel drive convertible go up the frozen mountain safely when it did not even make sense to be used in this context to begin with.)

2) mandated equal cost regardless of communication method even if some methods are significantly cheaper;

3) dangerous codification of physician-patient relationship that makes it easily defined for a singular visit and then easily terminated after one visit;

Anonymous said...

@11:16- you trust Randy Easterling to determine a patient's best interest?

Anonymous said...

Excellent Discussion and good, thoughtful points. Here's my observation:
1) mandated patient-driven choice of technology even if this technology may not be appropriate;
The committee substitute bill does not mandate patient-driven choice. It mandates that the company have alternative choices to telephone only services. The limits may be on the patient side depending on their equipment or location. If the patient has a choice and the cost is the same, then he will most likely choose what the physician recommends which dovetails into your next issue.

2) mandated equal cost regardless of communication method even if some methods are significantly cheaper;
This is not new as Miss. Code Ann. 83-9-353 (12) already mandates equal cost for health insurance and employee benefit plans that use telemedicine. However, by having equal cost for all communication methods a patient will be more likely to use the most appropriate method, which addresses your first concern. This would help keep costs down while utilizing the most appropriate communication method.

3) dangerous codification of physician-patient relationship that makes it easily defined for a singular visit and then easily terminated after one visit;
The purpose of Telemedicine, as opposed to Telehealth, is to treat minor, non-emergent medical issues complementing, not supplanting, the patient’s primary physician.

I believe it will be important not to specify the type of technology and how it's used. The technology will change as soon as we try to regulate it. Let the technology take care of itself while setting the standards of performance.

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Trollfest '09

Trollfest '07 was such a success that Jackson Jambalaya will once again host Trollfest '09. Catch this great event which will leave NE Jackson & Fondren in flames. Othor Cain and his band, The Black Power Structure headline the night while Sonjay Poontang returns for an encore performance. Former Frank Melton bodyguard Marcus Wright makes his premier appearance at Trollfest singing "I'm a Sweet Transvestite" from "The Rocky Horror Picture Show." Kamikaze will sing his new hit, “How I sold out to da Man.” Robbie Bell again performs: “Mamas, don't let your babies grow up to be Bells” and “Any friend of Ed Peters is a friend of mine”. After the show, Ms. Bell will autograph copies of her mug shot photos. In a salute to “Dancing with the Stars”, Ms. Bell and Hinds County District Attorney Robert Smith will dance the Wango Tango.

Wrestling returns, except this time it will be a Battle Royal with Othor Cain, Ben Allen, Kim Wade, Haley Fisackerly, Alan Lange, and “Big Cat” Donna Ladd all in the ring at the same time. The Battle Royal will be in a steel cage, no time limit, no referee, and the losers must leave town. Marshand Crisler will be the honorary referee (as it gives him a title without actually having to do anything).

Meet KIM Waaaaaade at the Entergy Tent. For five pesos, Kim will sell you a chance to win a deed to a crack house on Ridgeway Street stuffed in the Howard Industries pinata. Don't worry if the pinata is beaten to shreds, as Mr. Wade has Jose, Emmanuel, and Carlos, all illegal immigrants, available as replacements for the it. Upon leaving the Entergy tent, fig leaves will be available in case Entergy literally takes everything you have as part of its Trollfest ticket price adjustment charge.

Donna Ladd of The Jackson Free Press will give several classes on learning how to write. Smearing, writing without factchecking, and reporting only one side of a story will be covered. A donation to pay their taxes will be accepted and she will be signing copies of their former federal tax liens. Ms. Ladd will give a dramatic reading of her two award-winning essays (They received The Jackson Free Press "Best Of" awards.) "Why everything is always about me" and "Why I cover murders better than anyone else in Jackson".

In the spirit of helping those who are less fortunate, Trollfest '09 adopts a cause for which a portion of the proceeds and donations will be donated: Keeping Frank Melton in his home. The “Keep Frank Melton From Being Homeless” booth will sell chances for five dollars to pin the tail on the jackass. John Reeves has graciously volunteered to be the jackass for this honorable excursion into saving Frank's ass. What's an ass between two friends after all? If Mr. Reeves is unable to um, perform, Speaker Billy McCoy has also volunteered as when the word “jackass” was mentioned he immediately ran as fast as he could to sign up.

In order to help clean up the legal profession, Adam Kilgore of the Mississippi Bar will be giving away free, round-trip plane tickets to the North Pole where they keep their bar complaint forms (which are NOT available online). If you don't want to go to the North Pole, you can enjoy Brant Brantley's (of the Mississippi Commission on Judicial Performance) free guided tours of the quicksand field over by High Street where all complaints against judges disappear. If for some reason you are unable to control yourself, never fear; Judge Houston Patton will operate his jail where no lawyers are needed or allowed as you just sit there for minutes... hours.... months...years until he decides he is tired of you sitting in his jail. Do not think Judge Patton is a bad judge however as he plans to serve free Mad Dog 20/20 to all inmates.

Trollfest '09 is a pet-friendly event as well. Feel free to bring your dog with you and do not worry if your pet gets hungry, as employees of the Jackson Zoo will be on hand to provide some of their animals as food when it gets to be feeding time for your little loved one.

Relax at the Fox News Tent. Since there are only three blonde reporters in Jackson (being blonde is a requirement for working at Fox News), Megan and Kathryn from WAPT and Wendy from WLBT will be on loan to Fox. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both and a torn-up Obama yard sign will entitle you to free drinks served by Megan, Wendy, and Kathryn. Get your tickets now. Since this is an event for trolls, no ID is required. Just bring the hate. Bring the family, Trollfest '09 is for EVERYONE!!!

This is definitely a Beaver production.

Note: Security provided by INS.

Trollfest '07

Jackson Jambalaya is the home of Trollfest '07. Catch this great event which promises to leave NE Jackson & Fondren in flames. Sonjay Poontang and his band headline the night with a special steel cage, no time limit "loser must leave town" bout between Alan Lange and "Big Cat"Donna Ladd following afterwards. Kamikaze will perform his new song F*** Bush, he's still a _____. Did I mention there was no referee? Dr. Heddy Matthias and Lori Gregory will face off in the undercard dueling with dangling participles and other um, devices. Robbie Bell will perform Her two latest songs: My Best Friends are in the Media and Mama's, Don't Let Your Babies Grow up to be George Bell. Sid Salter of The Clarion-Ledger will host "Pin the Tail on the Trial Lawyer", sponsored by State Farm.

There will be a hugging booth where in exchange for your young son, Frank Melton will give you a loooong hug. Trollfest will have a dunking booth where Muhammed the terrorist will curse you to Allah as you try to hit a target that will drop him into a vat of pig grease. However, in the true spirit of Separate But Equal, Don Imus and someone from NE Jackson will also sit in the dunking booth for an equal amount of time. Tom Head will give a reading for two hours on why he can't figure out who the hell he is. Cliff Cargill will give lessons with his .80 caliber desert eagle, using Frank Melton photos as targets. Tackleberry will be on hand for an autograph session. KIM Waaaaaade will be passing out free titles and deeds to crackhouses formerly owned by The Wood Street Players.

If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!

This is definitely a Beaver production.

Note: Security provided by INS