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per month and provided the necessary personnel, infrastructure, and space.
On March 13, 2014, the Nurse Managed Parkinson’s Clinic
hybrid model with a mix of telehealth and face-to-face interactions all taking place in the same location. In this model, the nurse the patient to the MDS on a large monitor screen set on top of a telehealth cart. This multidisciplinary team model is a powerful way to provide health care. Telehealth technology allows for this model of care to be delivered anywhere. Since its inception the patient satisfaction rates have been very high, and as word has spread about the PD clinic, the wait list has grown to be 4-6 months long, necessitating the need to bring in a second movement disorder specialist from out of state to help see the volume of new patients. Three years after the opening of this part-time clinic, more than 250 new patients have been seen.
While the model works extremely well, the one barrier to its sustainability is the lack of Medicare reimbursement for telehealth. The overwhelming majority of patients with Parkinson’s disease are over the age of 65 and, as such, do not have insurance coverage for telehealth visits. The short term solution for this problem in this academic setting is to cover the cost of the telehealth specialists using grant funding and foundation support. Leaders in the Parkinson’s community are actively involved at the state level to resolve this issue at the legislative level.
BEHAVIORAL HEALTH SERVICES
The behavioral health clinical community in Delaware has
been gradually implementing telehealth for mental/behavioral health services; commonly used terms for these services include telepsychiatry, telemental health, telebehavioral health, and telepractice. Telepsychiatry is critical due to the shortage of psychiatrists and the need for prescribers, particularly in Sussex County.11 Use cases of telepsychiatry include on-call services at Delaware Psychiatric Center (DPC), medication assisted treatment (MAT) programs for opioid addiction licensed through the Division of Substance Abuse and Mental Health (DSAMH), crisis intervention, and screening and treatment services for depression and other behavioral health conditions.
Telehealth for counseling or therapy services is expanding, as well. Drug and alcohol counseling, family therapy, and psychology services are becoming available; a somewhat slower adoption,
however, may be due to the wait for regulatory guidance recently
Medicare population (i.e., seniors and individuals with disabilities) has few options due to the lack of Medicare reimbursement for telehealth anywhere in the state. (Reimbursement is discussed in more detail below.)
DELAWARE TELEHEALTH COALITION
As previously mentioned, the Delaware Telehealth Coalition was formed in response to the need to cultivate the use of telehealth
in the state. It was clear from the start that many local health care professionals and consumers knew little about telehealth except for a few programs already in operation including the eICU at Christiana Care Health System (CCHS), the CCHS Visiting Nurses Association (VNA) use of remote patient monitoring (RPM) for its home health program, and Nemours AI DuPont Hospital for Children (Nemours) use of store and forward technology for physician-to-physician cardiology consultations. The Coalition provides education, collaboration, and networking. Coalition member organizations have partnered on projects, shared policy and technical information with each other, and addressed barriers and challenges together.
One member — from the PD community — knocked on legislators’ doors until champions for telehealth surfaced and sponsored HB
69 (aka the telemedicine bill) which mandated private insurance reimbursement. Governor Jack Markell signed the bill into law and it became effective January 1, 2016.12 Unfortunately, after all of since most people with PD are covered by Medicare. The coalition continues to advocate for Medicare coverage by way of writing as by exploring the relationship of telehealth with new payment models such as those for the various types of Accountable Care Organizations (ACOs).
meeting in 2011 includes: the 2013 Delaware Telehealth Roundtable and the resulting 2014-2016 Telehealth Strategic Action Plan
(SAP), the implementation of the SAP, and a new roundtable
to refresh the plan in May 2017; the October 2015 Telehealth in Delaware Conference, a partnership between the Coalition, DHSS and the University of Delaware’s Division of Professional and Continuing Studies (PCS), attended by over 165 stakeholders;
and the creation of a position within DHSS to manage telehealth projects within the department, to serve as a local resource on
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