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The House Committee on Public Health met on June 28 to take up an interim charge on opportunities to improve population health and health care delivery in rural and urban medically underserved areas.

This report is intended to give you an overview and highlight of the discussions on the various topics the committee took up. This report is not a verbatim transcript of the hearing; it is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.

 

Dan Hunter, Texas Department of Agriculture

  • Federal funds for the State Office of Rural Health need a 3/1 match from the state
  • Have been allowed to use funds spent on capital improvement program as part of the match
  • Also run the Hospital Rural Investment Program
  • 63 of rural counties don’t have hospitals, 35 don’t have primary care physicians; need to look closely at what is involved in maintain operations
  • Need to look at innovative solutions, telemedicine is a critical part of this, likewise incentivizing nursing professionals
  • Healthcare in these remote areas is important to support economic activities of these areas

 

John Hellerstedt, Department of State Health Services

  • Have problems connected with tobacco, poor dental care is more prevalent in rural areas
  • Health professional shortage areas are identified with a decreased ratio of health providers, can cover entire/partial counties
  • Of the 375 shortage areas, most are for primary care and mental health providers
  • Shortage areas may provide incentives for new health professionals moving into the area
  • Regarding Conrad 30 Visa Waiver Program, allows foreign nationals to apply & be sent to these health professional shortage areas, 30 total
  • States with much lower populations get the same number of professionals to send, which makes it difficult in a large state
  • Price- The number of slots is a federal or state decision?
    • It’s a federal matter
  • In Texas at any given time, there are about 90 Conrad Visa professionals around the state in shortage areas
  • Almost 11% of rural counties have local public health departments, leaving most of the responsibility to DHS
  • Burkett- Do these people get a stipend or do we just help them get a visa?
    • They qualify for the waiver when they’ve been hired for a job for 3 years, and it does vary by specialty
  • Burkett- Are these people that are dealing in specialty practices based on the needs of the area?
    • I think they are based on where they can land a job
  • Collier- To get the visa, it must be an underserved area that they’re working in?
    • Correct, it must be an underserved area
  • Sheffield- Are there records kept about how many of these doctors stay in the initial area they move into?
    • I am not sure, I can do some research and get back to you
  • We have taken an extensive approach to travel to each of the regions to meet with leaders, to increased cooperation and receive feedback to improve
  • Resources being distributed around the state were affected by Hurricane Harvey
  • New ideas for cost-effective and efficient plans- increasing access to treatment from telemedicine.
  • Rather than a nurse driving 100+ miles to conduct and in-home visit, this can be done from a video link or cell phone to verify that patients are taking the correct medicine
  • We want to collaborate to increase disaster training, recognize human trafficking cases and find necessary help for victims, further disease prevention, and increase STD testing
  • We have initiatives such as rural health conferences, migrant workers, rabies vaccines for animals, human trafficking awareness and responses
  • Operation Lone Star- provides dental service in San Antonio each year to about 10,000 people
  • Tobacco prevention and control coalition being utilized, as tobacco use is the #1 risk factor in maternal mortality in Texas
  • In rural areas, EMS responsibilities are even greater due to the large distances that need to be traveled
  • Sheffield- Give us an example in high technology in EMS today?
    • It is now essentially a mobile ICU, where trained professionals can use IVs, lifesaving drugs
  • Arevalo- Expand a bit more about what type of outreach and training is being given to migrant workers?
    • I know we conduct those meetings, but I do not know the content. I can get back with you when I know.
  • Sheffield- 120 trauma designated facilities and 59 critical access facilities, can you explain what these are?
    • The trauma facilities are cleared by the American Association of Surgeons and are divided into levels 1-4 with 1 being the most critical, and 4 being a routine hospital visit. Their job is to stabilize patients, and quickly transfer them to whatever care they need.
  • Sheffield- So what are the critical access facilities?
    • That is a designation where it is a certain distance from a hospital, to serve as a care provider for those not close to a hospital
  • There are challenges to providing EMS service to rural areas, including the rapidly aging population of these rural areas
  • Of the 66,000 EMS personnel in Texas, less than 20% work in rural areas
  • Even at our peak responsiveness, it will take longer to reach one in a rural area, rather than an urban area
  • We are in process of 2 CDC grants to use in rural and bordering areas, we are hoping to hear back next month
  • Price- In addition to funding opportunities, are there any other movements being made to improve medical access in rural areas?
    • I do not want to speak yet, because we have not finalized them, but I will let you know
  • DHS is committed to working with local health services, and sending officers out to meet with rural communities
  • By the end of the summer, we hope to have a plan to improve care in the rural areas

 

Stephanie Stephens, Deputy Medicaid Director HHS

  • Acute care benefit covers both telemedicine and telehealth for Medicaid
  • Difference between telemedicine and telehealth is who can provide the help, they also differ in reimbursement. Telemedicine is available for reimbursement for a facility fee, however telehealth is not.
  • We’ve seen an increase of roughly 20% in telemedicine and telehealth between 2015 and 2017
  • Price- What’re the most common services received via this service?
    • Mental health
  • Occupational therapists and speech pathologists have been added in school settings to telehealth

 

Stephen Brint Carlton, Texas Medical Board

Scott Freshour, Texas Medical Board

  • Gives a summary of SB 1107 and the subsequent changes that have occurred because of its passing
  • Price- Currently if a Texan wants to see someone who is not certified by the State of Texas they must travel out of the state, are there any referrals or ways to make this easier through audio/visual?
    • Prescher- If a physician was to treat a Texas citizen, they would need a Texas certification.
  • Price- So, this is not allowable using telemedicine currently?
    • Prescher- Yes
  • Explains some of the barriers to the implementation of telemedicine, the standard of care must be the same as if they were in person. Protecting confidentiality and staying HIPA compliant is vital
  • Very few complaints to date about telemedicine, generally people seem to like it
  • Price- Do you guys know how many providers are taking advantage of SB 1107? Including knowledge of reimbursement and general understanding of the program. Ponders if the cost of technology and the difficulty to staying HIPA compliant deters potential candidates for this program.
    • Brint- Not aware that the medical board currently gathers these kind of statistics, however I can reach out.
  • Sheffield- You mentioned that narcotics cannot be prescribed over telemedicine, how about acute pain?
    • Prescher- Yes, some exceptions can be made

 

John Henderson, Texas Organization of Rural and Community Hospitals

  • No rural hospital closures thus far in 2018, however we are aware of 3 currently that will be closed soon
  • Rural hospitals not only provide care to patients but also vital infrastructure to the community
  • The average rural hospital employs 173 people, these institutions turn millions of dollars through the economy
  • Rural communities are generally composed of older and poorer people, they cost more to run due to location
  • Rural hospitals are paid about $65 million less than the operating costs they incur currently
  • If the commission were in the loop and held their payers more accountable, we would likely see less closures
  • Oliverson- Rural hospitals do not have a full floor of data crunchers and log keepers in order to stay current with administrative costs. Can you comment on how this factors into some of these closures?
    • Henderson- There is significant burden to getting the necessary paperwork done, with no reimbursement to account for the staffing required. I’m hesitant to complain about this.
  • Oliverson- Concerned the trend that healthcare is taking in regard to informatics disproportionately impacts rural communities
  • Believes that telehealth will be a gamechanger to rural communities, especially in regard to specialists

 

Janis Crawley, Bowie Economic Development Corporation

  • Provides information about the impact rural hospital closures had on her city
  • The impact is not just the immediate loss of jobs at the hospital, but the trickle-down effect as well
  • Price- Did you look at how this impact property taxes and the subsequent impact on schools that that might have had?
    • Unemployment rose to 5.2%. Lost 15 children out of the school district, the 15 all had medical needs.
  • Community college in the area used to have a skilled nursing program, however since the closure we’ve had to remove that curriculum despite the interest in enrollment
  • Warns the committee that many rural communities do not even have internet access yet, so telemedicine may be less effective than we think

 

Don MacBeath, Texas Organization of Rural and Community Hospitals

  • Stepdown rural hospitals are the most promising avenues we can pursue right now
  • The average budget for a rural hospital is $22 million dollars per year
  • The concept of the stepdown hospital is essentially an emergency room, where a patient can stay one night if need be
  • We believe this should be pursued because the cost of running a full-fledged hospital is very expensive currently especially in the rural communities
  • If we are successful in having congress pass this, then the burden falls on the legislature to sanction these as actual hospitals
  • Sheffield- Could that happen before the 86th session?
    • Very likely will happen in the next year, so probably the 2021 session.
  • Price- Are there circumstances where certain rural hospitals are more appropriate to be closed than others? I’m hesitant to say they need to be, but there’s not a one size fits all approach
    • Some communities simply cannot sustain a hospital
  • Every closure is different, but the primary reason is always the same- they did not have the money to fill payroll any longer.
  • What this legislature does have control over is Medicaid funding, 162 hospitals are being underpaid by $110 million dollars per year.
  • The hospital administration in Van Horn versus the multi-billion-dollar insurance companies, who do you think wins those negotiations? This was just meant to be an example.
  • Sheffield- One of our counties had a hospital and then lost it. What kind of strain does this put on EMS?
    • Very serious implication and strain on rural EMS. Dilemma is that the local ambulance now must take someone further away, and while they’re doing that there is no medical coverage for the remainder of the residents.
  • Arevalo- Are you seeing a decline in payments under managed care? What is different now as compared to before when we used fee for service.
    • There was state guidance to pay rural hospitals, however those were based on calculations from 2010. We are using 8-year-old data and rates to calculate.
  • Arevalo- So what are you seeing now?
    • I contended that the actual payments are $65 million dollars less than costs, despite the legislature mandating that they pay costs.
  • We not only fight prior authorization. also are constantly dealing with approval/denial issues.

 

Fred Cerise, Parkland

  • About 1 million uninsured in Dallas County
  • Dallas County has lowest acceptance of Medicaid rate among 15 densely populated areas
  • 75% of our business is from uninsured people
  • Two approaches to address high demand- look at delivery system and being more precise using predictive analytics
  • Price- How long have you used predictive analytics?
    • About 8 years
  • Price- Is it growing in use?
    • It is, while it started its use for deciding on hospital readmissions. The predictive factors that we come up, including their socioeconomic status and location of residence, with provide a good profile to better serve them
    • It can also share information with primary health care provider, helping prevent hospital visits and traffic (caused 40-50% drop in ED visits)
  • Price- Is this technology scalable and affordable to smaller systems?
    • It is scalable but may not be affordable. Our system was brought up by a $10 million grant. We have used this to connect health centers around the state.
  • Right Care program- We send a social worker out with the Police to deter behavioral issues from making it to ED
  • We developed an electronic consultor where we can email a specialist a question, and they can answer electronically and avoid a visit all together
  • Face to face visits have gone down drastically
  • 35-40% visits done electronically
  • This creates more space in our specialty clinics, and primary health providers can communicate with specialists to avoid a visit
  • Collier- If someone comes in for a Metrocare/mental health issue, then starts talking about another issue, is that when this would be used?
    • This piece would not include Metrocare. It would be more for an orthopedic and a primary care physician for example.
  • Collier- Are doctors getting reimbursed for these emails?
    • We don’t. This speaks to our system, where we have a population-based approach. We have a contract with the specialty physicians where if they choose to do these email consultations, we will reimburse the physicians. Most other places aren’t going to do this because insurance won’t pay for this email.
  • Collier- Your goal is the positive health outcomes, and you believe this is the best way to go about this?
    • Yes, we believe by eliminating the inefficient face to face visits and using information flow, we can help more people. Wait times around our system have dropped from months to weeks in most cases.
  • Doctors can also electronically prescribe, and this makes for a convenient system for our people
  • For behavioral problems that needed to be addressed by ED, 4 police officers would show on site and either arrest or bring the subject to the hospital
  • We are moving from arresting or hospital visits, to address behavioral issues with a social worker with the Rite Care system
  • Price- Do you have any sense of what the cost differential is on that?
    • I don’t have cost data yet, but we are freeing officer time and without going to the emergency room, we save money
  • Oliverson- I really like this idea, and I would love it if you could get some cost data. But I think this is a model program for the state.
    • I know the numbers will be good, and we will send those to you guys when we get them
  • Burkett- Is this only for the City of Dallas?
    • Yes, we partnered with Dallas PD
  • Burkett- I think police officers in Rowlett did this on their own, and I think it’s a great idea.
  • We have a new faith-health collaboration with about 80 congregations, where congregations will help patients with child care, etc. while in treatment
  • This network knits congregations that want to do this work with hospitals that need help
  • Our main goal is serving seemingly limitless demand with limited resources, and we have implemented these systems to be as efficient and cost-effective as we can

 

John Hawkins, Texas Hospital Association

  • The challenge of low reimbursement rates for health providers is a problem in both rural and urban areas
  • This highlights the need to get supplemental payments, as the Feds are phasing out paying for the Medicaid shortfall, which is about $2 Billion per year
  • Also points to the importance of trauma care, and the funding behind it
  • That funding also goes to the safety net hospitals, rural hospitals
  • DSRIP- Delivery System Reform Incentive Payment
  • The new waiver phases out DSRIP
  • CMS is not happy with DSRIP but as they move to value-based payment, they don’t want another payment system
  • We can figure how to weave the good things from DSRIP into this new system
  • This will be aided by telemedicine, and more efficient use of hospital and ED time
  • We need to make sure we keep the $3.1 Billion from DSRIP in the system
  • We have 175 hospitals signed up to reduce bad outcomes in the post-partum issue
  • Hospital staff such as doctors and nurses need to be kept up with the growing population
  • Oliverson- Is there anything that THA can be doing to help rural hospitals?
    • We are supportive of them doing things differently because our systems will not work in low-volume areas. The other initiative is on the federal level, as I met with HHS and we spoke on this issue.

 

Billy Phillips, Texas Tech University Health Sciences Center

  • My specialty is telemedicine and telehealth
  • Our area is Texas and Louisiana
  • 71% of specialists use telemedicine
  • According to the ATA 2017 Survey, there 200 networks, 3,500 sites, and 1 million people that have consumed telemedicine
  • We do have rural health disparities, as there is more chronic disease in West Texas
  • Women in rural areas are less likely to get prenatal care than in urban areas
  • The direct cost of these disparities is about 1.7-2.1 billion, and lost productivity is about 2.9-3.5 billion
  • Benefits of telemedicine include- increased access, increased customer satisfaction, convenience, and service diversion
  • This service diversion can put people in the right care, and Twitter can also be used for this
  • Having no care at all is more economical than our current system without telemedicine
  • I looked at a 2017 survey about the biggest 1,300 health care systems in the country, 69% of systems use telemedicine, and of those systems 70% plan to increase it in 2018
  • 76% of systems not using telemedicine already have made it a priority to adopt it in 2018
  • This will force the payer community to define telemedicine visits, and we will have to change our documentation of these encounters, and how we code them
  • Because of these changes, you could have a regular office visit reimburse $73 or $127 depending on the way it was coded
  • The average delay of payment is 181 to pay for telemedicine
  • Collier- Are they teaching telemedicine system in medical schools?
    • Yes, I will speak on that in a second.
  • Collier- In California more patients were treated electronically rather than face to face, is that a good thing?
    • It may not be a “good” thing but it is economical and efficient. It depends on a case by case basis what is the best way to treat each patient.
  • Collier- My concern is that everyone will go towards virtual visits, and patient contact with physicians will go away. What does a virtual visit look like? Because insurance companies will want to pay less for shorter visits.
    • I would like to see us come to a consensus on what a virtual visit looks like.
  • Price- It always confuses me, but the bill did try to clarify the use of telemedicine as a modality to provide a service. There is nothing on telemedicine that can’t be provided face to face. The payment should be no different because the language in the bill is clear.
  • Price- It seemed like when we were passing that law, the insurance companies wanted to package telemedicine differently, but I think it should be treated the same
  • We have reduced ER utilization, conversion rate of disease, and eliminated a 2 or 3-hour care ride for patients
  • Easy, trackable tasks are best uses for telemedicine, as much time spent in waiting rooms or transportation is eliminated
  • In past 3 years, we have seen much change in the way telemedicine is taught in medical schools
  • We made the first significant program in Texas to train our employees on telemedicine
  • We want every medical student trained in telemedicine, as we feel it should be mandatory to be trained in a system that is becoming more common
  • West Texas needs to be focused on, as it is a vital piece of the food, energy and many other things this state could not do without
  • To remain a top health care system, we need to keep up with new technology and telemedicine is the best way to link providers across Texas
  • Verizon’s 911 alterative may be a reality in West Texas, we have 10 EMS providers that run a mobile ER in a truck
  • We stabilize, triage and stop at the most appropriate trauma center and gets people exactly where they need to be

 

 

 

 

David Lakey, University of Texas System

  • Social determinants of health, health risk factors, health care all have disparities in rural areas compared to urban areas
  • 5 leading causes of death in the U.S., there is a significant difference in outcomes in rural America
  • Age adjusted mortality rate in urban areas is 704, as opposed to 830 in rural areas (18% difference)
  • Unintentional injuries are about 50% higher in rural areas
  • Suicide rates are higher in rural areas
  • Report from CDC- All age brackets have significantly higher obesity rates in rural areas
  • Texas rural obesity rates are 3rd highest, and urban obesity rates are the 8th highest
  • East Texas and the Border are the problem areas in Texas
  • Many rural areas are in our designated area for the University of Texas, so we have been making this issue a priority
  • If East Texas was a stand-alone state, it would have 6% of Texas’ population
  • Overall Texas mortality is 31st, East Texas 45th, and in some areas East Texas would rank worst like stroke (51st out of 51 theoretical states)
  • Tobacco usage rates are significantly higher in East Texas, rates of cardiovascular disease and stroke will be higher
  • The rate of pregnant women that smoke is over 10% in some areas
  • Collier- Did you differentiate between smoking and smokeless tobacco?
    • This is tobacco in general, as both can cause cancer
  • Price- Texas is different than the rest of the country and rural and urban areas are much different.
    • I think one of the challenges is that bad outcomes are hidden in the overall aggregate. It’s only when you pull it all apart that you see that in some places, Texas is on the same level as the Mississippi River Delta
  • Price- Are we concentrating some of our resources on tobacco prevention and other things in rural areas? How finetuned is that process or does it depend on what you’re trying to accomplish?
    • One of the hidden challenges in Texas in relation to putting money where it’s needed. When the money is put up and many areas try to have that funding come towards them, I could tell which areas would win out. The rural areas would get cut out and we must figure out how to get them the resources.
  • We have a new van that parks outside of schools in East Texas and is a mobile asthma clinic
  • We have already seen lower emergency visits and spending, which sends excess money back to the schools
  • Our new program allows to use the Health Science Center as an academic home for nurse-family partnership, where a nurse will work in the home of a woman having her first child and help them care for the new baby
  • We have partnered with MD Anderson to bring it to East Texas, to provide better cancer care
  • We have a separate partnership with UT Southwestern that does mobile cancer screening in rural areas
  • We have a program funded since 1995 looking at agricultural health and injury prevention
  • Another project is that we are starting a School of Community and Rural Health, and this will be the hub of education and prevention in the area
  • We purchased East Texas Medical Center to stabilize, and quickly add graduate education in what is now called UT East Texas
  • UTRGV is bringing graduate medical education to the Valley, and increasing residents training in health programs
  • We are working on initiatives focused on slowing Diabetes in the area
  • Partnered with United Health Foundation to build a collaborative van to go into rural areas and provide primary care in hard to reach areas
  • We are working on physician mentoring using telecommunications, as doctors can reach specialists to ask about cases, therefore becoming better educated on how to treat patients
  • Cortez- Is this UT Science Center in San Antonio playing a role in these initiatives?
    • They are doing a great job. They have a program called REACH and they go into rural areas and the Spanish-speaking community to help. They have been very active in the fight against Hepatitis C and have helped get UTRGV going.
  • Cortez- Glad to hear that. Thank you.
  • Collier- There is going to be 200 new medical slots in Northeast Texas?
    • Yes, we are planning on bringing in 200 more, to put it at about 300 total. People tend to stay where they’re training so hopefully they will stay in the area after their education.
  • Collier- I am excited about this effort to keep our medical students in Texas rather than having them go to other states.
  • Recommended that funding be put towards better data about the trouble areas of Texas in terms of health
  • Asked that the legislature focus on “health rather than healthcare” as tobacco and obesity are major issues in Texas
  • We need to be wise in our use of technology, as we have a large investment in telehealth within the UT System
  • We must better equip primary care physicians through tele-mentoring
  • The issue of broadband access in rural areas is a major problem that needs addressing
  • We need to look at how to integrate mid-level health professionals with primary care physicians and medical graduate students

 

Mari Robinson, University of Texas at Galveston

  • The committee being run by Dr. Lakey is going to be accompanied by Universities around the State to gather data
  • Hopefully the data will be collected by the end of 2018
  • UT Virtual Health Network- idea is to create care network across the state to provide care through telemedicine
  • We are currently underserved in every medical specialist area
  • Virtual Health Network goals- to build a centralized video platform to be able to easily communication, to build a scheduling and document sharing platform which displays the large schedule of doctors onto a central place,
  • Price- What is the expected timeline of implementation of the Virtual Health Network?
    • Some projects are already live, but the scheduling and software aspect will hopefully be finished in 1 ½ years

 

Nancy Dickey, Texas A&M University Rural and Community Health Institute

  • The rural Texas population is on average older, heavier, more likely to smoke, with higher uninsured and Medicaid rates
  • Many Texans are not going to see appropriate medical personnel because of inconvenience and long transportations to hospitals
  • Opportunities for hospitals are different in rural and urban areas, as rural hospitals are often stretched much thinner because of the less number of patients
  • There is a need for more education and leadership in the hospital system, and they often wait too long before seeking help
  • One way to combat poorly run hospitals is to downsize the facility and focus more on individual care
  • Hospitals should be able to track their progress and be able to tell their standing before it’s too late
  • Price- I think the stand-alone ER facilities, that are sometimes in the town over from these rural areas, are pinching these communities that are stuck with nothing.
    • These stand-alone ER facilities are much better served in suburban/urban areas. But when sending a doctor out to rural areas, they need to be trained. Not many medical students do not choose to train for rural care.

 

Brian McCall, Texas State University System

  • Sam Houston State University is looking to open a College of Medicine (Osteopathic Medical Care), and has the land and first 3 years of expenses paid for
  • We have identified 172-235 first year residency spots at no cost to the state
  • Not asking for funding or special legislation, this project is privately funded and operated
  • Collier- You said you can create up to 235 residency spots?
    • Yes, we can create up to 235, and we already have 72 signed up and the school is not finished.
  • Collier- These opportunities will be in rural and underserved areas at no cost to the state, how does that happen?
    • Yes, that’s correct. We are pulling federal dollars using a new program where the federal government can identify rural hospitals that can receive funding for graduate programs.
  • Collier- We’ve heard today that doctors most likely stay in the same area that they completed their residency in, so this sounds like a great plan.
    • Yes, we are going to recruit potential students from these rural areas and hope they remain there to serve the communities.
  • Collier- Is this going to be a private program?
    • We are applying a private school funding method to a public-school system. When we take our first care, the tuition should be a little below average compared to rest of the country’s medical schools.
  • Cortez- How can we help? This program sounds like an awesome plan.
    • We have a vote coming up next month, so we’re focusing on that.
  • Oliverson- Do you think that a written letter from some of the member on this committee would help your upcoming vote? If so, we will do it.
    • Yes, thanks you so much.

 

Kelly Rhone, Avera eCare

  • In South Dakota, we were started years ago and have expanded into 11 states including 4 critical access hospitals in Texas
  • Almost all the hospitals we work with are critical access hospitals
  • Through our telecommunications and networking calls, we can almost help any person in critical care and help doctors to care for them more effectively

 

Tucker Anderson, Code 3 Emergency Partners

  • Asked to authorize free-standing medical facilities ability to participate in Medicare and Medicaid programs
  • Code 3 operates a state-licensed Hybrid FEC in Rockport, Texas
  • We are required to treat any Medicare/Medicaid regardless of ability to pay
  • These programs do not have to pay our facility back for the patients that we are legally required to treat
  • Price- Is there any sort of waiver for emergency conditions that you experience?
    • We worked hard for a waiver after Hurricane Harvey and were denied. Now we are told it would take legislation to get our goal through.

 

Tamara Perry, Children’s Health

  • Our flagship location is in Downtown Dallas
  • Our mission is to make life better for kids, simply put
  • We want to be able to move care outside hospital walls using telemedicine, which will also save time and money
  • We also have school-based behavioral programs, over 110 schools that are on board
  • The program has saved the state $1.5 million
  • Collier- It sounds like because of the transplant complications, it’s important to monitor them after the operation, and it sounds like you are doing this through telecommunications.
    • Yes, this is one of the most beneficial pieces of our telemedicine. The provider knows exactly how their patient is, whether they are taking medicine etc.

 

Erin Biscone, APRN Alliance

  • Texas still requires a delegated authority for APRNs to practice
  • This makes it less likely for APRNs to move into Texas to work in rural or underserved areas
  • Research shows that APRNs are one of the most effective care strategies for rural areas
  • They work side by side other practitioners, like physicians
  • States that have taken away this restriction have lowered doctor visits, hospital costs among many others

 

Ahia Shabaaz, Texas Silver-Haired Legislature

  • We are working to increase access to medical care to the elderly by telemedicine
  • Some of the issues brought about by limited mobility of elderly people is solved by the advantages of telemedicine
  • Texas’ overall ranking in access/affordability is 44th, so we have work to do on our system
  • Cortez- Thank you for being here. Send us anything that you’d like us to read.

 

John Parks, Avera eCare

  • We serve around 400 hospitals around the U.S.
  • Telemedicine can be more than just patient-doctor interactions
  • Telemedicine can solve more goals around health care than you may think
  • Funding for broadband, initiative of staffing and recruiting efforts, etc.