1. A New Way to Look at the Business of Healthcare Nancy Nahlik Missouri Baptist Medical Center BJC HealthCare March, 2014

2. Background Missouri Baptist Medical Center is a Community Hospital in a large metropolitan market What could we do to set ourselves apart? Developed relationships with rural hospitals Educated Medical Staff on value of outreach Created a hospital philosophy dedicated to rural markets Started working on program development specifically for rural hospitals and patients CME programs Missouri Heart Network Affiliation Agreements

3. Then…….. 2002 – 82 specialty outreach clinics in… 13 rural markets by ….. 45 different physicians 2006 – Rural markets represented 31% of total MoBap “cases” 110 outreach clinics in … 17 markets by …. 63 different physicians

4. And Now 2013 – Rural markets represented 28% of total MoBap “cases” 90 clinics in… 15 markets by…. 50 different physicians

5. Other Outreach Programs – Access to Purchasing Contracts through BJC – Heart Life Line Alliance (STEMI) – ED to ED Transfer Program

6. Why Telehealth? Economy Physician retirement Younger physicians looking for quality of life and work/life balance

7. What is Telehealth? Telehealth: The use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.

8. Telehealth is …..  NOT SKYPE  NOT Texting pictures from phones Telehealth must be: - HIPAA compliant

9. Who is Using Telehealth Across the Country & World? Cleveland Clinic Mayo Clinic Johns Hopkins University of Michigan Emory University of Missouri Missouri Baptist Medical Center many more

10. How Are They Using Telehealth? ICU Coverage Hospitalist Services Stroke Coverage Consulting Services Surgical Assistance Physician “Office” Visits

11. And…. Pharmacy Support School Nurse programs In-home monitoring Long Term Care Assistance Chaplain Assistance – patient and family education

12. What Does Telehealth Look Like?

13. At the outlying site, it is this…

14. And this

15. At MoBap, It Is This…

16. Telehealth at Missouri Baptist Medical Center Mo Bap can beam into 4 rural robots Specialty physician visits ED transfers Working with a Long Term Care Company to put a robot in one of their skilled and rehab units

17. Specialty Clinics Cardiology Oncology Pulmonology ENT – discussed, but not implemented Neurology – within 3 months

18. Specialty Clinic Seeing 60 – 70 patients a month in two rural locations Both new patients and followups Patient satisfaction is HIGH Physician satisfaction is HIGH MoBap satisfaction is HIGH

19. Emergency Services Robots in 4 rural CAHs Available 52 hours a week In a 5-month period in 2013: – 86 encounters an average of 20 min. each – 64 were direct admits to a floor – 12 admitted to ICU – 4 were recommended for a higher level of care – 2 came to our ED – 1 discharged from rural hospital

20. Emergency Services in 2014 Averaging 4 calls a day 3 physicians providing service Will be starting 24 hour 7 day a week “Consulting Services” through the ED within the next 3 months

21. ER Physician in a rural ER determines that a patient needs to be transferred to MoBap. He calls Dr. Winer’s cell phone. Through Telehealth - on an IPAD - Dr. Winer is able to “beam into” the rural ER. Robot taken into the patients’ room. Dr. Winer introduces himself to the patient and through telehealth is able to confirm the condition of the patient – and reassure them about the transfer. Dr. Winer calls the MoBap ICU and arranges for a bed. The patient becomes a direct admit.

22. What Does This Accomplish? 1.With “eyes on” – the MoBap physician can be reassured about the condition of the patient 2.MoBap can make recommendations on method of transportation – Ground vs. Air 3.Keeps patient from being in 2 EDs 4.Patient and family satisfaction

23. Telehealth in Nursing Homes In the beginning phases Working with one group within Metropolitan Service Area Consults will NOT be billable Patients will have a record at MoBap whether the patient is admitted here or not

24. Advantages to Nursing Home A resource for staff during “off hours” to help determine whether a resident needs to go to the Emergency Department. Reduces the number of residents sent to Emergency Departments Reduces hospital re-admissions Makes nursing home a choice referral source for discharges from MoBap, knowing that they are involved in keeping the resident out of the hospital Clinical training/education supporting our staff

25. Advantages to Hospital A reduction in non-Emergency visits to the Emergency Department A potential increase in true Emergency Department admissions A reduction in re-admissions A collaborative partner on the clinical care of patients

26. Why Telehealth? Efficient patient care The technology is dependable It is reimbursed by most insurance plans Strengthens rural providers Provides a platform to grow marketshare Consistent with our Mission: To improve the health of the people and communities we serve

27. Let’s look……