A health care program that would use technology to reach rural areas of Missouri was signed into law Thursday, but the money to support the program was defunded due to state budget withholdings.
Gov. Jay Nixon signed Senate Bill 716 on Thursday, creating the Show-Me Extension for Community Health Care Outcomes (ECHO) Program.
ECHO will be managed by the University of Missouri with collaborative efforts from the Department of Health and Senior Services (DHSS), according to the bill's summary. Though the program was given legislative approval, it is classified as subject to appropriations, meaning it lacks funding.
The program was defunded along with $1 billion in new spending for other projects in Nixon's recent cuts and withholdings to the state budget. The university and the Missouri Telehealth Network (MTN) are exploring their options for funding, which include grants and donations from organizations that would potentially fund healthcare projects. However, the organizations are hoping to get appropriated tax dollars for funding, officials said.
"It's an exciting program, there is widespread support for it, and we are looking forward to being able to get started," said Dr. Karen Edison, medical director for MTN. "Those of us who are working passionately on Show-Me ECHO are encouraged about the governor signing the legislative authorization for the program. Our challenge now is to fund the project."
ECHO uses "telehealth" technology similar to Skype or other web-chatting services to share knowledge and best practices from a team of medical experts to local primary care physicians, according to the bill summary. It is meant to benefit rural and underserved areas of the state that lack specialists who are qualified for treating chronic, common, complex and costly diseases and illnesses.
The costs of the program are paying an operational team to run the program and portions of the medical team's salaries who will be in the teaching role during the ECHO sessions. These teaching teams will consist of not only specialist physicians, but also pharmacist, psychologist and social workers as well, depending on the case, said Rachel Mutrux, senior program director for MTN.
The primary care doctors of rural areas who are in the student role will receive a lecture on the topic, or illness, and also present their cases to the interdisciplinary team to get advice on treatment. This way, the participating physicians learn from the team and each other, Mutrux said. They will not be paid for attending, but they will get continuing medical education credits. And not all attendees are physicians, community healthcare workers will also attend the ECHO program so they can sharpen their skills and learn, Edison said.
Some common problems that ECHO will cover are chronic pain, Hepatitis C, mental health, diabetes, high risk pregnancy, autism and more. The individual ECHO programs will be centered on one or more problems in an area that is relevant to the attending physicians. For instance, there could be one program based on practicing medicine in prison, so the teaching team will be doctors, social workers and psychologist that are specialized in commonly occurring illnesses in the penal system. The student team would include prison physicians, nurse practitioners and even a group of prisoners who could be trained as community healthcare workers.
The ECHO Project was started in New Mexico by Dr. Sanjeev Arora, a hematologist. It was funded in part by a grant from the Robert Wood Johnson Foundation and has received support from the New Mexico Legislature, the University of New Mexico, and the New Mexico Department of Health.
It started as a way for Arora to mentor doctors in rural areas with the treatment methods for Hepatitis C. It then expanded to cover the treatment of substance abuse and diabetes for rural areas and prisons in New Mexico, then underserved urban areas started engaging in the program, according to the University of New Mexico School of Medicine's website.
Now ECHO works with several physicians on a variety of illnesses in more than 19 different areas across the state of New Mexico. The main purpose of the program is to build medical expertise and create a force multiplier that will make healthcare better across the board, Arora said in a video on the school's website.
"I was really pleased and a little bit surprised that people understood it. This program makes sense and can really be a game changer in terms of healthcare delivery," Edison said. "In research on the program that has occurred to date, it has been found that the distant providers have the same healthcare outcomes in their patients as do the academic specialist. The providers who are participating in the program end up providing the same level of care as if the patient was treated by a specialist."