Federally Qualified Health Centers (FQHC) provide access to primary care for medically underserved populations including those that are uninsured or covered by Medicaid. One program was initiated to improve access to specialty care in FQHCs by using telemedicine for eye exams.
Detachment of the retina caused by tiny hemorrhages in the eyes of people with diabetes is the leading cause of new cases of blindness among adults in the U.S with the disease-induced blindness predicted to grow in the future.
Minority patients face a higher-than-average risk of diabetic retinopathy and are more likely to become blind. Although regular eye exams and prompt treatments can prevent retinopathy-induced blindness, many patients do not receive such care. Telemedicine is being closely examined to see if it can offer a low cost effective way to perform eye exams on these patients.
The organization Community Health Center Inc. (CHCI) a FQHC located in Middletown Connecticut is supporting the study “Telemedicine-Based Eye Exams Enhance Access, Reduce Costs, and Increase Satisfaction for Low-Income and Minority Patients with Diabetes”.
CHCI, the state’s largest FQHC with 13 primary care sites and more than 200 service locations, has developed a comprehensive annual visit for patients with diabetes that includes retinal screening enabled by telemedicine technology.
The project has CHCI using specially designed retinal imaging equipment and trained medical assistants to take digital images and then send the images electronically for evaluation to the Yale Eye Center.
CHCI pays the ophthalmologists a flat fee to do the remote interpretation of the images. At the same time, Yale agreed to supply results within 48 to 72 hours and to provide any necessary follow-up care for patients who could not find in-person care closer to home.
The first step was to choose a telemedicine system after the CHCI staff evaluated various systems. Ultimately EyePAC® first implemented by UC Berkeley Optometric Eye Center was selected. Initially the plan called for UC Berkeley-based ophthalmologists to interpret the images but since they were not licensed to practice medicine in Connecticut, CHCI decided to partner with Yale’s Eye Center.
Generally, the program provides more access to retinal screenings, reduces costs, and generally makes medical care more convenient for patients. Since the program was so successful, the legislature in Connecticut has authorized a demonstration project where Medicaid would reimburse for remote interpretation of ophthalmologic images but as of yet, the demonstration has not been funded.
For more information, go to www.innovations.ahrq.gov or email J. Nwando Olayiwola MD, CHCI CMO at Nwando@chc1.com or call 800-852-0809.