Telehealth Spotlight
La Clinica de la Raza and UCSF Work to Make Tele-Dermatology Financially Viable
Since 2007, a Northern California clinic network and dermatologists at UC-San Francisco have been crafting a novel tele-dermatology program to serve safety net patients.
UCSF and La Clinica de la Raza, a federally-qualified health center (FQHC) with 26 offices in Alameda, Contra Costa and Solano counties, are using store & forward technologies to triage, or make initial assessments, on dermatology cases. The dermatologists refer routine cases back to La Clinica’s primary care providers (PCPs), with diagnosis and treatment plans, while treating complex cases in person, via monthly specialty clinics at a La Clinica office in Oakland.
The program’s benefits are familiar to those with experience in telehealth—increased access to specialty care among patient populations who routinely endure onerous waits for services, valuable educational experience for primary care providers, enhanced case management.
But La Clinica also is hoping to close in on that most elusive goal of telehealth programs—breaking even on the financial end.
La Clinica Looking to Boost Reimbursement
“We didn’t think of this as a moneymaker, we just wanted to break even,” says Nermeen Iskander, MS-HCA, Projects Planner at La Clinica. “There are multiple benefits to patients and providers, that go beyond cost. We are removing a burden on the safety net health care system overall, and we are creating a system here where the patients who really need dermatology care, are getting that care.”
La Clinica is Federally Qualified Health Center; in 2009, it delivered 305,000 visits to its 62,000 patients, 94 percent of whom are on public insurance or are uninsured.
La Clinica has a contract with UCSF to provide both tele-dermatology and in-person dermatology services for 2011. There is no limit on the number of tele-dermatology consults, which are averaging 25 per month.
La Clinica can bill for the in-person dermatology consults that UCSF dermatologists provide at its clinics. However, La Clinica is not yet billing for the UCSF tele-dermatology triage consults. While Medi-Cal covers standard store & forward tele-dermatology consults, La Clinica is still working with Medi-Cal officials to clarify whether La Clinica can bill for these tele-dermatology triage consults.
Iskander says the ability to bill for the UCSF tele-dermatology triage consults would be a key to getting close to the break-even point. Iskander says she is hopeful that La Clinica and Medi-Cal can agree on terms for reimbursement.
“At this time, we don't yet know if it would get us to the break-even point, but it would certainly get us closer, and it would be a stable funding stream,” says Iskander.
La Clinica’s tele-dermatology efforts began in 2007, with a grant from the California HealthCare Foundation (CHCF), under its Telemedicine to Improve Access & Efficiency in California Clinic Networks project. The grant covered $42,500 in startup costs for La Clinica, which included such items as equipment and training. UCSF began providing tele-dermatology services to La Clinica under this grant. When the grant ended, La Clinica continued its relationship with UCSF.
UCSF an Able Partner
Toby Maurer, MD, Associate Professor of Clinical Dermatology, and Chief of the UCSF Department of Dermatology based at San Francisco General Hospital, UCSF, which had led development of a similar tele-dermatology triage program for San Francisco, and thought it also might succeed with La Clinica. Maurer also knew a number of La Clinica’s primary care providers, as they had all trained as residents together at San Francisco General Hospital.
“We’re very happy to work with the whole group at La Clinica, and it’s a great experiment in tele-dermatology,” says Maurer. “It’s more a triage consult, with a bit of a different model, with the safeguard of having a live clinic for complex patients.”
Maurer and UCSF is also a participant in The Specialty Care Safety Net Initiative, a CCHP demonstration project that connects 38 safety net clinics across California with medical specialists at all five University of California Schools of Medicine. The SCSNI serves as a laboratory to identify the means of establishing permanent relationships between UC medical schools and California’s safety net providers.