Innovative Policies for Developing a Statewide Rural Telehealth Network
Rex E. Gantenbein PhD
Center for Rural Health Research and Education
University of Wyoming
http://www.uwyo.edu/health
Background
According to the 2010 U.S. Census, Wyoming has a population of 563,626 people, making it the
least populated state in the United States. With the ninth largest area of any state in the Union,
Wyoming’s population density is also low. Many of Wyoming’s residents live in isolated
communities, where accessibility to health professionals and services poses a significant
challenge.
To begin to address these issues, the Wyoming Department of Health and the University of
Wyoming obtained federal funding to establish the Wyoming Network for Telehealth, or
WyNETTE. The initial purpose of WyNETTE was to support pilot projects in the state that
aimed to increase acceptance of telehealth among health professionals. Most of these early
activities centered on education and administration.
Exacerbating this problem is the shortage of primary care providers and specialists in the state.
Wyoming is ranked 47th among the fifty states in terms of physicians per 100,000 residents in
the population and 50th among the states in terms of medical specialists per 100,000 residents in
the population. Twenty-two of the state’s twenty-three counties qualify as Mental Health
Professional Shortage areas. Wyoming’s rural nature combined with its shortage of health
professionals make it so many of the state’s residents must either travel long distances, often
through dangerous weather, to receive health care, or else forego obtaining necessary care.
However, in 2009, the Wyoming State Legislature established the Wyoming Telehealth
Consortium, the purpose of which is to facilitate operation of a statewide telehealth network in
Wyoming. The Consortium has been central to the state’s efforts to develop telehealth capacity
and increase its adoption. As part of its work, the Consortium has helped develop a number of
innovative policies within the state to support the growth of telehealth.
Innovations for Developing Telehealth in Wyoming
TELECOMMUNICATIONS CAPACITY
LICENSING
Wyoming received funding from the FCC Rural Health Care Pilot Program to improve
telecommunications for health care facilities throughout the state. As of 2011, 37 individual sites
were provided with high-speed connectivity. Sites in the program included most of the state’s
Critical Access Hospitals, as well as several primary care clinics and mental health/substance
abuse centers.
The Wyoming Board of Medicine implemented a “fast track” licensing process for physicians
wishing to practice in the state on a limited basis via telehealth. Applications can be submitted
online and do not require an interview by the Board. A background check is performed and
applicants who qualify for the program can receive temporary licenses within two weeks. These
licenses allow the physician to practice in Wyoming up to 12 days per calendar year. Physicians
wishing to practice in the state more frequently can apply for a regular state license.
VIDEOCONFERENCING EQUIPMENT
Funding from the Wyoming Hospital Association and the Wyoming Department of Health
provided videoconferencing units to most of the FCC program sites. The state legislature
recently provided funds for a managed desktop application server and over 100 individual
licenses. These licenses are being distributed to health care providers in the state to facilitate
telehealth connections in additional locations.
REIMBURSEMENT
Wyoming’s Medicaid/Medicare office instituted telehealth-specific reimbursement codes for
most care categories, as well as an origination fee for sites presenting patients to providers via
telehealth. All other major third-party payers in the state now also reimburse for care delivered
by appropriate telehealth technology.
SUSTAINABILITY
As part of the FCC pilot program, the state prepared a ten-year sustainability plan for the
network that includes cost reduction measures as well as revenue sources. The ultimate vision
for the network is that of a member-based, independent, not-for-profit corporation with an
elected board of directors, which will represent both public and private entities and be
responsible for the management and operation of the network.
A new Web site, www.wyomingtelehealth.org, has been developed to provide both information
about telehealth in Wyoming and contacts for practitioners available through telehealth
technology.
Conclusions
As a result of these policy developments, health care facilities in Wyoming are moving rapidly ahead in the adoption of telehealth. Clinical applications currently in operation or in development
include mental/behavioral health, dermatology and wound care, radiology, cardiology, ICU monitoring, ePrescribing, trauma care, and neurology/stroke, among others. Efforts are underway to
expand access into more practitioner offices as well as public health offices in the state. The network also provides continuing educational opportunities for rural practitioners through video
courses and seminars.
This project was funded in part by grant D1BIT166426 from the HRSA ORHP Office for the Advancement of Telehealth.