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10/24/2013 Denver senator visits Med Clinic; health options mulled

As a physician, District 32 state senator Irene Aguilar understands health care issues

Colorado Senator Irene Aguilar, a Denver Democrat, visited Westcliffe’s medical clinic on Monday, October 21. Clinic staff members gathered in the conference room to discuss innovative new health options and a possible solution to the Veterans Affairs issue in the county.

"We’re trying to keep veterans from driving down the road," said clinic director Delwin Lester. "We want to keep them here. The issue is how we can be reimbursed for our expenses."

Senator Aguilar, who represents Senate District 32, understands health care since she first began her career as a doctor. Aguilar worked in primary care and internal medicine.

"A lot of cost control is early diagnosis," Aguilar stated, "and treatment before there is an incident. The further it is to seek medical care, the less likely you are to do it."

One of the ideas the senator discussed with the clinic included a way to support local EMS, the clinic and the patients.

"There is potential in trying to triage patients that aren’t emergently ill," Senator Aguilar said. "They can come to the clinic instead of going to the hospitals in town. I think that’s something that we, as a state level, can look at. Right now, everyone in the state is talking about lean principles."

A lean principle is the idea of seeing the right person, at the right place, at the right time. While many people may call a paramedic because they aren’t sure how urgent their situation is, if the paramedic goes to triage, talks to a physician and determines that the patient’s life is not threatened, then the patient is able to be triaged to the clinic instead.

"Triage is not only good to sustain the facility," Senator Aguilar said, "but it’s good for the patient, because then they aren’t abandoned an hour away from home because they were not emergently sick."

Other concepts that came up were telehealth, which is when a patient could come into the clinic, be checked in by a nurse or a medical assistant, and then Skype with a doctor. The specialist could instruct the nurse that is with the patient to take a pulse or an EKG, and determine what testing or treatment should be taken.

"Our medicaid department is interested in applying for a waiver to be able to provide telehealth care, and specialty care in particular, to patients," Aguilar said. "I know that United Health Care has provided investment to telehealth, and that bigger hospitals are starting to try to have those relationships. That would be another way to sustain local access to care, as well. That way, patients aren’t forced to decide if it’s worth a half day of their time to go see a specialist."

Another health option that the state is looking into is email consultation. Email consultation would be for patients who have a non-emergency question about what their next step in a treatment might be.

"Rather than having to make a referral and incur the cost of having someone go there," Senator Aguilar said, "the patient could just ask a question over email and get an answer. These are the things we are looking at in our state medicaid. We are hopeful they could help areas like Custer County."

Email consultation would be a service to the providers, and no copay would be necessary.

Senator Aguilar stated that she will receive a briefing from her department in the first week of November. They will let her know what steps they’ve taken and what barriers they’ve reached.

Aguilar explained that the cost of these services would be dealt with by cost shifting. By treating patients before they become seriously ill, ER and specialist visits will go down. Money can come from those areas to continue maintaining public health.

Telehealth and the email consultations are still exploratory and are not expected in health facilities until mid 2014.

"Senator Larry Crowder is helping Senator Aguilar in these issues," Lester said. "Both of them are striving to help us find a solution to the reimbursement issue with the VA."

Lester reported that a contract from the VA should be sent to the clinic in the next few weeks.

"I won’t let this issue go with our veterans," Lester insisted. "I will continue reminding the VA until something happens."

-J.E. Ward