Cutbacks in federal and state hospital reimbursement rates — whether existing or proposed — have put more emphasis on providing quality care for a lower cost, particularly to rural communities.

Telemedicine has been defined as “the use of interactive audio, video or other electronic media for the purposes of diagnosis, consultation or treatment.”

The service is aimed at individuals who live in rural areas and/or who have difficulty getting to an urban hospital.

Telemedicine services have grown in North Carolina, in large part through partnerships with urban health-care systems, such as Novant Health Inc. and Wake Forest Baptist Medical Center, and rural hospitals.

Those services typically include: emergency care or behavioral health services to a patient via video conference; monitoring a patient’s blood pressure or medication adherence remotely; providing consultation to another physician on a difficult or rarely seen condition.

However, DHHS said more than 250,000 N.C. households, including many within the Appalachian region, cannot access these services because they lack broadband infrastructure and the technology and tools to use it.

The Triad and North Carolina have been successful in attracting federal and state grants aimed at improving telehealth technology.

However, progress has been limited in the state legislature by the Senate’s reluctance to vote on telemedicine funding bills that have had overwhelming bipartisan support in the House.

House Bill 967 would have established statewide telemedicine policies, as well as pursued federal Medicare incentives for expanding medical education in rural counties. It passed 113-0 in June, but was not heard in the Senate.

In November, DayMark Recovery Services, a provider of behavioral health services in the Triad and statewide, said it received a $391,498 grant to bolster telemedicine access in rural communities.

DayMark has its Forsyth County offices in the Cardinal Wellness Center at 650 Highland Ave., Suite 100, in Winston-Salem.

The grant is particularly geared toward assisting individuals with mental health and substance abuse disorders who also are being treated for opioid addiction.

DayMark’s Telehealth program debuted in 2006 and now covers 30 counties. The provider says telepsychiatry has helped reduce the negative impacts of substance and mental illnesses on local jails and emergency rooms.

The provider’s program served about 50,000 patients in fiscal year 2017-18. About 20,650 received medication during 61,834 medical visits, while 7,072 of these patients received 18,875 telehealth visits.

“These services have been crucial,” said Billy West, DayMark’s chief executive. “We are able to ensure patients receive immediate and high-quality psychiatric care even during a nationwide psychiatrist shortage. Our goal is to treat a patient before they are in crisis.”

In February, Forsyth and five other Triad and Northwest North Carolina counties gained a $98,273 federal grant. The grant comes from the Appalachian Regional Commission’s Power fund and covers 20 western counties that include Alleghany, Ashe, Surry, Watauga and Wilkes.

The Office of Rural Health within the N.C. Department of Health and Human Services and the N.C. Department of Information Technology’s Broadband Infrastructure office were the applicants.

The grant is aimed at “investigating existing resources to implement telehealth infrastructure.”

“We can use technology to help people lead healthier lives, and this grant will help us bring that possibility to more people in North Carolina,” Gov. Roy Cooper said in a statement. Cooper is co-chair of the commission, which covers 13 states.

The two state departments will partner with local and state organizations “to conduct a 12-month study of opportunities, challenges and gaps for broadband and health care infrastructure in the 20-county region.

The fund also allows for studying programs that address health disparities within the 20 counties.

“Health happens outside the four walls of a hospital or a doctor’s office, and health care providers in North Carolina need greater access to use telemedicine to treat their patients,” state Health Secretary Dr. Mandy Cohen said.

“Increasing access to care for North Carolinians will help them live healthier, more productive lives.”

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rcraver@wsjournal.com 336-727-7376 @rcraverWSJ

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