In 2013, Community Health Plan of Washington through a quality initiative purchased 24 retinal cameras to be deployed in participating community health centers to improve the detection and treatment of diabetic retinopathy. The EyePACS teleretinal system was chosen to make the annual retinal exam for patients with diabetes available during their primary care visits. 31 additional cameras were purchased by the clinics through 2014 in order to increase their retinal exam capacity. During the summer of 2015, EyePACS surveyed those health centers to determine the program’s success. Eighty percent of the participating CHCs responded, providing data from 44 sites representing 14 Washington FQHCs. Below we summarize the results of that survey.
Responding health centers reported diabetic populations mostly under 2000 in number, with half the clinics serving 500 to 2000 diabetic patients. Participating clinics are still a long way from examination of all their diabetic patients yearly. The vast majority reports capturing retinal images from 25% to 75% of that population each year. Seventeen percent believe they are serving more than 75% of their diabetic population, while 12% believe they serve less than 25% of the target population. None of the participating CHCs employs an ophthalmologist, and only 9% employ an optometrist.
Ninety-five percent of the survey respondents indicated that patient compliance with the recommendation for a yearly retinal exam has “improved” or “significantly improved” since starting the EyePACS program. As for the patient response to this opportunity, 77% were reported to have been “pleased and satisfied” and 23% “neutral.” Patient response to the retinal exam procedure itself is reportedly very similar: 80% are pleased and satisfied with the exam, while 20% have had no observable response. Forty percent of participating clinics indicated their patients used the words “quick” and/or “easy” to describe the exam in the primary care visit.
The overall satisfaction rate with the program includes 87% either “satisfied” or “extremely satisfied” and only one clinic “dissatisfied” (the clinic had not yet launched the program due to internal logistics). Thirty-nine of the 44 responding clinic sites indicated they use EyePACS certified staff to read their retinal images, uploaded to a picture archiving and communication system via the Internet. Of those, 95% rated the appropriateness of patient referrals resulting from EyePACS image reading and response either “satisfactory” or “extremely satisfactory.”
Coding, payment and reimbursement, while always challenging and particularly challenging for telemedicine, has been less an issue than might have been expected. Eighty percent report satisfaction with their patients’ third-party payers. Roughly one-third of the clinics report a cost saving through the EyePACS program because they used to refer patients to specialists for this simple annual exam. About 15% of the participating clinics do not charge for the annual retinal exam but absorb the cost internally. A little over half the clinics report “significant measurable savings” or “some measurable savings” with the EyePACS program. Eight percent said the cost for this service has actually risen.