Copper Queen Community Hospital Jim Dickson CEO MISSION

Copper Queen Community Hospital Jim Dickson CEO

MISSION To maintain and support access to basic primary healthcare throughout Southern Cochise County by providing leadership and vision to address opportunities and challenges.

SERVICE AREA

HEREFORD/PALOMINAS RHC Services Offered: Radiology, Lab, Physical Therapy, Tele. Medicine, and Primary Care Services including internal medicine and family practice. One stop shopping for healthcare.

CQMA DOUGLAS Services Offered: Radiology, Lab, Physical Therapy, Tele. Medicine, and Primary Care Services including internal medicine and family practice. One stop shopping for healthcare.

CQMA BISBEE Services Offered: Radiology, Lab, Physical Therapy, Tele. Medicine, and Primary Care Services including internal medicine and family practice. One stop shopping for healthcare.

The Douglas Emergency Department opened on April 4 th, 2017. In August of 2015 the Douglas Hospital closed leaving the Douglas community without Emergency Care.

Enhancing ED Services Ø Douglas Arizona is a town of 16, 000 people which lost it’s hospital. Just across the border is Aqua Prieta is a town of 80, 000. Ø Copper Queen built a Free Standing ED in Douglas Ø In addition to lab and radiology we can provide remote stroke, cardiology, pediatrics, pharmacy as well as consultations with the hospital in Bisbee. Ø Douglas now has more services in the Free Standing ED than they had at Douglas Hospital, other than a Med. Surg unit.

TELEMEDICINE PROGRAMS • • • A unique solution to the physician misdistribution problems in Arizona, rural America, and the USA. Solving rural problems of high geographic low demographics Services include the following: o Tele. Trauma (2007) o Tele. Neurology (2008) o Tele. Radiology (2009) o Tele. Home Health (2009) o Tele. Cardiology ( 2010) o Tele. Concussion (2014) o Tele. Pediatrics (2014) o Tele. Endocrinology (2016) o Tele. Behavorial (2017) o Tele. Orthopedics (in progress)

The Current Cost of Helicopter Transport From Bisbee to Tucson is $35, 000 in 2017 The Savings is closer to $ 1, 250, 000

Tele. Medicine Benefits 1. Tele. Medicine counterbalances disparities between urban and rural medical environments. 2. Tele. Medicine results in better disease management. 3. Tele. Medicine improves potential to practice evidence-based standards. 4. Tele. Medicine lowers cost on several levels.

Tele. Cardiology Ø A group of hospitals in Southern Arizona formed the Southern Arizona Tele. Medicine Alliance. Ø With a grant from United Health Care we implemented our Tele. Cardiology program. Ø We have total cardiac disease management from the Emergency Room to Med. Surg to Clinics.

Broadband Requirements • In the early days of our telemedicine program bandwidth was an issue. The largest consumer of bandwidth in telemedicine is radiology. • Audio requires 100 kilobit • Video requires 1 megabit • Radiology Cat. Scan is a time versus bandwidth issue • At Copper Queen since 2007 we have gone from 6 MB to 100 MB on our internet connection

Newer Tele. Medicine Services Ø We have since added concussion, pediatrics, endocrinology and behavioral health. Ø The major limitation is to find physicians who will commit to care with substandard compensation and in some cases no compensation. Ø These services are necessary to achieve effective cost reductions through evidence based disease management.

Important Tele. Medicine Notes Ø Remote Telemetry services located in Bisbee at CQCH has allowed the Douglas Emergency Department to save close to $600, 000. Ø In the Douglas Emergency Department a Nurse Practitioner functions in-place of a Physician but is backed up via Tele. Medicine equipment.

Tele. Education ØHep. C patient review with St Joseph in Phoenix. ØGrand Rounds presentations for CME credits with the University of Arizona.

Lessons Learned Ø Remember Tele. Medicine is for the patients benefit not for profit, it is about the expansion of services that raises your profile as a healthcare facility Ø Develop protocols for which patients fit the program and for those who should be transferred immediately Ø Remote physicians should not expect to make a profit on the consult. They will make it on the referrals Ø Test your computer equipment regularly. The time for failure is not when the physician is in a consult Ø Train the remote physician and make it as easy as possible to perform the consult Ø Send documentation in advance whenever possible so that consult time is not wasted on the delivery of patient information Ø Talk to legislature and insurance companies to demonstrate the financial benefits to the insurance companies and for the patient not being transported to an urban hospital. Ø Telemedicine requires commitment on the part of the remote provider for emergency services when it may not always be convenient. Ø Treating virtual patients like a regular visit will save the provider time. Stacking virtual patients who then are no shows wastes the provider’s time. Ø Adequate Broadband, especially for Stroke and CT images is necessary. Tele. Medicine that does not require instruments like behavioral health or endocrinology can be performed using a Verizon wireless card.

Thank you