With decreasing reimbursements and continued uncompensated care, health systems adjust to do more with less funding. Most notably, in an attempt to increase access and introduce innovative practices, hospitals have invested in tele-health services that allow doctors to use video to talk to specialists in other cities.

Fred Duggan, the chief medical adviser and a pulmonary/ critical care specialist at Rush Foundation Hospital, has already seen the effects to tele-health. Rush Health Systems has several smaller hospitals, known as critical access hospitals, across Eastern Mississippi and Western Alabama in addition to a major hospital in Meridian.

While the critical access hospitals across the area have a full staff of emergency doctors in their departments, they might not need a full-time physician who specializes in pulmonary care.

“One of things we want to do is improve the care in the critical access hospitals, the rural hospitals,” Duggan said. “It allows us to look in at a patient in the critical access hospital and do a consult just like we’re at the bedside.”

Duggan said this system allows patients to stay in their own communities to receive care, rather than having to travel to Rush Foundation Hospital in Meridian. The doctor can evaluate the patient at a smaller hospital and determine the severity of the problem, giving advice to the doctors at the critical access hospitals.

Currently, Rush offers the tele-health system only at Laird, in Union, where it recently opened chronic care ventilator units that provide a higher level of pulmonary care. Duggan estimated he’d done 10 consults already, however, and by the end of January had only one patient transferred to Rush Foundation Hospital for treatment.

“To have the ability to bring internal medicine doctors (and) critical care doctors to that process really allows us to take care of a sicker patient in a critical access hospital,” Duggan said. “We’re looking at adding tele-stroke where we’ll have a board-certified stroke specialist looking in at the patients at the critical access hospitals and making decisions about whether or not they need to be transferred to a bigger center.”

Though the program still has kinks, Duggan said he hoped to the expand the service and offer it to all of the critical access hospitals at all hours.

“We’re going to see more and more of (tele-health). We’re kind of on the front line of that right now,” Duggan said.

At Anderson Regional Health System, CEO and president John Anderson said the hospital would explore tele-health with physicians at the University of Mississippi Medical Center in Jackson.

“University has a very well-established tele-medicine, tele-health program,” Anderson said. “How can we bring that to the Meridian area and advance care?”

Anderson said that advancing care locally would allow people to stay in Meridian versus having to travel to Jackson.

“We really do try to live advanced medicine, compassionate care, close to home. This fits that… The affiliation allows us those opportunities that we otherwise wouldn’t have,” Anderson said.

For the Cardiovascular Institute of the South clinic in Meridian, cardiologists can team to consult on a difficult case in a network of doctors through tele-health systems.

“You can have a patient present to an emergency department that may not have a cardiologist on staff,” said Ross Brown, the clinical manager of CIS’ clinic in Meridian. “If they present with chest pain, through this technology, a cardiologist can pick up an iPad, any sort of tablet or computer, even an iPhone or any smartphone, and see that patient, access that patient along with the emergency department physician to determine if that patient needs to go to a larger healthcare system for cardiac care or is that something that can be handled locally at that smaller hospital.”

Brown said that doctors could communicate via Bluetooth stethoscopes, expanding the access to advanced care in smaller markets.

“One thing that we’re going to look to expand in Meridian that’s already in Louisiana markets is tele-cardiology. So we’re looking to partner with regional hospitals to provide that tele-cardiology,” Brown said. “Our goal is reach outlying, rural areas and provide the best cardiovascular care available. I think if you look at what both healthcare companies in Meridian have done, they’ve tried to reach and expand in those markets and we want to do the same thing.”

New spaces and phases

The CIS clinic in Meridian, currently housed in the Anderson hospital’s south campus on Constitution Avenue, takes up three floors, often forcing physicians and patients to run from floor to floor to access care.

Due to recent growth, the clinic announced in 2017 it would move to a new location on Great River Drive off North Hills Street. The new facility will expand the clinic’s lab capabilities and keep everything on one floor, something both patients and staff members at CIS-Meridian will appreciate.

The new location will also allow CIS-Meridian to introduce new lab procedures into their clinic, such as Cardiac PET exams in addition to nuclear studies. The cardiac positron emission tomography (PET) exam measures the blood flow of the coronary arteries to the heart.

“(Cardiac PET) allows us to see patients with a higher BMI and doesn’t require a treadmill,” Brown said. “The patients get a better study and the physicians get a better, higher quality image.”

Additionally, Brown said the new site would allow CIS-Meridian to create the radioactive dosage required for the test on-site, instead of having to order it from Jackson. Previously, patients would have to come at a later time to complete their test because of the delay in the delivery of the dosage from Jackson.

As part of the network of CIS clinics across the Southeast, Brown said the cardiologists had doctors who could work together to solve difficult problems.

“It really allows you to find best practices. We have nine cardiologists on staff here but CIS has 54 total,” Brown said. “You really have the ability to collaborate and talk about things that may have happened in unique cases or certain situations so anytime you can have 50-plus cardiologists working for the same company it’s a huge advantage.”

For Anderson, the upcoming year means navigating a new affiliation with the University of Mississippi Medical Center and bringing advanced pediatric care to the area.

“Part of that affiliation is to provide more robust pediatric care locally,” Anderson said. “Anderson is the only in-patient pediatric care service (in Eastern Mississippi) and a lot of our children that we were taking care of we would send to (UMMC in Jackson). We wanted to be able to take of them locally.”

Anderson said that, over time, the affiliation would involve inviting guest physicians to hold specialized clinics at Anderson’s hospital for patients without the cost and hassle of traveling to Jackson.

“At the end of the day, pediatric care is all about parental confidence,” Anderson said. “What are we doing to ensure parents that their child is being well taken care of?”

For most areas in Mississippi, UMMC serves at a tertiary hospital, or a hospital with certain types of specialized care.

Anderson said despite advances in pediatric care, UMMC would still serve that role.

“Children that need to go to Children’s (in Jackson) will go to Children’s. But those that we can take care of locally, we’re going to do that,” Anderson said. “Unfortunately, no matter what, there are going to be times when kids are too sick to be taken care of locally.”

In addition to visiting physicians, Anderson will also develop a fellowship or pipeline of physicians with UMMC, which will help with recruitment efforts.

“Establishing the relationship with university, particularly with specialty physicians — critical care, pulmonary, internal medicine… allows us to establish either a resident or a fellow rotation where those specialized physicians come and help take care of the patients that are here,” Anderson said.

Ideally, some of those medical students would stay in Meridian after establishing relationships with the community.

“So that pipeline creation is very important…. (and) the best way to do that is to partner with (UMMC),” Anderson said. “You have a constant need for doctors and having that relationship and (we’re) using that relationship to try to create that physician pipeline to recruit doctors, to replace physicians that retire or recruit new physicians to the community.”

In addition to several new doctors, including an internist, a neurosurgeon and an ears, nose and throat specialist, Rush looks to continue adding physicians as well. 

“The lifeblood of a medical institution is recruiting, finding young doctors to keep,” Duggan said. “We have in Meridian a very old community, relatively speaking, and so that’s a really important part of growing your services.”

Duggan, who runs the Intensive Care Unit (ICU) helped start an intensive medicine care program just over a year ago after 24 years of private practice.

“We recently added a second physician (to the program) and our vision is to actually go to full-time intensive care doctors for a total of four,” Duggan said. “We’ve already got two but we’ll be ready for a third in the summer. So we’re really growing that pretty quickly.”

Looking forward

In the coming months, Rush will continue with its comprehensive diabetes program, going beyond the standard medication adjustments to decrease the number of amputations and renal failure often associated with the disease.

“It’s more than just coming in and looking at your medicines. It’s comprehensive. We want (the patients) to know how to take care of themselves,” Duggan said, adding that they’ll look at feet, adjust diet plans and add to patient knowledge. “What can we do to intervene, to change that paradigm?”

CIS-Meridian will also do its part to keeper patients healthier as they age, encouraging patients to check in with a cardiologist before they need one.

“So if you’re 50 years old and you say, ‘You know what? I’ve never seen a cardiologist,’ ” Brown said. “(They) can come in and start a baseline to see and follow it annually as need to make sure (they’re) where (they) need to be from a cardiac standpoint.”

As a regional cancer care provider, Anderson plans to introduce a MRI-and-ultrasound-guided prostate biopsy.

“First of its kind in this region. It provides a less invasive method of gaining biopsies for prostate cancer and (it’s) never been done in this area before so it’s exciting to have that,” Anderson said. “Being a regional cancer provider, you’re always looking for new and better ways to diagnose and treat cancer.”

The new procedure will also provide greater comfort to the patient.

With all of the exciting technology, each health leader said they felt proud of their staff and how they care for their patients.

“It’s what gets me up in the morning: making a difference,” Duggan said. “There’s no other profession in the world where you can make a difference in somebody’s life every day you get up and go to work.”