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New Senate Bill Proposes Using Project ECHO as National Model for Rural Care

May 3, 2016
by Heather Landi
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Senators Orrin Hatch (R-Utah) and Brian Schatz (D-Hawaii) have introduced the Expanding Capacity for Health Outcomes (ECHO) Act with the aim of expanding New Mexico’s Project ECHO as a national model for using telehealth for rural care.

Project ECHO launched in 2003 at the University of New Mexico Health Sciences Center, with a focus on treating hepatitis C and has since grown significantly across the globe and across numerous other health conditions. As reported by Healthcare Informatics Managing Editor Rajiv Leventhal, dozens of academic medical centers in the U.S. now operate teleECHO clinics that address more than 40 health conditions. Globally, teleECHO clinics are running in 10 countries. The Department of Veterans Affairs has its own version of Project ECHO, the Specialty Care Access Network-Extension for Community Healthcare Outcomes, and the Department of Defense has a global ECHO chronic pain management program.

Project ECHO links community providers with specialist care teams at academic medical centers to manage patients who require complex specialty care. Using basic videoconferencing technology, they participate in weekly teleECHO clinics, where primary care providers from multiple sites present patient cases and work with a multi- disciplinary team of experts to determine treatment. The team mentors community providers to treat conditions that previously were outside their expertise.

The proposed legislation, the ECHO Act, aims to better integrate the Project ECHO model—referred to as a “technology-enabled collaborative learning and capacity-building model”—into health systems across the country.  The bill would require the Secretary of the U.S. Department of Health and Human Services (HHS), in collaboration with the Health Resources & Services Administration (HRSA), to prioritize analysis of the model, its impacts on provider capacity and workforce issues, and evidence of its effects on quality of patient care.

The bill also calls for a U.S. Government Accountability Office (GAO) report “regarding opportunities for increased adoption of such models, efficiencies and potential cost savings from such models, ways to improve health care through such models, and field recommendations to advance the use of such models.”

And, the bill would require the HHS Secretary to submit a report to Congress on the findings of the GAO report and the HHS report, including ways such models have been funded by HHS and how to integrate these models into current funding streams and innovative grant proposals.

“In states with large rural populations like Utah, it’s vital that we do everything we can to ensure that patients have access to quality health care—no matter where they live,” Sen. Hatch said in an announcement about the bill. “By using technology to connect patients and providers, this bill will benefit Utahns living in rural areas by helping them receive the care they need.  I’m grateful for the valuable input Utah’s health leaders have provided in crafting this proposal, and I hope the Senate will act quickly to advance this critical legislation.”

Sen. Schatz said, “Technology has the potential to transform how we train doctors and deliver health care. Our bill would help connect primary care providers in underserved areas with specialists at academic hubs, making it easier for medical professionals to access the continuing education they need and provide health care to more people.” 

According to Hatch and Schatz, the bill would address a number of rural health challenges. Only about 10 percent of physicians practice in rural areas of the country despite nearly one-fourth of the population living in these areas. Rural areas have higher rates of some chronic diseases and face many challenges, including transportation, connectivity, and isolation. And, it can be difficult to recruit healthcare providers to work in rural and underserved areas, and opportunities for professional development and support in such areas can be difficult, according to a statement from Sen. Schatz about the bill.

In a statement included in the announcement about the bill, Barbara McAneny, M.D., immediate past chair of the American Medical Association, stated, “Project ECHO is bridging geographic divides to connect physicians and experts with patients in underserved, rural areas. An exemplary model of using new technologies to improve patient care, Project ECHO has potential to bolster access to specialists, reduce incidence of chronic disease, and rein in costs through reduced travel and fewer ER visits. The AMA believes the ECHO Act would provide policymakers with critical information to expand such models to improve clinical practice.”




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