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Copyright © 2000 Midwest Rural Telemedicine Consortium
All rights reserved.
Last updated: January 2001

 

 

MRTC History

Established in 1993 as a joint development program of Mercy Medical Center-Des Moines and Trinity Health Services (formerly Mercy Health Services), the membership of the Midwest Rural Telemedicine Consortium (MRTC) currently consists of 26 health care provider organizations. The MRTC is the largest telemedicine program in Iowa, and one of the largest in the U.S. Since 1994 the MRTC has been a HCFA Telemedicine Demonstration Project operating under a Demonstration Waiver to explore telemedicine reimbursement strategies.

As the health care delivery system continues to change in response to the demands of the market and governmental policies, the MRTC believes that telemedicine will result in benefits for all parties. Health care providers will be able to provide higher levels of care in lower-cost settings. For "payers" (Medicare, Medicaid and private insurance companies), per-beneficiary expenses will be lower. Most importantly, customers will be able to obtain needed services more conveniently and with fewer out-of-pocket expenses.

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Program Funding

The Midwest Rural Telemedicine Consortium was established in 1993 as a joint development program of Mercy Hospital Medical Center (Des Moines) and Mercy Health Services (West Des Moines).

In 1994 HCFA awarded the first demonstration grant to the MRTC to explore patient and provider acceptance of telemedicine and the effects of telemedicine on healthcare access, quality and costs. Originally conceptualized as a 3-year demonstration, the MRTC was to develop evaluation tools, install 8 interactive video sites, and collect data on clinical video consultations. The budget did not include payments for physician services provided through video consultation. Physician services were to be reimbursed pursuant to a waiver of Medicare payment regulations. The initial vision was expanded to involve a broader scope of services across a broader central Iowa service area.

The MRTC sought and received additional funding from a variety of federal (ORHP/HRSA), state (ITTC), and private entities to expand the number of sites on the network and the overall utilization of the telemedicine technology implemented. The membership of the Midwest Rural Telemedicine Consortium (MRTC) grew to consist of the current 38 sites within 30 health care provider organizations. The MRTC is the largest telemedicine program in Iowa and one of the largest in the nation.

Although promised in 1994, the Medicare waiver was not issued until October 1996.  It had been anticipated that Medicare reimbursement would be available for the participating providers at the inception of the program.  It did not take effect until substantially later because of policy issues that needed to be resolved at the departmental level with regard to funding.  This caused a practical problem in terms of dampening provider enthusiasm to participate in the program, and in fact, made it virtually impossible to get provider participation. Subsequent close scrutiny of the rules revealed that there wouldn’t be adequate reimbursement for providers if they were to participate, thus continuing the strong disincentive on the part of providers to participate in the demonstration.  The three-year demonstration period had nearly passed. HCFA ultimately granted extensions with additional funds to continue the demonstration, and collect more data through September 1997. The project was to end having operated under the waiver for less than 1 year.

The MRTC then requested an additional two years of funding to sustain operations further into the project period. After operating for 9 months without funding, HCFA approved additional funds for the period beginning in July, 1998 and continuing through July, 2000, authorized under Grant No. 95-P-90425/7-04. At about the same time, the Medicare waiver was expanded to cover up to 34 sites, effectively expanding the reimbursement demonstration to all MRTC facilities. The Medicare waiver, and consequently the project period, remains in effect through September, 2001.

The early vision for network development has been realized and the MRTC is poised to provide the data needed to assess the potential of widespread telemedicine implementation in rural areas.  The MRTC is now nearing completion of the first year of the two year continuation requested in 1998 (year 4 and year 5 of the project period). Overall clinical utilization of the MRTC in calendar year 1998 increased by 400% over the previous year, suggesting that appropriate clinical applications for telemedicine were beginning to be found. It supports our assertion that we are now entering a critical data collection period – one which promises to yield a significantly greater amount of data than previous years.

Application was made requesting the balance of continuation funding as requested in 1998. The amount originally requested was $1,985,681.  $968,576 was awarded for the period 15 July, 1998 to 14 July, 1999.  An additional amount of $224,424 was subsequently awarded to be applied to expenses incurred during the period 15 January, 1998 to 14 July, 1998. This award was issued as an advance on year five funding. The balance of $792,681 was requested and awarded to cover the period of 30 September 1999 to 29 September 2000.

Funding/Waiver History as of 081700

7/15/94-1/14/96 HCFA $1,777,831 (3/14/96 ext 60)

Install 8 sites, develop evaluation tools, network connection; install 2 sites matching funds; install 1 site self-pay

3/15/96-3/14/97 HCFA $1,251,484

Operating funds

3/15/96-3/14/97 HCFA $199,921

Install 4 additional sites (supplemental)

7/96-7/97 ITTC $135,000

Install 2 sites

9/96-9/29/97 ORHP/HRSA $1,964,800

Install 17 sites (10 hosp, 4 clinics, 3 LTC)

Install 1 site self-pay/Primecare Grant

10/01/96-9/30/99 Medicare Waiver

12 HCFA sites (8 original, 4 supplemental)

3/15/97-9/14/97 HCFA $1,008,026

Operating funds + (supplemental $186,887)

10/01/97-9/30/98 ORHP/HRSA $15,000

Supplemental 12 month extension for data collection

9/15/97-7/14/98  HCFA  

No cost extensions – (1) 9/15/97-11/14/97 (2) 11/15/97-1/14/98 (3) 1/15/98-2/14/98 (4) 2/15/98-4/14/98 (5) 4/15/98-6/14/98 (6) 6/15/98-714/98

1/14/98-7/14/98 HCFA $224,424

Advance from Year 5 (9/30/98 received) $1,985,681 requested Year 4&5 

6/01/98-9/30/01 Medicare Waiver

Modification to waiver - all MRTC sites eligible, continued through September 30, 2001

7/15/98-7/14/99 HCFA $968,576

Continuation funding Year 4

10/01/98-9/30/99 ORHP/HRSA   

No cost extension for data collection

7/15/99-7/14/00 HCFA $792,681

Continuation funding Year 5 (to be requested) Amount available after subtracting $224,424 advance from $1,017,105 Year 5 budget requested in Year 4&5 continuation

9/30/99-9/29/00 HCFA $792,681

Continuation funding Year 5

The MRTC has 34 sites approved for Medicare waiver under Rural Telemedicine Demonstration No. 95-P-90425/7-03. The Terms and Conditions for the operational phase of the waiver continue through September 30, 2001.

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Organizational Structure

The MRTC's membership consists of two of the largest hospital networks in Iowa. With organizational "hubs" at Mercy Medical Center-Des Moines and Mercy Medical Center-North Iowa (Mason City), the networks extend to 23 Iowa hospitals, as well as extensive clinic systems and sub-acute care facilities. By virtue of other formal and informal collaborative relationships, the networks reach communities throughout the state. The MRTC provides a vehicle for collaborative efforts among member organizations. The geographic distribution of MRTC member organizations can be viewed on the Member Sites (LINK to http://www.mrtc-iowa.org/temp/sites.html) page.

The MRTC is governed by an executive committee consisting of physicians and hospital administrators affiliated with the two hospital networks. Individuals with expertise in specific areas of MRTC interest are routinely recruited to serve on standing and ad hoc committees. Full-time staff (Link to http://www.mrtc-iowa.org/temp/people.html) include a program director, a programming and administrative services coordinator, a telemedicine services coordinator and a secretary, all of whom have offices at Mercy Medical Center-Des Moines. Part-time site coordinators at other MRTC member organizations provide a single point of contact for information about telemedicine-related services and activities in their communities.


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Data Collection

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HCFA Waiver

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Reimbursement

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