Hospitals test different approaches to improve access in rural areas of South Carolina

Medical University of South Carolina Dr. David McSwain consults with another doctor during a demonstration of one of MUSC's telemedicine carts. The technology allows providers to interact with each other in different hospitals. File/Staff

For three hours every week, a psychiatrist sees low-income, often uninsured patients at Volunteers in Medicine on Hilton Head Island. Yet it's not enough.

The clinic, which relies on volunteers and schedules more than 30,000 visits per year, has had to stop scheduling new consultations.

Doug Wolter, a clinical psychologist and director of the clinic's mental health services, said Volunteers in Medicine has been overwhelmed with the number of patients who need this treatment.

So a partnership was built with the Medical University of South Carolina to allow Charleston psychiatrists to see the clinic's patients via telecommunication. Wolter said for these patients, telemedicine could make a significant difference in their mental health care. 

"It could be of a tremendous benefit to some rural areas where there is not access to medical specialists," he said. 

Only 240 psychiatrists were employed in South Carolina in 2016, according to the Bureau of Labor Statistics. To better utilize the psychiatrists in the state, providers have begun to turn to telemedicine.

Experts agreed mental health is the area that stands to benefit the most from telemedicine, which is practiced remotely with technology such as video conferencing. It allows providers to tend to patients even if they are not in the same place.

State lawmakers have bought into the idea, investing millions of state dollars into the South Carolina Telehealth Alliance in recent years. But Wolter and other providers in the state have faced obstacles to putting telemedicine in place, even as it has gained a foothold in hospitals and clinics. 

Volunteers in Medicine has come up against funding difficulties. The clinic is working toward compliance with federal privacy regulations, which has temporarily hindered its partnership with MUSC.

Licensing is also a challenge. The S.C. Department of Mental Health and MUSC have asked to expand the use of telemedicine, but their requests have been denied by boards of the state Department of Labor, Licensing and Regulation. 

The Kaiser Family Foundation estimates about 1.8 million people are living in areas of South Carolina with a shortage of mental health professionals. The foundation estimates 42 additional professionals are needed to fill the gap. 

Robert Bank, the Mental Health Department's director of medical affairs, said bringing psychiatrists to the state can be a challenge, and those trained here don't always stay. He said the department needs to bring on 30 to 40 psychiatrists every year to make up for those who leave and account for the state's population growth. 

Telepsychiatry has long been under way at the Mental Health Department. Psychiatrists based in Charleston and elsewhere see 450 patients per month at 25 emergency departments across the state. The same doctors do about 1,200 "visits" to patients at 16 community health centers. 

Bank approached Labor, Licensing and Regulation with a request to allow nurse practitioners to conduct follow-up appointments — something they already do on the ground — via telecommunication.

While advanced practice nurses have been lobbying the Legislature to expand their allowed scope of practice, the licensing board denied the Mental Health Department's request, arguing South Carolina's Nurse Practice Act did not allow for such telemedicine appointments. 

"The issue is that we need to move our practice acts into the modern era," Bank said.

Lesia Kudelka, spokeswoman for the licensing department, said physicians have to obtain approval from the Board of Medical Examiners to prescribe certain drugs via telemedicine. MUSC was granted permission to treat ADHD and ADD using telepsychiatry, she said.

A proviso effective July 1, valid for only a year, will allow advanced practice nurses to use telemedicine if they request approval from the licensing boards, Kudelka said.

James McElligott, a pediatrician and medical director for telehealth at MUSC, said the licensing department approves these requests case by case, he said. But momentum for the argument for telemedicine is building.

"It's cracking open," he said. 

The state invested in the Telehealth Alliance for the first time in 2013. Legislators gave MUSC $8 million for the effort this fiscal year, MUSC lobbyist Mark Sweatman said.

MUSC is working now to secure approval for its doctors to prescribe medications remotely to treat pregnant women for opioid use disorder. Currently, these women must visit an MUSC doctor to receive their prescriptions.

McElligott said he respects the board's role of protecting the integrity of medicine in the state. While the state has been supportive as a whole, he said the more medical professionals are permitted to use telemedicine, the smarter providers can be about utilizing the state's limited resources.

"We can get a lot done," he said. "We just have to remember we're all in the same sandbox."

Reach Mary Katherine Wildeman at 843-937-5594. Follow her on Twitter @mkwildeman.