American Telemedicine Association’s policy duo, Jonathan Linkous, CEO, and Gary Capistrant, Senior Director of Public Policy, return with updates and new information regarding telemedicine.

Congress
In the wake of the Government shutdown, Congress continues to debate several different legislative proposals and provisions. One aspect involves the repeal of the medical device tax which charges a 2.3% tax on all medical devices; including some telemedicine components. The provision to repeal this tax is on the table; however, Capistrant says while this is possible it is not probable.

Bill HR 3077 was introduced by Congressmen Devin Nunez and Frank Pallone to allow providers with one state license to provide care via telemedicine to Medicare beneficiaries wherever. A similar bill, HR 2001, by Charles Rangel would provide the same for VA beneficiaries. These bills will essentially make one license enough for healthcare providers working with federal agencies or federal programs. This will help expand access to telehealth services which can provide numerous cost benefits to both patients and providers.

Greg Harper’s bill, mentioned in the last webcast, to improve Medicare coverage for telehealth has not been introduced because of the shutdown. However, because this is the beginning of a two year congressional session, even if this bill does not get passed this fiscal year there is still next year.

FDA
The FDA has released final guidance on mobile medical applications in an attempt provide clear direction to device makers and application developers as to what constitutes as a medical device and needs to go through the FDA approval process. Their regulatory focus will be on medical apps that present a greater risk to patients if they do not work as intended. Additionally, the FDA will develop a web-based platform for developers to seek advice about devices and situations. This will provide better guidance and make it clear as to when the FDA needs to be engaged and what the provisions will be.

States
Fiscal year 2013 was a very busy year for state telehealth legislation and this year will be more of the same. Much of the legislation that was not enacted last year will be reintroduced in 2014. At the top are the 10 states that had proposals for parity with private insurance companies that were not enacted. These states include Connecticut, Florida, Illinois, Massachusetts, Ohio, New York, South Carolina, Tennessee, Washington, and Pennsylvania.

In other news, it was reported that an Oklahoma doctor was disciplined for using Skype to treat patients. However, the use of Skype was inconsequential to what physician Thomas Trow was doing wrong. The main disciplinary issues were Trow’s over prescription of narcotics and failure to maintain medical records. In fact, Trow had previously received disciplinary action from the Oklahoma Medical Board (OMB) for over prescribing, narcotics violations, and record violations. The OMB filed action September 12 and 16 and put out proposals that, according to Capistrant, may be over-reaching and affect telemedicine. The ATA is working with the OMB to ensure these new provisions do not negatively affect telehealth services.

Guidelines
ATA is currently working on a series of guidelines and telehealth best practices for remote ICU, burns and wounds, and primary and urgent care. They are currently awaiting review and approval from the Board and should be available in the next few months.

The next This Month in Telemedicine webcast is scheduled for October 29, 2:00-3:00PM EST.

American Telemedicine Association’s policy duo, Jonathan Linkous, CEO, and Gary Capistrant, Senior Director of Public Policy, return with updates and new information regarding telemedicine.

Medicare
Several weeks ago Medicare created its proposed rulemaking for the physician fee schedule, set to begin on January 1st, 2014. There have also been two major improvements proposed for telehealth. One is the expansion of the definition of a rural health shortage area. The purpose of this is to increase coverage of telehealth by allowing more areas to be considered metropolitan counties. This proposal will help the 104 counties that lost their telehealth coverage due to their lost status as a metropolitan county.

The second proposal would provide telehealth coverage for CPT codes for transitional care management services. With this process however, there are some difficulties. While there will be a website people can visit to find out if they are covered, it does not have direct yes or no answers, making it hard to determine coverage. Another issue is that eligibility for coverage is renewed yearly, meaning one year a person may be eligible and the next they are not.

Congress
In last month’s installment of This Month in Telemedicine, Linkous and Capistrant mentioned legislation that Congressman Greg Harper was working on. His bill is moving forward, and some changes were made in the process of finalizing it. “The effort is to really deal with the Congressional Budget Office and what they will end up saying about telehealth provisions” explained Capistrant. There have also been several proposals to get a savings estimate from the CBO.

  • To have a Medicaid option for high risk pregnancies. Two years ago ATA got an estimate that it would save Medicaid 168 million over 10 years.
  • Giving hospitals an incentive for doing a better job in reducing their number of readmissions. It would allow the hospitals to share in the savings and will pay for home monitoring and video.
  • Have Accountable Care Organizations currently under Medicare (which serve about 4 million beneficiaries) use telehealth the same way Medicare’s managed care plan does. Medicare has started an effort to experiment with bundling with hospital payments with post-acute payments. There has participation in almost 400 hospitals all over the country. The goal is to have those hospitals be able to use telehealth to deal with that post-acute care and not have the restrictions that are in Medicare’s statute continue to apply.
  • Allow home video to people who are doing dialysis at home. This will empower more home dialysis and yield savings.

Other Harper package provisions that have been added include: restoring coverage for 104 counties, provision to go for coverage for telestroke diagnosis country wide, as well as some provisions dealing with critical access hospitals that are in metropolitan areas. These hospitals will not be included in the health shortage area because it is a hospital.

States
There has been a lot of progress among the states with telemedicine. The Governor of Missouri has signed a bill that will allow a parody law for private insurance covering telehealth. Missouri is now the 19th state that has this law. The ATA is finalizing three of the state best practices for Medicaid uses of telehealth, as well as a final report of major gaps in each state about telehealth

The ATA Board just recently approved online, web-based mental health services. It is also interested in developing practice guidelines for teleICU, web based or online primary and urgent care services that are starting to be developed, and remote health date management on wounds and burns, according to Linkous. Telepathology guidelines are also being rewritten.

Fall Forum in Toronto
The focus of the Fall Forum in Toronto is to examine some of the problems that have recently been discussed involving telemedicine. A major focus will be reducing readmission rates in hospitals. “A big topic in every hospital, in not only this country but around the world, is how do you reduce the readmission rate within the hospital and there’s a lot of work that’s been done on this using telemedicine as part of the answer. Not as the answer, but part of it,” explained Linkous. They will also be covering issues such as Telehealth networks, and how you can make those networks sustainable, as well as how to engage customers. They will also be covering topics such as mainstreaming in health applications, or “apps” to be integrated into the healthcare system. Other topics include virtual care and provider services.