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
There are currently 30 plus proposed bills before Congress and 2013 has been one of the biggest years for telehealth legislation. The most notable is the Harper Bill which has been previously discussed; the biggest emphasis is getting this bill to the Congressional Budget Office so they can provide their estimate as to the cost savings this bill provides.

Telestroke is a major component which Linkous says can help revolutionize stroke care. Last year over 100,000 people who had a stroke were seen in an ER remotely by a neurologist. While he can’t be sure how many lives were saved, he guesses it was a significant percentage. Unfortunately, the savings associated with telestroke are not necessarily while patients are in the hospital. They come after patients have been discharged since they don’t have to go to rehab or go to the nursing home as much. This presents a challenge for the Congressional Budget Office to quantify the savings of the Harper Bill.

Another bill introduced is Peters H.R. 3507 for TRICARE and all of Veterans Affairs (CHAMPVA). Essentially, it will establish parity coverage for teleheath and it will also make one state license all that’s necessary for physicians to practice via telehealth. Other bills include the Step Act (H.R. 1832), VETS Act, H.R. 2001 and the TELE-MED Act, H.R. 3077 which also support the requirement for only one state license necessary to practice telehealth.

State Activity
A major topic is dealing with internet prescriptions or the ability to prescribe medication without actually seeing a patient in person. There are several state professional regulations and state medical boards that have different rules regarding licensing, standard of care and scope of practice. Since there are so many different ways states are handling this topic the ATA is working on developing a set of guidelines.

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.

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.

Mobile Health
Mobile Health is making much more than a dent in the telemedicine industry; $161 Million has been dedicated to mobile health from 43 different companies in the last quarter. This is a drastic increase compared to earlier in the quarter when only $42 Million was dedicated to mobile health.

Currently the guidelines that involve mental health correspond with mobile health. ATA is currently in the process of doing an accreditation of mobile health care services online, and hopes to have it ready by early next year. This is a major step for ATA and for telemedicine. A Special Interest Group on mobile health is hosting a webinar on privacy and international applications in mobile health.

Telehealth Opportunities
A component of the Affordable Care Act, which is currently being implemented, says that those in the health insurance exchanges have to support essential health benefits. However, there is no basis in the regulation to not pay for a telehealth claim. It is all supposed to be provided and covered on the same basis as in-person care.

The CMMI, or Center for Medicare and Medicaid Innovation, continue to create funding opportunities either directly for projects or through the states. There is managed care within Medicare and Medicaid populations, most of the managed care plans have had the flexibility to use mobile health or other telehealth aspects. Hospitals have grown interested in home monitoring of people, and other aspects dealing with readmissions problems. Since Medicare cuts funding for hospitals not reducing their readmissions enough, many have grown more receptive of using difference health technologies such as mobile health.

Medicare Physician Fee Schedule
A major change that is expected in the new fee schedule for telehealth is CMS will use a much more open definition of rural health shortage areas that will allow telehealth to be provided on the fringes of rural areas.

Legislation
Harper Bill, H.R. 3306 is a very notable bill for mHealth and has many bipartisan sponsors. Telehealth for Medicare ACO’s, or Accountable Care Organizations, currently don’t have coverage for telehealth in metropolitan areas, where most of the ACO’s are. The goal is for ACO’s to have full flexibility of telehealth.

It will also have shared savings for reducing Medicare readmissions. This proposal gives hospitals the incentive to do better than their own benchmark, in hopes of saving money for Medicare. It is an opportunity for hospitals to have some sort of income, and it will ultimately be a positive thing for patients. It will also target home dialysis, hospice, and homebound patients. Mobile Heath can cover these kinds of patients at home, and have the same kind of in person physician assistance.

There are also several other bills that are pending and being discussed. The Step Act (H.R. 1832) was enacted in December 2011. This act expanded the authority for the defense department to require only one state license for health professionals to operate in any state. This model is also being expanded to apply to two others, the VA: VETS Act, H.R. 2001, or Vets affairs facilities and TELE-MED Act, H.R. 3077, or the Medicare population.

Finally there is also the SOFTWARE Act, H.R. 3303, which is Sensible Oversight for Technology Which Advances Regulatory Efficiency and has been proposed by Congresswoman Marsha Blackburn. This bill deals with the volume of applications that have flooded FDA for mobile applications.