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TECHNOLOGY

Telemedicine: staying current amid ongoing changes

The American Telemedicine Association (ATA) defines telemedicine, also known as telehealth, as the remote delivery of healthcare services and clinical information using telecommunications technology. This includes a wide array of clinical services using Internet, wireless, satellite, and telephone media.

Although telemedicine is often associated with remote consultations, services are actually much broader. For example, remote cardiac monitors, used by nearly 1 million Americans, fall under the umbrella of telemedicine.

As technology and related applications become more sophisticated, and physician and patient levels of comfort with technology increase, telemedicine will further expand.

Projections with regard to expansion vary greatly. However, one report, from WinterGreen Research, which segments telemedicine into two areas, estimates that telemedicine dedicated device and software markets worldwide will reach $2.9 billion by 2019, and mobile health (m-health) markets related to telemedicine will reach $1.5 trillion by 2019 due to the use of 7 billion smart phones and half that many connected tablet devices all over the world.

With growth comes change, and challenges.

Focus on payment

One of the areas of focus, which has been cited as a potential obstacle to the growth of telemedicine, is coverage and reimbursement.

New technology and procedures may initially present payment challenges. However, once adoption becomes widespread, as in the case of cardiac monitors, for example, coverage is usually not an issue. Nevertheless, getting from point A to point B isn’t always easy.

Be that as it may, there is widespread awareness of the role telemedicine plays in healthcare—and there are substantial efforts underway that will help expand its use.

The ATA, the leading international resource and advocate promoting the use of advanced remote medical technologies, points out that both the Senate and House have recently introduced several bills to expand federal support for telemedicine. 

“Such action is unprecedented in the 22 years that ATA has been working with Congress,” said Jonathan Linkous, CEO of ATA.  “These actions signify how the nation is poised to embrace the use of telecommunications in the delivery of care. This is one more step in fulfilling ATA’s mission to improve quality, access, equity, and affordability of healthcare.”

  • Rep. Gregg Harper (R-MS) recently introduced the Telehealth Enhancement Act of 2015 as H.R. 2066. The bill aims to strengthen Medicare, Medicaid, and federal telecommunications programs through expanded telemedicine coverage. The ATA indicates the bill has strong bipartisan support and additional sponsors are expected.
  • A Senate companion bill to H.R. 2066 was recently introduced by Sen. Thad Cochran (R-MS) and others. Interest in the Senate was highlighted in a committee where 17 Republican and Democratic senators expressed their strong support for measures that will transform healthcare through the use of telemedicine.
  • The House Energy and Commerce Committee has released a long-awaited discussion draft of its 21st Century Cures bill. The bill covers a range of innovations related to digital healthcare. The ATA notes that portions related to telehealth were once thought scrubbed but may still include provisions, thanks to the strong support of the committee’s leadership and a congressional telehealth working group.
  • Rep. Mike Thompson (D-CA) has introduced the Medicare Parity Act, which the ATA indicates also has strong bipartisan support. The bill seeks to remove restrictions to telemedicine in Medicare and require parity with in-office visits.

Focus on practice

Another area of focus and concern is physician practice standards and licensure. The American Medical Association (AMA) points out that “each state has unique laws regarding the scope of practice permissible through telemedicine.”

This is further complicated by the fact that the laws in the state where a physician is licensed may not be compatible with the laws in the state where a patient resides.

HealthIT.gov, a federal website for healthcare providers and professionals, as well as patients and families, provides this synopsis of the state-to-state licensing issue: “Licensing can be a problem for telehealth programs. Most states require physicians to be licensed to practice in the originating site’s state, and some states require providers using telehealth technology across state lines to have a valid state license in the state where the patient is located. Therefore, with limited exceptions, telehealth consultations with a physician across state lines require licensing paperwork. If you electronically interact with patients in other states or prescribe medication across state lines, you should establish licensure in those other states.”

Keeping up with changes

In addition to keeping up with evolving technology, medical office manager must stay current with changes to coverage and reimbursement, as well as practice standards and licensure requirements.

A report from the ATA, “State Telemedicine Analysis: Coverage & Reimbursement,” provides detailed information about coverage and reimbursement by state, as well as a “report card” for each of the 50 states.

View the report here. Individual state report cards begin on Page 24 of the report (Page 29 of the PDF document).

Another report from the ATA, “State Telemedicine Gaps Analysis: Physician Practice Standards & Licensure,” provides information about physician practice standards and licensure by state, as well as a report card for each state.

View the report here. Individual state report cards begin on Page 10 of the report (Page 15 of the PDF document).

As telemedicine continues to evolve, changes will be ongoing. But the benefits to patients and the practice should offset any challenges.


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