AcuteCare Telemedicine Blog


States are Leading the Way on Telemedicine Expansion

The states of Missouri and Kentucky are the two most recent states that are making significant strides in increased implementation and utilization of telemedicine.  Effective Jan. 1, 2014, a Missouri law (House Bill 986) makes private insurers responsible for reimbursing providers offering telehealth services just as these payers are for in-person services.  The bill states that insurers “shall not deny coverage for a health care service on the basis that the health care service is provided through telehealth if the same service would be covered if provided through face-to-face diagnosis, consultation, or treatment.”  While the new legislation benefits patients with private insurance payers, Missouri law still lacks provision for Medicaid beneficiaries.

In Kentucky, where state laws are in place for private and public payers, the legislators have expanded coverage of telemedicine services for Medicaid beneficiaries so long as these are delivered exclusively by way of interactive video-conferencing. The telehealth services covered by the law are extensive, ranging from mental health evaluations and care management to diabetes and physical therapy consultations.

These most recent events are indicative of individual state legislatures making the most aggressive progress towards removing regulations and passing legislation to accommodate the new technology’s use, while the federal government continues to focus on achieving a last place finish in the race for expansion.

American Telemedicine Association (ATA) CEO Jonathan Linkous said in a public statement recently. “The federal government places unnecessarily strict barriers and restraints on how Medicare patients are served when they deserve access to quality healthcare, regardless of geographic location and technology used.”

Kentucky and Missouri are joining a growing list of states that are realizing the benefit of telemedicine as a cost-effective delivery model for quality healthcare even though the two states have taken different approaches to expand access to telemedicine services. “This is a true win-win scenario,” said Jonathan Linkous, “First, it is a big victory for patients in Kentucky and Missouri, who now have greater access to the best-possible healthcare. It’s also a win for the treasury and taxpayers in those states, who will save significantly on public healthcare costs.”

With healthcare costs rising rapidly and access to specialized care diminishing for many Americans, it is well past a reasonable period of time for the top payer of medical services, the federal healthcare agencies and the U.S. Congress, to pick up the pace on making advances in passing and implementing legislation that will promote the advancement of telemedicine throughout the entire country.



Minority Communities May Benefit Most from mhealth Technology

Mobile Health (mHealth) is the newest entrant in the world of telemedicine.  Delivery of health services by way of mobile, smart phones is promising to be a quickly expanding healthcare delivery device and minority communities may be the segment of population that will benefit the most from the technology.  The Joint Center for Political and Economic Studies recently released a report entitled “Minorities, Mobile Broadband, and the Management of Chronic Diseases,” which evaluates the vast potential of mobile broadband technologies to help address our nation’s most pressing health concerns.

Diabetes, heart disease, cancer, arthritis, and obesity claim the lives of 7 out every 10 Americans each year and these chronic diseases affect minority communities disproportionately, with many individuals lacking the ability to effectively treat and monitor their health due to geographic, financial, cultural and linguistic barriers.  mHealth may be the answer to breaking down barriers to minorities receiving treatment for these chronic conditions.  With more than 63 percent of the minority population having access to mobile devices like smartphones and “pads”, equipping them with functionally relevant mobile applications can enhance the doctor-patient communication and empower patients to make informed healthcare decisions.

Some of the report’s policy recommendations include:

  • Ensure universal access to mobile broadband for households in both un-served and underserved areas.
  • Reform regulatory barriers that limit the use of non-traditional medical treatment.
  • Create incentives for physicians to use mobile broadband-enabled technologies for current and preventative care.
  • Avoid excessive and regressive taxation on wireless goods and services.

According to the latest industry data available, there are presently 31,000 health, fitness, and medical related apps on the market, and the rate of new introductions is growing rapidly. According to Washington, D.C.-based eHealth Initiative, the number of smart phone apps increased 120% during the past year alone and while there are hundreds of the apps that really work and are completely legitimate, the medical community has legitimate concern about many of the products safety and effectiveness.

Patients, physicians, and the vast mHealth community are profoundly optimistic about the future of health apps in bringing much needed medical care to those who suffer from chronic illnesses, not only in the minority communities but the increasingly aging population as well.



Will Mobile Technology Help Close The Digital Divide?

A recent study is revealing that patients using telemedicine are more likely to be urban and well educated. Based on data from 53,000 households collected by the Census Bureau in July 2011, the report found 8 percent of urban Internet users took part in telemedicine initiatives, compared with 4 percent in rural areas. That stands in contrast to telemedicine’s common selling point that it can more effectively and conveniently provide services to people in remote locations.

Participants were also found to be wealthier.  At income levels of $100,000 or more, 11 percent of Internet users took part in remote care, compared 4 percent from households in the under $25,000 bracket.  The 25-44 age group was found to be the most likely segment using online services for medical care and information.

As access to telemedicine opportunities continue to grow it is expected that the demographics will likely shift to include lower-income and less-educated patients.  One technology that may improve access to telehealth services is the mobile or smart phone devices which appear to be closing the digital divide among various demographic segments of the population. Mobile technology has become especially critical for low-income minorities who have no other technological means of connecting to the internet.

Survey results released in September by the Pew Research Center’s Internet & American Life Project indicate that African Americans and Hispanics are more likely than whites to own a smartphone, with 49 percent of Hispanics, 47 percent of African Americans, and 42 percent of whites owning these mobile devices.  For these groups, mHealth has the potential to be a powerful tool in promoting healthy living and preventive medicine, particularly in combating the high rates of diabetes in these populations.

Development of new and innovative health related mobile applications and growing the number of smart phones in the hands of the more economically challenged population promises to be an effective means to bridging the healthcare gap in America. Health and Human Services (HHS) has called on developers to create a mobile application to help educate minorities and women about cancer screenings and allow secure access to medical records.

Only time will reveal whether telemedicine’s promising benefits of increased access and lower cost of quality medical care will better attract and reach those who are most in need.



VETS Act Expands Veterans Access to Care

A bi-partisan bill, introduced by Representatives Charles Rangel (D-NY) and Glenn Thompson (R-PA) and cosponsored by 21 Members of Congress, would permit U.S. Department of Veterans Affairs health professionals to treat veterans nationwide with a single state license. The bill, known as the VETS Act, builds on the unanimous congressional enactment of the 2011 STEP Act (Servicemembers’ Telemedicine and E-Health Portability Act,) which provides a similar provision for healthcare providers in the U.S. Department of Defense. A similar licensing rule for patients and providers of Medicare, Medicaid and other major federal health programs was included in a comprehensive telemedicine bill submitted by Rep. Mike Thompson (D-CA) in December 2012.

These bills are a simple way, while preserving the states’ role to license, to address shortages of medical specialists, to improve patient access to the best qualified physicians, and to accommodate mobile Americans and multi-state health plans,” said Jonathan Linkous, Chief Executive Officer of the American Telemedicine Association.  Currently, most providers who practice interstate telemedicine must be licensed both where the patient and provider are physically located. In some states, medical boards are even imposing stricter licensing requirements for telehealth providers than they do for in-person care, such as requiring a prior face-to-face examination for each and every case.

The Veterans Administration is consolidating many medical specialties in regional facilities that are often located a considerable distance from veteran patients who need regular treatments for injuries suffered in the defense of the country.  In some cases these patients need to travel into another state to receive specialized care, resulting in significant inconvenience and expense to VA beneficiaries.  The ability to treat these patients across state lines by use of telemedicine technology promises considerable benefits to patients and the VA care providers.

For the Veterans Administration who is currently experiencing a backlog of more than 500,000 requests for benefits, removing or lowering regulatory barriers will surely enhance the accessibility of care for patients living in areas remote from VA treatment centers while generating operational efficiencies for the VA.