AcuteCare Telemedicine Blog


Florida Attempting To Become 20th State To Require Private Insurers To Cover Telehealth Services

State Senator Arthenia Joyner is sponsoring a bill that would make Florida the 20th state to require private insurers to cover telehealth services, starting in 2015.  The bill would require reimbursement for remote consultations, on a basis equivalent to in-person consultations with physicians, with allowable co-pays and deductibles. The telemedicine services and coverage include multi-payer coverage and reimbursement, for stroke diagnosis, high-risk pregnancies, premature births, mental health services, and emergency services.  With current limited public payer coverage of telehealth services, the technology has not been widely used in Florida.

Florida’s 3.5 million seniors could benefit from expanded telemedicine but given the recent restructuring of Medicare designated rural areas few of Florida’s seniors now qualify for Medicare reimbursements for telehealth services as a result of new data which now includes them in federally-designated metropolitan statistical areas, making them ineligible for Medicare telehealth reimbursement. It appears to be another example of the nation’s leading payer of healthcare shooting the patient in the preverbal foot based more upon the patient’s location rather than on the subscribers medical service needs and further denying patients expanded healthcare access and the behemoth program the cost benefits of new technology.

As technology continues to evolve ahead of the law, at least the state of Florida is moving to join other enlightened state legislatures to craft a forward-looking health reimbursement policy for emerging technologies such as telehealth, telemedicine and mobile health.

Telemedicine services, as Joyner’s bill defines it, includes “synchronous video conferencing, remote patient monitoring, asynchronous health images, or other health  transmissions supported by mobile devices, such as mHealth, or other telecommunications technology used for the purpose of diagnosis, consultation, treatment, transfer of medical data, or exchange of medical education information by means of audio,  video, or data communications.”  A definition certainly adequate enough to match the new technologies forward momentum and an example of the kind of vision that Congress needs to adopt if they are to seriously get with the technology program anytime soon.



Expanding tPA Stroke Treatment Through Telestroke Delivery Model

For years, the mantra of neurologists treating stroke victims has been “time equals brain.” That’s because getting a patient to the emergency room quickly to receive a drug that dissolves the stroke-causing blood clot can make a significant difference in how much brain tissue is saved or lost. Established research has demonstrated that administering a tissue plasminogen activator (tPA) intravenously up to 4.5 hours, after the onset of a stroke, benefits patients with moderate to severe acute ischemic stroke. An ischemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to the brain and it accounts for 87 percent of all stroke cases.

While the use of tPA significantly improves a patients recovery from stroke its administration requires the availability of neurologic expertise within this narrow window of time.  Specialized stroke care at large academic medical facilities is very effective in providing stroke care but access to these centers is limited to patients living in rural areas of the country.  Practiced-based telestroke services, staffed primarily by general neurologist, offer a streamlined organization that facilitates the dissemination of this vital emergency treatment but a comparative analysis of the data between the two delivery systems is a critical.

“Expanding Access to Intravenous Tissue-type Plasminogen Activator with a Practiced-based Telestroke System” was recently published by the Journal of Stroke and Cerebrovascular Diseases.  The study was prepared by 4 practiced-based neurologists at AcuteCare Telemedicine (ACT), an Atlanta-based company that’s billed as the largest practice-based provider of teleneurology in the southeast.  Summary findings included data gathered over a two year period at 7 hospitals on 202 emergency telemedicine consultations and treatment of 54 telestroke patients with IV tPA.  Patient demographics and outcome measures were not significantly different for patients treated by practiced–based or academic providers with the exception of lower age and shorter stay duration of the practiced-based treatment group.

The results indicate that emergency stroke care provided by the two delivery models can achieve similar patient outcomes and that a practiced-based telestroke system can expand the availability of IV tPA treatment with clinical outcomes no different from previously published studies.

“Meeting the requirement of providing rapid neurology care to all of the nation’s emergency rooms will necessitate a concerted effort of academic and practiced-based stroke systems”, said Dr. Keith A Sanders, ACT.  The technological, organizational and financial hurdles which currently limit telestroke use and expansion will likely be resolved as the benefits of telemedicine become more evident with its expanded use.

For more study details and the full article, contact info@acutecaretelemed.com



Positive Patient Outcome Advances the Telemedicine Delivery Model

Recently a team of researchers from UCLA completed a major study on the use of tissue plasminogen activator, or tPA, on stroke victims within 4.5 hours after the stroke occurs. That study of more than 50,000 stroke patients, as reported in a recent issue of JAMA, The Journal of the American Medical Association, confirms that the sooner tPA is administered, the better chance of recovery.  In response to the study, AcuteCare Telemedicine (ACT), an Atlanta-based company that’s billed as the largest practice-based provider of teleneurology is making an aggressive push to help smaller hospitals and networks that don’t have immediate access to neurologists.

Their efforts have proven to be life saving for one Ozark, Alabama resident and recent stroke victim.  The collaboration between ACT and the Southeast Alabama Medical Center (SAMC) is having its desired effect for SAMC patients, providing once unavailable, advanced life saving treatments to stroke patients. The Stroke Care Network, established in Dothan, Ala., in collaboration with ACT, the Southeastern Alabama Medical Center Foundation and the Alabama Partnership for Telehealth provides stroke services for a 240-square-mile swath that includes southeast Alabama, southwest Georgia and the Florida Panhandle.

The collaboration was initiated when Cecilia Land, SAMC’s division director for rehabilitation services discovered an increase in the areas mortality and morbidity due to stroke. “We recognized an immediate need to establish a stroke care network, providing patients with access to 24×7 teleneurology,” said Land.  SAMC officials hope to add more “spokes” to the network, in the form of hospitals and clinics, and also want to use the network to educate communities on the importance of wellness and identifying precursors to a stroke.  Dr. Keith A. Sanders from AcuteCare Telemedicine hopes to extend ACT’s telemedicine platform to other specialties, such as telepsychology, and he expects more hospitals and health networks will buy into the system as executives see the benefits of sharing specialist services without having to house them on-site.

This most recent life-saving patient outcome from the collaboration between ACT and SAMC is proof that the new telemedicine health care model is an excellent vehicle to advancing the availability and quality of telestroke care to SAMC patients and to underserved patients all around the country.



CMS Expanding Telemedicine Coverage

The Centers for Medicare and Medicaid Services have proposed rules that would provide telemedicine services to nearly 1 million new Medicare beneficiaries.  CMS proposes to increase the number of beneficiaries eligible for telemedicine by modifying their urban/rural definitions and proposes several new reimbursable telemedicine services.

The first change would extend reimbursable telehealth services to “originating sites” serving nearly one million rural beneficiaries living in large metropolitan areas. Currently, Medicare uses a strict county-based classification to enforce its rural-only rule for telemedicine coverage. The new rule would create a more precise urban/rural distinction based on geographically smaller census tracts.

The second proposed change would increase coverage for transitional care management services under Current Procedural Terminology (CPT) codes 99495 and 99496, involving post-discharge communication with a patient and/or caregiver. Reimbursement of these services will help healthcare providers deliver improved in-home care to at-risk beneficiaries and significantly reduce needless hospital readmissions.

Jonathan Linkous, Chief Executive Officer of the American Telemedicine Association cautiously supports the change and in a statement said, “This is one small step in the right direction.  For 15 years the federal government has placed strict restraints on the use of telehealth while employers, private payers, states and many other nations have moved boldly forward, improving the quality and reducing the cost of care. It is time to unleash the power of modern technology and allow Medicare beneficiaries, regardless of whether they live in a rural area, underserved inner-city, in a clinic or at home to be eligible to receive the benefits of telehealth.”

The proposal is currently open for comment and ATA encourages all telemedicine advocates to express their support.  The American Telemedicine Association is the leading international resource and advocate promoting the use of advanced remote medical technologies. ATA and its diverse membership work to fully integrate telemedicine into healthcare systems to improve quality, equity and affordability of healthcare throughout the world.



FDA, mHealth Regulations are on the Horizon

A battle is beginning to build between various stakeholders and investors in new medical mobile applications over the timing of the release of long-anticipated Federal Drug Administration (FDA) regulation of the medical app industry. A group of 100 organizations including medical trade associations and electronic health record product companies wrote to federal regulators recently, urging the need for slowing the course on mHealth regulation, particularly until a mandated federal workgroup finishes working on a report to guide Congress on the issue.

Brad Thompson, attorney for the mHealth Regulatory Coalition, the group working to prepare the report for Congress, submitted a letter to regulators the same week urging the release of mobile app regulations as soon as possible. Thompson, a member of the workgroup says he’s “pretty familiar with what that group is doing, and I don’t see publishing the FDA guidance as frustrating at all.”

Mobile app developers need regulations now in order to know if their product needs FDA approval. Without it, they could be breaking a federal statute

if they go to market before the regulation is released and may find that they will be undersold by competitors who do not seek FDA approval.

The dollar amount of investments awaiting federal guidance is significant and the risk is even greater.  The uncertainty over the guidelines which will ultimately determine whether some medical application need FDA approval before going to market is palpable for stakeholders who are reserving large amounts of capital pending the news.  As is often the case with governmental regulations, knowing is far better than not knowing in the eyes of many investors.

Medical applications for use with mobile devices are a very promising niche for those who are marketing medical services through telemedicine.  Mobile applications promises to expand and ease accessibility to chronic disease patients who currently are underserved, particularly when it comes to highly specialized medical care.

FDA officials have indicated that they are moving toward an October 2013 release of regulations.