AcuteCare Telemedicine Blog

Does The FSMB ‘Compact’ Go Far Enough?

A new bill was introduced to Congress earlier this month that is designed to remove what many are calling a significant barrier to the expansion of telemedical services throughout the US. The “Telemedicine for Medicare Act,” or HR 3077, was introduced Sept. 10, in the House by Reps. Devin Nunes, R-Calif., and Frank Pallone, D-N.J.

In introducing the bill, Rep. Nunes said, “By reducing bureaucratic and legal barriers between Medicare patients and their doctors, it expands medical access and choice for America’s seniors and the disabled.” For doctors who treat Medicare patients, the bill will remove the state-by-state licensing requirement which has existed since the very formation of the states. Presently, each state requires a physician to be licensed in the state where the medical care is being performed, making it difficult and unnecessarily expensive for doctors to practice telemedicine across state lines.

“Keeping medical licensure within the states’ domain maximizes surveillance of physician quality while fostering diversity by preventing potentially unreasonable control by Federal agencies,” says AcuteCare Telemedicine Chief Executive Officer Matthews Gwynn, M.D. “The efforts by regional state groups to streamline licensure is a good solution.”

Joel White, the Health IT Now coalition executive director says, “Congress has already had success in implementing a national telemedicine framework for members of the Department of Defense (DOD) and Veterans Administration (VA), this Nunes-Pallone bill does the same thing for Medicare beneficiaries.”

As if taking a cue from the bill sponsoring congressmen, the Federation of State Medical Boards (FSMB) has just released model legislation which would create a multistate “compact” system, where member states will experience a streamlined interstate licensing process. While the proposed compact promises to expedite the path to individual licensing requirements within those member states, it appears that it will not sufficiently address the costs associated with fees charged for each license or with the process as a whole in non-member states. The model legislation calls for at least seven states to participate in the compact.

Many industry leaders feel that if more states sign-on to the compact it will head-off the federalization of medical licensing. But at first read, the FSMB compact model would complement many of the same negative, bureaucratic, bells, whistles and hoops that would most likely come with a national licensing system, leading others to see the proposed FSMB legislation as a means to preserve the centuries-old influence of state medical boards’ authority over the authorizing of physicians’ practices.

With the Congress already demonstrating a respectable performance in providing a successful framework for telemedicine to flourish, through the DOD and the VA, the present actions and efforts by FSMB and their supporters to bring the entrenched state licensing process into the 21st century, and avoid federal intervention, may be an example of too little, too late.

Universally Consistent Telemedicine Guidelines Still Out Of Reach

Recognizing the strong growth and innovative approach in telemedicine practices, the American Medical Association (AMA) enacted a set of guidelines for care provided by telecommunications earlier this year. The guiding principles seek to address the concerns and issues within the medical community relative to the development and implementation of telemedicine programs. The AMA guidelines support the “use of telecommunications in the delivery of healthcare while ensuring favorable standards of care; patient safety; quality and continuity of care; transparency; and the responsible handling of patient medical records and privacy.”

The action by the AMA appears to address the many valid concerns among the medical community while providing much needed flexibility, if telemedicine is to fulfill its many promises to increase availability of specialized medical services to rural communities, reduce costs of medical care and have a positive impact on the anticipated future shortage of physicians.

More recently, the Georgia Composite Medical Board enacted a new regulation governing the standards for telemedicine practice for physicians practicing in the state of Georgia. Much like the AMA guidelines, the regulations establish consistent standards of practice for providing treatment and consultation through the use of telecommunication technologies. The regulations were enacted after more than two years of evaluation and discussions by the state Board. The requirements, like those of the AMA, appear to successfully address many of the same concerns and issues.

The Georgia regulations require that all providers of telemedicine services, which include physicians, physician assistants (PAs) and advanced practice registered nurses (APRNs), hold a valid Georgia state license. However, one area of inconsistency between other proposed individual states requirements and the AMA guidelines is the requirement relative to prior in-person examination.

The AMA prefers not to specify whether the prior face-to-face examination requirement, before rendering treatment via telecommunication, must be performed in person or by a video encounter. The Georgia regulation specifically requires an in-person relationship prior to the any telemedicine service, but enumerates several exceptions and qualifiers which defer the requirement in specific instances. In many other states, including Tennessee, a much more defined requirement of pre-telemedical care relationship is mandated.

Perhaps the most prevalent impact of technology on our society is its effect on breaking down pre-existing divisions, both geographical and social. State lines, geographic hurdles and physical market limiting factors are obliterated by advances in telecommunications. If the full benefits of telemedicine are to be realized, consistency and clarity in regulations and guidelines must prevail.

Few in the healthcare community advocate for blanket federalization of regulations. The industry can do more to enact a core set of standards and practices that successfully address the bulk of concerns and issues of each entity while assuring every patient, regardless of where they reside, receives the best quality and most efficient medical care available.

Dr. Lisa Johnston, as CFO, finds AcuteCare experience to be priceless

Knowing how to analyze, organize and execute made her a star point guard on her undefeated high school basketball team, on Long Island, N.Y.

Those same qualities now in her professional life enable Lisa H. Johnston, M.D., to shine as the chief financial officer and founding partner of AcuteCare Telemedicine.

From Queens, N.Y., originally, it was at a young age that she decided to become a doctor. “I remember going to see my doctor at his house and thought, ‘Wow, he gets to work at home and make sick people feel better’,” Dr. Johnston says. “I remember looking through encyclopedias to figure out how old I would be when I graduated from medical school. Funny how it was so old then and so young now,” she laughs.

Initially, she wanted to become a physiatrist, but studying Neurology as an elective caused her to change course. “I remember seeing a man in a wheelchair whose left arm kept hanging out of the chair. I thought, ‘doesn’t he know it’s getting caught in the spokes,’” Johnston says, “and the resident said, ‘he had a stroke in his right parietal lobe. He has neglect and doesn’t know that’s HIS left arm.’ And that was it for me. I was completely sold after that.”

Dr. Johnston received her BA and MD degrees from Brown University and completed her initial post graduate training at Rush Presbyterian St. Luke’s Medical Center in Chicago. She was trained in Neurology at Emory University Hospital, where she also completed a fellowship in Sleep Medicine. Dr.  Johnston is a partner in Atlanta Neurology, P.C. and served as Medical Director of the Sleep Disorders Center at Northside Hospital. She is board certified in Neurology and Sleep Medicine.

Creating AcuteCare Telemedicine in 2009 was an easy decision for Dr. Johnston and her partners. “We had an opportunity as a group to provide telemedicine services at a community hospital nearby,” Dr. Johnston remembers. “We realized that we could provide the same service to other similarly situated hospitals; alas, ACT was born.”

Knowing the value of teamwork, Dr. Johnston says she and her colleagues share a work environment that is trusting, reliable, and cohesive. “We four partners of ACT are very fortunate that as physicians we have worked together for the past 15 years, sharing patient cases, new ideas and future goals. On call duty, in certain ways, can be a very solitude and at times daunting part of being a physician. There is comfort in knowing that there is always a partner that is willing and able to provide backup if needed.”

Dr. Johnston notes their commitment is multi-faceted. “Not only are we the physicians taking care of patients through ACT, we are the owners of ACT,” Dr. Johnston says. “We have a vested interest, not only in providing superior quality care of patients, we have an interest in making our company thrive. There is an all-around positive energy into everything we do – caring for our patients, and caring for our company. It’s a great environment to be a part of.”

She sees the healthcare environment for telemedicine as an increasingly expanding area. “Unfortunately there is an exodus of neurologists away from hospital work and on call duty. There is a particular lack of neurologists in many rural hospitals,” Dr. Johnston says. “As the trend continues, the need for telemedicine is only going to grow, especially in the field of Neurology, where assessing an acute stroke patient can be swiftly and completely performed via remote presence.”

Dr. Johnston finds her inspiration in the fast-paced, challenging work that emanates from remote presence. “You are talking about trying to intervene either to save someone’s life or improve their quality of life, within a limited period of time. You have to be there ‘now’ and you have to be on,” she says. “You have to decide whether to take the jumpshot or pass the ball inside … and the clock is ticking.”

Edward Herring’s relationship with his daughter is a pillar of Dr. Johnston’s success today. Her late father would have been 90 years old this year. “My dad (with mom’s support of course!) made tremendous sacrifices for me and my brother; some sacrifices that took me until adulthood to appreciate,” Dr. Johnston says. “His own dreams were deferred in order that ours could be realized. I know that he would not have had it any other way.”

In what spare time she gets, Dr. Johnston enjoys traveling, photography and spending time laughing and simply enjoying life with her husband and their teenage son.

For Dr. Johnston, being able to care for patients on an emergency basis through AcuteCare Telemedicine is invaluable. “I know that when ACT is called to see a patient for an acute stroke, there is no other neurologist at that time at that facility who is available to provide care and that’s what makes the work ACT does so impactful. We are providing care to patients that otherwise might be delayed or simply unavailable,” she says. “To me, to be able to serve in this manner, is priceless.”

Has The VA Been Telehealth’s Most Effective Proving Ground?

Every new product, marketing campaign, movie or television series has something in common. Each go through a period of trial and error to work out the specific details of the product or production where problems, glitches, barriers or creative faux pas are tweaked and corrected before making a debut to the greater community. Each new plane has its test flights; each new television series has its pilot episode; and every new product has its test market before being premiered to the whole of the world.

The Veterans Administration (VA) has long been out in front of the medical industry when it comes to providing remote monitoring and the delivery of virtual healthcare to it patients. Charged with healing a significant patient population afflicted with chronic illness, most living long distances from VA care centers, the VA may be the ideal proving ground for a new and revolutionary healthcare delivery model.

A new study published by Adam Darkins, Chief Consultant for Telehealth Services, and published in EHR Intelligence, highlights some of the results of the virtual healthcare programs first piloted by the VA. The study reveals that 11 percent of veterans received some portion of their care remotely in 2013, a growth rate of some 22% over the previous year. The VA’s telehealth programs include video interactions between caregivers and patients, remote monitoring of chronic disease, and teleradiology. A new program, currently under evaluation, allows veterans to access treatment for mental disorders like post-traumatic stress disorder (PTSD) from remote locations through a secure video connection. The challenge of connecting to patients residing away from regional care centers mirrors that of the greater healthcare community, where patients living in rural areas often have limited access to specialized chronic care treatment and facilities.

The confined organizational environment of the VA has allowed it to effectively navigate around several barriers that continue to frustrate the wider expansion of telemedicine in the private sector: Payment for telemedical services, limited or inadequate technology info structure, and the individual state licensing requirements of telehealth practitioners.

It appears that the VA has been a respectable micro test environment to develop, design, engineer and ultimately introduce virtual healthcare services. Dr. Darkins says, “Telehealth in VA is the forerunner of a wider vision, one in which the relationship between patients and the health care system will dramatically change with the full realization of the ‘connected patient.’ The high levels of patient satisfaction with telehealth, and positive clinical outcomes, attest to this direction being the right one.”