AcuteCare Telemedicine Blog


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.



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.



Medicare Recipients to Lose Telemedicine Services Benefits

Even though the availability of telemedicine has proven its value by lowering costs, increasing access and improving treatment and remote monitoring for chronic diseases, thousands of Medicare beneficiaries will soon lose access to telemedical services simply because of where they live, or more accurately stated, how government statistics identify where a patient lives.

Medicare patients from Hawaii to Puerto Rico to Minnesota will be redefined as living in “metropolitan” areas, precluding them from receiving Medicare coverage for video conferencing and other telehealth activities, even though 80% of beneficiaries live in urban counties such as those cut from the list.

“Congress has long overlooked the need for telemedicine services for residents of urban counties, despite the fact that they often suffer similar problems accessing healthcare.  Now, because of a statistical quirk, even more people will lose coverage of these services, reducing access and care,” said Jonathan Linkous, CEO of the American Telemedicine Association.

Originally, telemedicine technology demonstrated its most obvious benefits to rural communities, where specialized and chronic medical services and treatments were often not readily available without significant cost and inconvenience to patients.  However, the same cost/availability benefits have proven to be just as effective in urban areas and when chronic illness and extended, after hospital, care is encountered.

A study provided by the Commonwealth Fund shows that telehealth consultations are effective in reducing the amount of time patients spend in the hospital for care of chronic illnesses.  By examining data from large telehealth programs run by the Department of Veterans Affairs (VA), Partners HealthCare in Boston, and Centura Health, based in Colorado, researchers found that home monitoring programs can cut costs and raise patient satisfaction up to 85%.  Under the new guidelines, Medicare coverage will not be available for telemedicine visits to beneficiaries living in metropolitan areas–where over 80% of recipients live, resulting in cost reductions for the Medicare program.  Correcting this oversight will require an act of Congress, another incident of bureaucratic, regulatory interference with beneficial advancements in the delivery of healthcare to patients all around the country.

Given the increased involvement of government in the total delivery of health care in the coming years, this lack of insight does not bode well for reducing costs and improving availability to those who are most in need of the best in healthcare services.



AcuteCare Telemedicine and the American Telemedicine Association Team Up in Austin Texas

American Telemedicine Association (ATA) held their 18th Annual International Meeting and Trade Show On May 5-7 in Austin, Texas.  More than 6000 healthcare professionals and entrepreneurs in the telemedicine, telehealth and mhealth industries attended the premier forum on telemedical technology and health care services.

This year’s event offered more than 500 educational presentations and 300 exhibitors including AcuteCare Telemedicine (ACT), a leading practice-based Neurology provider of Telemedicine services. A day long video, a technical demonstration with GPT and InTouch and information on ACT telemedicine services was presented at the AcuteCare booth. ACT representatives sought out potential business opportunities throughout the conference with other vendors and service providers from markets in Mississippi, Arkansas, Florida and Latin America

Dr. Keith A. Sanders, from ACT, attended the “Telemedicine Venture Fair”, which featured industry experts from the Venture Capital community who shared their expertise and advice on strategic partnerships and venture financing with attending Telemedicine start-ups.  In addition, fellow ACT members attended multiple educational and business development presentations on neurology telemedicine. Speakers from UPMC in Pittsburgh, PA focused the discussions on topics concerning return on investment and business sustainability models.

During the three day event, The American Telemedicine Association named the winners of its prestigious annual awards and announced the election of two new members to the ATA College of Fellows. The winners of the 2013 ATA Awards represent the true innovators and best-of-the-best in our field,” said Stewart Ferguson, PhD, President of the American Telemedicine Association. “These individuals and organizations have proven that telemedicine is an invaluable tool in saving lives and improving healthcare, both here in the United States and around the world.  We are honored to recognize their great accomplishments.”

The American Telemedicine Association is the leading resource which advocates promoting the use of advanced remote medical technologies.  The diverse membership works to fully integrate telemedicine into healthcare systems in order to improve quality, equity and the affordability of healthcare to millions of people around the world.



Is There a Doctor in the House?

For those who can still remember the day when your family physician came to the house in response to a telephone call requesting medical service, the current debate over the acceptance of telemedical services in place of face-to-face visits with a doctor will bring back memories of a similar debate exorcised over the abandonment of house calls with in-office visits. Back then the vocal decry from opponents to the change suggested that patients would reject the idea and inconvenience of traveling to the doctor’s office to receive medical care and that somehow the process would have a negative effect on the quality of health care.

Few predict that the face-to-face, hands on, talk to me now visits with a physician is likely to go the way of the personal home visits anytime soon.  However, organizations resistant to changes with the current medical services delivery model and are unwilling to consider utilizing telecommunication technology will not be able to meet the growing demands of the patients and communities they serve.

A recent study by Cisco reveals that 74 percent of consumers are open to virtual doctor visits.  The results of the Global Customer Experience Report focused on health care, demonstrated a shift in consumer attitudes toward personal data, telemedicine and electronic access to medical information. The global report conducted in early 2013, includes responses from 1,547 consumers and HCDMs across ten countries.

The results indicated that 80 percent of American’s were comfortable with submitting personal medical and diagnostic information to the cloud to help ensure that all relevant personal medical information is readily available to receive treatment.  Perhaps the most interesting result was that the findings challenged the assumption that face-to-face interaction is always the preferred health care experience by consumers. While consumers still depend heavily on in person medical treatments, given a choice between virtual access to care and human contact three quarters of patients and citizens would choose access to care and are comfortable with the use of technology for the clinician interaction.

The benefits of face-to-face visits to quality of care are valid and current telemedical service visits will not likely replace all physician/patient personal interactions anytime soon, nor should they.  But recurring studies are beginning to reveal that patient’s reluctance and suspicions of telemedicine is no longer a valid excuse for delaying the broader expansion of telemedical services.

Perhaps we shouldn’t be all that surprised that patient objections to a reduction in face-to-face doctor office visits are fading.  Consulting with your family health care practitioner, via telecommunication technology, in the comfort and convenience of your own home has a familiar ring.  House calls revisited? What goes around comes around?