AcuteCare Telemedicine Blog


The VA Is Leading The Federal Charge On Advancing Telemedicine

Two California Congressmen have submitted a bill that would expand telehealth coverage to active-duty service members, their dependents, retirees and veterans.  The 21st Century Care for Military & Veterans Act (H.R. 3507) was submitted earlier this month by U.S. Reps. Mike Thompson (D-Calif.) and Scott Peters (D-Calif.). Co-sponsored by Reps. Gregg Harper (R-Miss.) and Peter Welch (D-Vt.) and endorsed by the American Telemedicine Association, the bill would establish and expand current reimbursement policies for telehealth coverage under the Veterans’ Administration (VA) and The Defense Department’s TRICARE.

The VA has seen a 40 percent reduction in bed days and 87 percent reduction of annual per-patient costs when compared to home-based care programs, according to VA studies. Adam Darkins, MD, the VA’s chief consultant for telehealth services, anticipated that some 825,000 veterans would be served through telehealth by the end of 2013.

This new bill will offer members of the Armed Forces and their families the highest quality healthcare in a timely manner no matter where they live or how far away they are from the doctor they need to see. Technology can create a responsive and more efficient healthcare system that provides for better care and lower costs.

Earlier this year, U.S. Rep. Devin Nunes (R-Calif.) joined U.S. Rep. Frank Pallone (D-N.J.) in sponsoring the Telemedicine for Medicare (TELE-MED) Act (H.R. 3077), which would enable healthcare providers to treat Medicare patients in other states with telemedicine tools and services but without needing a different license for each state.

The VA, which launched telehealth services in 2003, appears to lead the way for the rest of the federal healthcare bureaucracy by eliminating many, still well-entrenched, barriers to the rapid expansion of telemedicine technology.  Given the history of the VA’s percieved poor performances in delivering much needed traditional healthcare services to our veterans, their leadership in advancing the use of telemedicine is a trend that is more than just a little encouraging.



Advancing the Benefits of Telehealth and Telemedicine

Dr. Teresa Myers, a family practice physician in Copley, Ohio, describes what she can see on her computer screen during a telehealth conference. “You know what HD television looks like. You can actually see the pimples on the actors’ faces,” she says. “I had a patient who was able to shine her iPhone flashlight to the back of her throat. I could see the exudates [pus-like fluid]. If you see that, you can be pretty sure.” A few more questions, as well as having the patient take her temperature and feel and describe her lymph nodes, and Myers felt confident diagnosing strep throat and prescribing an antibiotic.  The consultation started less than five minutes after the patient logged in, cost $49 and lasted 10 minutes. The patient never left home, learned a few things about examining her own body and, two days later, said she felt much better when Myers followed up.

The rural health care workforce is stretched to its limits in most states. Despite programs operated by state, federal and local governments aimed at recruiting and retaining primary care professionals to these areas, the need outpaces the supply in many communities. Also, many of the current primary care physicians are nearing retirement and the numbers to replace them are insufficient.

For many states with large rural populations, telehealth has emerged as a cost-effective alternative to traditional face-to-face consultations or examinations between provider and patient. Telehealth is the use of technology to deliver health care, health information or health education at a distance. Real time telehealth communications allows the patient and physician to connect and interact through video conferencing, telephone or video health monitoring device.  Store and forward telehealth refers to the transmission of data, images, sound and video from one care giver to another.

Forty-two states currently provide some form of Medicaid reimbursement for telehealth services and 17 states require private insurance companies to cover telehealth services. While individual states appear to be well out in front of the federal government on supporting telehealth innovation, the federal government is finally moving to catch-up with the recent introduction of “The Telehealth Enhancement Act of 2013 (H.R. 3306).”  The bill promises to strengthen Medicare and enhance Medicaid through expanded telemedicine coverage and calls for the adoption of payment innovations to include telehealth and to make other incremental improvements to existing telehealth coverage. Another Congressional bill, “TELE-MED Act of 2013” (H.R. 3077) would permit certain Medicare providers in a state to provide telemedicine services to Medicare beneficiaries in a different state.

The convergence of medical advances, health information technology, and a nationwide broadband network are transforming the delivery of health care by bringing the health care provider and patient together in a virtual world, especially those in disadvantaged areas. Telemedicine has the potential to improve health care access and quality to patients in urban and rural America alike, but a variety of barriers, such as reimbursement and licensing issues, continue to stand in the way of more aggressive, widespread adoption.

The recent progress by state and federal governing bodies to recognize the significant advantages of increased telehealth services for all Americans with the introduction of new and meaningful legislation to address and remove established barriers to expansion, is encouraging to those in the health care community whose fundamental goal is to provide the best quality medical care to their patients no matter where they live.



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.