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.



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.



New Technologies Improving Health Care

Much has been said and written about technology and its effects on the practice of medicine regarding how telemedicine and telehealth promises positive economic availability of health care going forth into the future.  As the doctor shortage and increase in the costs of medical services continue to front and center the debate, medical technology companies focus their resources on providing less expensive, faster and more efficient patient care.

To speed up and simplify the approval process of new medical devices, the Federal Drug Administration (FDA) recently formed the Medical Device Innovation Consortium (MDIC).  The organization seeks input from industry, government, and other nonprofit organizations and will prioritize the regulatory science needs of the medical device community and fund projects to streamline the process.  “By sharing and leveraging resources, MDIC may help the industry to be better equipped to bring safe and effective medical devices to market more quickly and at a lower cost,” says Jeffrey Shuren, M.D., J.D., director of the FDA’s Center for Devices and Radiological Health.

Every year industry observers and media select their favorite technology trends that propose to have the most favorable impact on overall medical care costs, patient care quality and safety.  Here are just five of this year’s technologies that fit the criteria.

The Optical Scanner

Melanoma, the most deadly form of skin cancer, has always been impossible to diagnosis without an invasive surgical biopsy.  The MelaFind optical scanner is not for definitive diagnosis but rather to provide additional information a doctor can use in determining whether or not to order a biopsy.  The new device is manufactured by MELA Sciences and uses missile navigation technologies originally developed by the Department of Defense and scans the surface of suspicious lesions.  The data is collected and processed using heavy-duty algorithms and matched against a registry of 10,000 digital images of melanoma and skin disease.

Electronic Aspirin

A reliable, long-lasting treatment for the most severe form of headache, chronic Cluster Headache (CH), is lacking. CH has long been associated with the sphenopalatine ganglion (SPG), a sensory nerve bundle in the head. Blocking pain directly at the SPG has been an elusive goal. A technology under clinical investigation at Autonomic Technologies, Inc., is a patient-powered tool for blocking SPG signals at the first sign of a headache.  The system involves the permanent implant of a small nerve stimulating device in the upper gum on the side of the head normally affected by CH.   The lead tip of the implant connects with the SPG bundle, and when a patient senses the onset of a headache, he or she places a handheld remote controller on the cheek nearest the implant. The resulting signals stimulate the SPG nerves and block the pain-causing neurotransmitters.

Needle-Free Diabetes Care

Anyone who suffers from Diabetes has to deal with the constant need to draw blood for glucose testing, the need for daily insulin shots and the heightened risk of infection from all that pricking and poking.  Echo Therapeutics is developing technologies that would replace the poke with a patch.  The transdermal biosensor reads blood analytes through the skin without drawing blood. The technology involves a handheld electric-toothbrush-like device that removes just enough top-layer skin cells to put the patient’s blood chemistry within signal range of a patch-borne biosensor. The sensor collects one reading per minute and sends the data wirelessly to a remote monitor, triggering audible alarms when levels go out of the patient’s optimal range and tracking glucose levels over time.

Autonomous Navigation Robots 

Telemedicine is well established as a tool for triage and assessment in emergencies, but new medical robots are taking the process one step further.  With the capability to patrol hospital hallways on more routine rounds, checking on patients in different rooms and managing their individual charts and vital signs without direct human intervention these new robotic devices are improving routine health care to hospitalized patients.  One of these new devices, the RP-VITA Remote Presence Robot produced jointly by iRobot Corp. and InTouch Health is the first such autonomous navigation remote-presence robot to receive FDA clearance for hospital use. The device is a mobile cart with a two-way video screen and medical monitoring equipment, programmed to maneuver through the busy halls of a hospital.

The Sapien Valve

The Sapien trans catheter aortic valve is a life-saving alternative to open-heart surgery for patients who need new a new valve but can’t endure the rigors of the operation. Manufactured by Edwards Life Sciences, the Sapien valve is now finding its first use in U.S. heart centers where it is being limited only to the frailest patients. The Sapien is guided through the femoral artery by catheter from a small incision near the grown or rib cage. The valve material, made of bovine tissue, is attached to a stainless-steel stent, which is expanded by inflating a small balloon when correctly placed in the valve space. This new device and simpler procedure promises dramatically shorter hospitalizations and is bound to have a positive effect on the cost of care.

Medical industry leaders agree that today’s most desirable technologies, whether telemedical communications or Sci-Fi-gadgets, strike a balance between reducing the overall cost of medical care while increasing safety and survival rates among patients.   While not immune from controversy and push-back from both health care providers and patients alike, new technologies hold the greatest promise to bringing higher quality and more efficient and affordable health care to millions of people around the world.