AcuteCare Telemedicine Blog


The Importance of Educating Legislators on Telehealth

Telemedicine legislation has been a frequent subject of much debate among healthcare professionals, Federal agencies, and State legislators. In recent news, the Governor of Delaware signed a new comprehensive telemedicine bill into law which requires healthcare companies to pay for telemedicine services at the same rate as in-person visits. Delaware joins 29 other states who have adopted similar requirements. U.S. Representative Mike Thompson is also actively working on the Medicare Telehealth Payment Parity Bill expanding the list of telehealth services available to Medicare patients.

In an effort to increase national attention on telehealth related issues, the American Telemedicine Association (ATA) is announcing The ATA Fall Forum, an event to educate members of Congress and push for important telemedicine policies. National Telehealth Lobby Day will be held on Capitol Hill in Washington DC. on September 16, 2015, and will be part of the event that includes training sessions on telehealth legislative priorities and expert tips on how telemedicine supporters can start discussions with Congressional leaders.

“Telemedicine has rapidly become the new standard of care,” comments Dr. Matthews Gwynn, Partner, AcuteCare Telemedicine. “In order to drive positive legislative change, we must educate legislators on the importance of access to telemedicine as well as the overall impact of telemedicine to patients and healthcare organizations.”

The Association leadership believes the best way to influence members of Congress is through face-to-face interactions with legislators. Federal and state legislation regarding physician licensing, care quality, scope of treatment and reimbursement of telemedicine is critical to expanding healthcare access and improving patient outcomes.

The ATA is the leading international resource and advocate for advanced remote medical technologies. Established in 1993, as a non-profit organization, the ATA membership works to fully integrate telemedicine into a transformed healthcare system to improve quality, equity and affordability of healthcare throughout the world. Their mission is to promote professional, ethical and equitable improvement in health care delivery through telecommunications and information technology. The ATA Fall Forum in an opportunity to further this mission.

“As a leading practice-based provider of telestroke care, we support initiatives that open a dialogue with legislators, practitioners, and healthcare leaders with the intent on drafting smart legislation that will have a positive impact on our healthcare system,” said Dr. Keith Sanders, Partner, AcuteCare Telemedicine.



Do We Risk Getting Lost, Getting There from Here?

For the healthcare industry, this is the year for consumers to leverage new communication technology and the benefits it promised to lower cost and increased access to quality medical care.  Greg Donahue of Benefitspro said, “Telemedicine is becoming a hugely popular health care product, and a great way to connect doctors and medical facilities with patients. Although many people are still not familiar with its application or availability, the medical community is acutely aware of the cost savings and efficacy of providing direct access between the healer and the sick.” And in a recent Harris survey, more than half of American healthcare consumers indicated that they want to use telemedicine to connect with a physician is an indication that providers are in sync with their patients on the subject of telehealth and its impact on developing a new healthcare delivery model.

With a dozen or so state legislature’s and medical boards currently eying legislation and regulations that could, if adopted, remove the barriers to unfettered progress in the expansion of telemedicine nationwide, the discussion now centers, not on the factual merits of telemedicine, but rather on the question; how do we get there, all together, from here? As one watches the process that a few states have been going through in recent weeks, even the most cynical and experienced observers have to be amazed at the variety of results all the individual States efforts have produced. One thing is truly obvious; determining how we all get to the same destination is taking us all over the map.

While one universal theme consistently centers on the premise that practicing telemedicine shall use the same standard of care as if the healthcare services were provided in person, commonality ends there. Some states require face to face encounters between doctor and patient to exist prior to a virtual treatment, some require a previously established doctor patient relationship via in-person or through telecommunication, some require face to face relationships with exceptions for emergency or specialized care and others ban out-right telemedical care without a previous face to face doctor patient relationship. In a few instances, state law makers have gone as far as determining and mandating the specific illnesses that can or cannot be treated via virtual care.

Addressing the rising high cost of healthcare, universal accessibility and the looming threat of a doctor shortage should be a goal shared by all entities with the responsibility to impact and initiate effective solutions to our healthcare crisis. Technology can and will play a significant role in meeting those shared objectives, but only if all stakeholders gravitate towards setting policy that permits some individuality and flexibility but promotes continuity across all existing boundaries such that it does not interfere with the efficient application of that technology.

The journey to removing the barriers to progress is not concluded and the elongated process may, in the end, produce a better set of solutions for all. Collective intentions focused on the creation of a new and better healthcare delivery model for providers and their patients will help is all get there, together, from wherever we are.



Telemedicine Legislation is Moving; In All Directions

The use of telemedicine and telehealth is increasing becoming the subject of debate in state legislatures all across the country, making the delivery of medical care via telecommunication technology a priority legislative issue for 2015. Ten states; Arizona, Arkansas, Connecticut, Montana, New Hampshire, New Mexico, Oklahoma, Virginia, West Virginia and Wyoming are moving legislation that will impact how their state licensing boards enforce established clinical practice standards. In Arkansas, Connecticut, Indiana, New Jersey, Rhode Island, and Washington law makers are considering legislation that will require telehealth parity under private insurance.

Ron Bachman, a foremost expert on health care consumerism, consumer-centric Medicaid and Medicare, the uninsured population and mental health, predicts an estimated half a billion smartphone users worldwide will be using a health care app to connect to a healthcare giver by the end of 2015. An emerging, technology-using generation is becoming increasingly comfortable with using mobile devises to access their medical care through smartphones, tablets and laptops. Entrusted with an increased responsibility for paying the rising costs of healthcare, these new consumers are embracing disruptive technologies to command lower cost, more convenient, higher quality, consumer oriented medical care. “It is impossible to stop a mega-trend,” says Bachman. “Telehealth is the cutting-edge future of health care worldwide. Telehealth, in its various forms, will provide convenient medical services because consumers will demand it.”

In another recent Harris survey, more than half of Americans indicated that they want to use telemedicine to connect with a physician, and they also think it should cost less than an in-person visit. It is an indication that consumers identify telemedicine as a different means by which to deliver care not a different type of healthcare. Data consistently indicates that telemedicine can deliver quality healthcare outcomes comparable to in person office visits while lowering consumer costs for routine care. Emergency Room (ER) treatment tops the list as the most expensive, least efficient and most frequently utilized way to provide non-emergent care, with an ER visits costing from $1,500 to $3,000 on average. Visits to a Primary Care Physician (PCP) can coast from $130 to $190. A telemedicine visit can cost as little as $40. With the popularity among voting consumers growing there is little wonder why state lawmakers are aggressively marching telehealth legislation forward.

In a recent Forbes article entitled, “Telemedicine Is a Game-Changer for Patients, The System,” contributor Bill Frist points out that there are multiple barriers to the widespread uptake of telemedicine with the most prohibitive being regulatory policies at the state level. The laws in many states either severely limit or completely ban the practice of telemedicine. In Frist’s opinion, for consumers to gain the most benefits from telemedical technology legislation must address four persistent barriers to complete telehealth adoption:

The legislation needs to provide payment parity by requiring insurers to reimburse licensed health care providers for services delivered remotely at the same rate they would pay if the visit were in-person. This assures there would be no financial incentive to favor face to face care over telemedical services. The caveat that it cost the same acknowledges the value of the telephysicians expertise and the indirect costs of providing this service. Cost savings would still be realized through a reduction in lost workforce productivity and less reliance on emergency medical services.

For quality assurance, any legislation should establish that the same standard of practice applies whether the services are delivered in person or remotely.

Proposed legislation should prevent the use of additional rules requiring in person visits before or after telemedicine encounters or the presence of care facilitators during an encounter. Such restrictions effectively eliminate the possibility of most telemedicine models from operating.

State licensure requirements should allow exemptions for telemedicine.

The legislation that is passing through some states is attempting to encompass many of these points. The Arkansas House of Representatives was able to pass a new bill (SB133) that is more restrictive than one that had been previously voted down. While the bill does not meet all goals of an open telemedicine market for consumers and provider alike, it will allow telemedicine practitioners to be licensed as doctors in Arkansas, waives the requirement for a pre-existing, in-person relationship with the patient in cases of emergency and demands that telemedicine be reimbursed by Medicaid and private health plans.  Arkansas lawmakers, like those of many states, are finally willing to open the door to a new healthcare delivery model by way of modern technology, if only a little.

Other states have also passed or are considering telemedicine legislation that would expand telemedicine within their states. There appears to be little consistency in the various offerings except for a tendency towards over-regulation and complexity. Telehealth is exactly the type of innovation that can solve many of the challenges currently facing the healthcare system. Elected representatives must move more vigorously to craft legislation that serves to promote this innovation while limiting litigiousness and overregulation.



Telehealth Legislation Continues to Evolve

Things are heating up in state and federal legislatures when it comes to advancing legislation that will help accelerate the spread of telehealth across America. The American Telemedicine Association (ATA) is working with congressional representatives to move forward on what is known as, “21st Century Cures”. The ATA is recommending that Congress take immediate action to improve coverage for telehealth services under Medicare payment innovations in a number of areas from fee-for-services to Accountable Care Organizations to bundled payment programs. The House and Energy Commerce Committee recently released a draft bill that will, in part, direct the Centers for Medicare and Medicaid Services (CMS) to implement a methodology for coverage of telehealth services.

Outside of Washington and all across the country, State legislatures are making telemedicine a priority issue for 2015. Ten states; Arizona, Arkansas, Connecticut, Montana, New Hampshire, New Mexico, Oklahoma, Virginia, West Virginia and Wyoming have introduced legislation that will impact how their state licensing boards enforce established clinical practice standards. In Arkansas, Connecticut, Indiana, New Jersey, Rhode Island, and Washington law makers are considering legislation that will require telehealth parity under private insurance.

In the state of Florida the battle to find acceptable legislative action to help increase access to health care in their rural communities is on-going. A bipartisan group of House and Senate leaders are confident they will reach agreement this year on how to boost the use of telemedicine in their state. “It’s abundantly important that we get it done and get it done right,” House Health Care Appropriations Chairman Matt Hudson, R-Naples, said during a news conference at the state Capitol in Tallahassee. As with several other states, law makers continue to struggle to pass legislation that satisfies legislators’ and healthcare industry concerns for the safety of patients and maintain the fiduciary responsibility of state government.

Lawmakers during the past few years have filed telemedicine bills that would allow for the use of modern telecommunication technology in the delivery of healthcare but the Florida House and Senate have not been able to reach an agreement. This year legislative leaders are expressing confidence that they can resolve their differences on regulatory issues. One of the points of disagreement in Florida and other states is the issue of individual state licensing and whether out-of-state physicians should be allowed to provide telemedical care to patients in their state. The current requirement and process of requiring a physician to be licensed in each state where treatment is rendered continues to be a significant stumbling block to the unabridged expansion of the practice of telehealth across state boundaries.

If the year 2015 is to become the predicted tipping point for expanding the benefits of technology driven medical care, state legislatures in Florida, and other states around the country, will need to do more than just debate and negotiate over the future of regulations that were relevant to times past.