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.

Another Attempt To Expand Medicare Coverage For Telemedicine

Two members of the U.S. House of Representatives are not giving up on expanding Medicare coverage for telemedical services.

In 2012, Glenn Thompson (R-Pennsylvania) introduced legislation amending Title VIII of the Social Security Act with sweeping changes that would allow Medicare payment coverage for nearly all telemedicine services where the corresponding in-person treatment would be covered. That aggressive legislation died in committee, but Glenn is back and has added Rep. Mike Thompson (D-California) as co-sponsor of the Medicare Telehealth Parity Act of 2014. The new bill is less aggressive and seeks to phase-in telemedicine coverage over a four-year period. The phase-in term will allow for measuring the effectiveness of the new coverage and an opportunity for Health and Human Services (HHS) to develop standards for remote patient monitoring and other potential telemedical care.

Current Medicare rules only permit reimbursements for telemedicine services to patients who reside in designated rural areas that are beyond the reach of comprehensive urban healthcare centers. Some critics have complained that the current rules are arbitrary and create situations for some Medicare patients and physicians which restrict access to needed care simply based upon where a patient lives. The new legislation calls for expanded telemedicine coverage in urban areas with a population of 50,000 people or less, and would expand the acceptable care sites from hospitals and doctors’ offices to include retail clinics as well.

Two years after enacting the new bill, coverage would expand to urban areas with a population between 50,000 and 100,000, and would add home telehealth to the acceptable care sites. Also, outpatient services like speech therapy and physical therapy would be added as a covered category for reimbursable telehealth services.

After four years, telemedicine would become reimbursable everywhere, under the provisions of the Act. Medical care provided by phone or email alone would not be covered.  After the second year the legislation requires the United States comptroller to conduct a study to determine the efficacy and potential savings to Medicare from telemedicine.

Often for very legitimate reasons changes in well-established government sponsored programs do not seem to come about quickly, but this new bill provides the opportunity “to test the water,” evaluate the ongoing progress and allows for adjustments along the way to insure its effectiveness. It is also encouraging that the legislation has bi-partisan sponsorship and support. Perhaps it is time another barrier to telemedicine’s benefits be set aside in the interest of patients and the doctors and caregivers dedicated to delivering their care.

Telemedicine Delivering Advanced Pediatric Care To The World’s Children

Telemedicine was originally trumpeted as a technological tool capable of delivering specialized medical care and treatment to patients living in rural areas of America. But the technology, which helped connect stroke patients, diabetics and the chronically ill to medical specialists located at urban medical centers, is now helping to effectively deliver quality specialized healthcare to children all around the world.

Doctors in Latin America believe that telemedicine has improved the outcomes for young patients in those countries. A new study just released by researchers at Children’s Hospital of Pittsburgh (Children’s) at UPMC has shown that physicians in Latin American countries were very satisfied with services offered by Children’s. The results were gleaned from more than 1,000 pediatric consultations between physicians at CHP and doctors in Latin America.

“We know that telemedicine-assisted pediatric cardiac critical care is technologically and logistically feasible in the international arena,” said Ricardo A. Muñoz, M.D., FAAP, FCCM, FACC, of Children’s Hospital. He is chief of the Cardiac Intensive Care Division and led the study. “And now we know that the physicians we assist internationally consider this technology to be useful for patient outcomes and education.” But Pittsburgh is not the only city reaching out to the world’s children.

The Cincinnati Children’s Hospital Medical Center, in Ohio, has a new telemedicine program that is diagnosing and treating sick children located in the Dominican Republic, using virtual technology. Physicians at the Center for Telehealth at Cincinnati Children’s are able to share medical information about patients, video and audio without the costly and inconvenient aspects of long-distance travel. Specialists in pediatric cardiology, neurology, psychiatry, cancer, blood disease and urology are available in Cincinnati for international consultation.

Physicians and patients in the country of Ukraine are connecting with specialists and subspecialists at the Miami Children’s Hospital’s (MCH), through telemedical technology, for individualized medical consultations, electrocardiograms, ultrasound, endoscopy and audiology exams and treatment. Through their partnership with Ukraine-based Boris Clinic, the MCH program is helping support the treatment of Ukrainian children.

Even when children are sailing on the Seas of the world, telemedicine is ensuring that the best in medical care is not far away. MSC Cruises is initiating new technology across its entire fleet of passenger ships to enable the long distance care of children with onshore support from specialists located at The Giannina Gaslini Institute in Genoa, Italy. The world-class pediatric medical center will enable onboard doctors to confirm their diagnoses and treatments using a cutting-edge system of remote image and data transmission. Virtual consultations with pediatric specialists, radiology and health monitoring will be available to the ship’s young passengers 24/7.

In the past, providing quality medical care to sick children living in hard-to-reach areas of the world required extensive travel and complicated logistical solutions for caregivers and patients alike. Technology, especially telemedicine, is rapidly improving the delivery of quality medical care to children living not only in rural America but throughout the world.



Restrictive Rules On Use Of Telemedicine – Is It To Protect Or To Preserve?

The Tennessee Board of Medical Examiners (TBME) recently issued proposed changes to regulations governing the delivery of medical care through telemedicine technology. Patients in that state who seek care through telemedicine may soon be faced with new, complicated and restrictive regulations. Proponents argue the new rules are necessary to ensure that every patient in Tennessee has a primary care physician.

One of the most controversial rules mandates that patients have a face-to-face visit with a primary care doctor prior to receiving telemedical treatment. In addition, the new rule requires the patient to receive an in-person appointment with a physician annually or on the fourth consecutive time the patient receives care. Vaughn Frigon, chief medical officer for TennCare, the state’s Medicaid program, explains, “We want every patient in the state to say, ‘I have a primary care doctor,’ and that their initial access is through the primary care provider.”

In a time when general practice or specialized care physicians are in short supply, particularly in a state with large rural communities whose residents often do not have access to much needed healthcare, it is difficult for telemedicine advocates to understand how such restrictive regulations will provide rural Tennesseans with better or easier access to either general or specialized healthcare. It is as if the residents of geographically challenged rural areas had the opportunity to utilize a new state-of-the-art super highway to deliver better, less expensive life sustaining benefits offered by the outside world, only to have new restrictions levied to frustrate its use.

Applying the TBME logic to this scenario would mandate that anyone using the new improved highway would first be required to take the old path, slowly winding through the mountains on the old, more dangerous narrow roads so as to ensure the traveler has the opportunity to have the appreciation for the longer travel time and the abundance of beautiful scenery. To be certain that no one misses the experience, once each year, or every fourth trip, each traveler must repeat the more difficult journey.

This analogy may be over-simplified due to the fact that face-to-face medical care is important and will always have an important role in the delivery of quality patient care, but the comparison emphasizes that telemedicine is not a different or a lesser valued form of healthcare, only a different, and in most cases, less expensive and efficient means of delivering healthcare that improves access and availability to patients in rural and outlying communities.

Meaningful regulation across all industries is necessary to ensure the safety and protection of all people and communities. But excessive, though well-meaning, regulations often counter the promises of new technology to improve our lives. Expanding access to efficient, quality healthcare to all people is a worthy goal.