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.



Has The VA Been Telehealth’s Most Effective Proving Ground?

Every new product, marketing campaign, movie or television series has something in common. Each go through a period of trial and error to work out the specific details of the product or production where problems, glitches, barriers or creative faux pas are tweaked and corrected before making a debut to the greater community. Each new plane has its test flights; each new television series has its pilot episode; and every new product has its test market before being premiered to the whole of the world.

The Veterans Administration (VA) has long been out in front of the medical industry when it comes to providing remote monitoring and the delivery of virtual healthcare to it patients. Charged with healing a significant patient population afflicted with chronic illness, most living long distances from VA care centers, the VA may be the ideal proving ground for a new and revolutionary healthcare delivery model.

A new study published by Adam Darkins, Chief Consultant for Telehealth Services, and published in EHR Intelligence, highlights some of the results of the virtual healthcare programs first piloted by the VA. The study reveals that 11 percent of veterans received some portion of their care remotely in 2013, a growth rate of some 22% over the previous year. The VA’s telehealth programs include video interactions between caregivers and patients, remote monitoring of chronic disease, and teleradiology. A new program, currently under evaluation, allows veterans to access treatment for mental disorders like post-traumatic stress disorder (PTSD) from remote locations through a secure video connection. The challenge of connecting to patients residing away from regional care centers mirrors that of the greater healthcare community, where patients living in rural areas often have limited access to specialized chronic care treatment and facilities.

The confined organizational environment of the VA has allowed it to effectively navigate around several barriers that continue to frustrate the wider expansion of telemedicine in the private sector: Payment for telemedical services, limited or inadequate technology info structure, and the individual state licensing requirements of telehealth practitioners.

It appears that the VA has been a respectable micro test environment to develop, design, engineer and ultimately introduce virtual healthcare services. Dr. Darkins says, “Telehealth in VA is the forerunner of a wider vision, one in which the relationship between patients and the health care system will dramatically change with the full realization of the ‘connected patient.’ The high levels of patient satisfaction with telehealth, and positive clinical outcomes, attest to this direction being the right one.”



Telehealth Takes Important Care To Veterans Through The VA

Even before the recent revelations of the administrative follies at the Veterans Administration (VA), it was common for each of us to know of a veteran seeking medical attention from a VA Hospital. Usually the discussion centered on the time it took the patient to travel to the nearest VA Medical Center, particularly for those patients living in more rural communities many miles from the urban centers where most VA facilities are located. It was even more difficult for those veterans who needed specialized care from a consolidated, regional VA Center located many more miles from their home, often one or more states away.

Despite today’s plethora of negative information coming from the embattled Veterans Administration, it appears that someone at the organization was doing something right in order to bring better and more accessible healthcare to our nation’s military veterans via telecommunication technology. The VA System seemed the perfect proving ground for implementing telemedicine on a larger scale. With patients scattered far and wide, doctors and caregivers were able to connect virtually with VA patients no matter how far they were from the hospital.

A recent review of the telehealth services initiatives at the VA indicates that more than 600,000 veteran patients received some element of their health care via telehealth in 2013. The patients represented 11 percent of the veterans in the VA health care system who participated in 1.7 million telehealth episodes of care. According to Dr. Adam Darkins, “telehealth in VA is the forerunner of a wider vision, one in which the relationship between patients and the healthcare system will dramatically change with the full realization of the ‘connected patient’. The high levels of patient satisfaction with telehealth and positive clinical outcome, attest to this direction being the right one.”

Forty-five percent of the patients live in rural areas, limiting their access to VA healthcare. The number of veterans receiving care via VA telehealth services is growing approximately 22 percent a year. Telemental Health is one of the leading specialties provided through telecommunication. The VA has delivered 1.1 million patient encounters through 729 community based outpatient clinics since 2003 and in 2013 the VA delivered 278,000 Telemental Health encounters to 91,000 patients.

The use of TeleDermatology is up by 279 percent from its inception, treating more than 45,000 veterans. New programs under development include TelePathology, TeleWound care, TeleSpirometry and TeleCardiology. Dr. Darkins says, “Telehealth is often described as helping provide the right care in the right place at the right time, which translates into many veterans receiving care in their own home and local community. In doing so, telehealth often avoids the need to travel, but can also alert the VA that a patient needs to be rapidly seen in the clinic or hospital.

Based on this report, the agency’s telehealth initiatives are positively impacting veterans by providing quality and accessible care.



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.



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.