Telemedicine can reduce the number of emergency visits to hospitals and cut the length of hospital admissions and can assist with healthcare delivery in several ways. For example, many US emergency departments have inadequate on-call coverage by specialists, and lack of specialist availability is strongly associated with poorer outcomes. But telemedicine can help alleviate this shortage by allowing specialists to work remotely with emergency departments. Telemedicine is also proving effective in remote monitoring of chronically ill patients and patients who have just been discharged from hospitals.
Telemedicine is expected to grow rapidly in coming years, but there are still legal barriers based on old-school assumptions about medical care delivery. Traditional licensing laws assume face-to-face healthcare, while telemedicine uses service delivery at a distance, including across state lines, while states have different licensing requirements, medical boards, and regulations. Reimbursement issues also need to be ironed out, since Medicare, Medicaid, and private insurers all use different definitions and requirements.
States Embracing Telemedicine
More states now have telemedicine laws somewhere in the legislative process. Jon Linkous, CEO of the American Telemedicine Association, says, “It’s double the action this year than it was last year. Not all of them will adopt the legislation, but a number of them will.”
Most recently, Colorado, Nebraska, and Nevada have signed telemedicine-related bills into law. Mississippi now allows insurance companies to reimburse doctors who use telemedicine to consult with patients in rural areas, and Vermont signed a new law focused on a pilot program studying the effects of telemedicine delivered outside healthcare facilities. The Affordable Care Act, which is adding millions of people to insurance rolls, is a big driver of the growth of telemedicine at the state level.
In many areas of the country, telemedicine is not seen as a mainstream way to provide patient care, but rather as a bonus benefit for rural farming communities where access to healthcare services is limited. Despite private insurer enthusiasm for telemedicine, governmental attitudes toward telemedicine are only changing slowly, but several states, including Connecticut, Florida, Illinois, Kansas, and Missouri, have introduced legislation to expand telemedicine services.
New Federal Regulations
On May 7, a rule was issued by the Centers for Medicare and Medicaid Services (CMS) that has the potential to expand telemedicine adoption and save billions of dollars in healthcare costs. The main provisions of the new CMS rule are:
- Eliminating onerous requirements on ambulatory surgical centers for radiological services, allowing them more flexibility in physician supervision requirements
- Permitting nuclear medicine technicians in hospitals to prepare radiopharmaceuticals without the supervising physician or pharmacist always being present, allowing better off-hour patient services
- Eliminating redundant data submission requirements and unnecessary survey processes for transplant centers without compromising federal oversight.
Additionally, the new rule eliminates requirements that physicians travel to rural or federally qualified clinics at least once every two weeks. This should allow physicians to provide some types of care to remote facilities at lower costs. Under this rule, healthcare providers are expected to save $660 million yearly and a total of $3.2 billion over a five-year period.
New Telehealth Center in Missouri
St. Louis-based Mercy Health systems, a 33-hospital system, recently broke ground for a 120,000 square foot, four story Virtual Care Center. This single location will house 75 telemedicine programs, including multiple e-ICU services, teleradiology, and a 24-hour nurse call center. Mercy launched its first telehealth program a decade ago to provide virtual ICU services. When the new center opens in 2015, it will be home to 300 healthcare professionals and support staff, and is expected to log 3 million telehealth visits over five years. Mercy Health has already been able to increase telemedicine services in recent years due to grants from the US Department of Agriculture for bringing connectivity to rural emergency rooms and clinics.
American Telemedicine Association 2014 Policy Goals
In 2014, the American Telemedicine Association hopes to address several policy goals, namely:
- Fixing outdated licensure and practice rules for health professionals
- Improving coverage and parity for telemedicine services by Medicare, Medicaid, and private insurers
- Integrating telemedicine into federal healthcare programs
- Making better use of the FCC’s broadband deployment and universal service programs
- Encouraging mobile (wireless) healthcare and its integration into care delivery
- Increasing federal coordination and its impact on telemedicine
- Integrating electronic health records and health information exchanges into telemedicine
- Improving emergency preparedness and response
- Improving international telemedicine policy
Though two telemedicine bills were introduced in Congress in late 2013, neither has made much progress. H.R. 3077: TELE-MED Act of 2013, sponsored by Devin Nunes (R-CA), was introduced to amend title XVIII of the Social Security Act to permit certain Medicare providers licensed in one state to provide telemedicine services to some Medicare beneficiaries in other states. It was referred to committee in September, and according to govtrack.us has a 2% chance of being enacted.
H.R. 3750: Telehealth Modernization Act of 2013, sponsored by Doris Matsui (D-CA), was introduced to promote the provision of telemedicine by establishing a federal standard for telehealth. Like H.R. 3077, this bill was also referred to committee, and has only about a 1% chance of being enacted, according to govtrack.us.
Most of the laws governing telemedicine in the US are state laws and jurisdiction is based on the patient’s location rather than the doctor’s. This can hinder healthcare providers who want to establish multi-state telemedicine practices, and will be one of the biggest issues telemedicine advocates will be tackling in coming years. Whether and how state laws will catch up to private sector advocacy for telehealth coverage still remains to be seen. As of right now, however, physicians who want to offer telemedicine services need to pay attention to their state’s guidelines as well as legislation on the state and federal level.
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