TAMPA, Fla. -- Getting technology to accommodate telemedicine is fairly straightforward for health care providers, once the network pipes extend from the host facility to the remote site it will serve. Getting telemedicine reimbursement from public and private insurers, however, is much more difficult.
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That was the theme at a handful of sessions at the American Telemedicine Association's ATA 2011 annual meeting, where telemedicine industry stakeholders mingled with federal and state Medicare and Medicaid officials.
As of now, only certain services are covered by the Centers for Medicare and Medicaid Services (CMS), once providers jump through a series of credentialing hoops -- but only for certain facilities far enough from large hospitals.
As funding appears, telemedicine reimbursement revisited
That is changing, however, as telemedicine advocates identify opportunities in the health care reform law as well as stimulus bill programs to fund telemedicine pilot projects they hope will scale up to national practice. Furthermore, California is considering updating its Telemedicine Development Act of 1996 to reflect current practice and to allow more patients access to telemedicine services, said Mario Gutierrez, policy associate at the California Center for Connected Health Policy.
His group wrote and got sponsored California Assembly Bill 415. This amends the country's first telemedicine law to, among other things, broaden the definition of telemedicine to include new services; add telemedicine courses to college primary care physician degree programs; permit telephone and email consultations, and do away with signed informed consent patient waivers, as the law presently requires.
The latter point, Gutierrez said, is an important part of the legislation. "Back in 1996, when [telemedicine] was relatively new, it was almost seen as an exotic form of the delivery of health care. In order to achieve the passage of this legislation…it was necessary. We have now found it to be an obstacle that actually inhibits the use of telemedicine, another flag for Medicaid to [deny] reimbursement."
Thirty-four other states have some form of Medicaid telemedicine reimbursement, said Dr. Karen Rheuban, medical director of the University of Charlottesville (Va.) office of telemedicine. However, she said, utilization remains very low for a number of reasons, including restrictive rules that make few health care providers eligible for telemedicine reimbursement.
Rheuban told SearchHealthIT.com that telemedicine technology offers hospital CIOs an argument for bringing more patients and business to their facilities through technology investment. In general, telemedicine proponents may be able to justify Medicaid telemedicine reimbursement on the basis of money saved in patient mileage and transportation savings, for which Medicaid pays. Her facility did.
Telemedicine proponents may be able to justify Medicaid telemedicine reimbursement on the basis of money saved in patient mileage and transportation savings.
"We were careful about ensuring it was a zero expense to the Commonwealth," Rheuban said. "They considered them services that patients were going to travel to anyway to receive. They can get care earlier, in a timely fashion, and they were aware that they were spending a lot of money on transportation. Our Medicaid transportation budget was $54 million in 1999…just on taxicabs and ambulances."
Emerging opportunities to use telemedicine technology
Alice Borrelli, Intel Corp. director of global health and workforce policy, said that both the HITECH Act and health care reform laws offer opportunities for health care providers applying for grants.
On the Medicare side, the Independence at Home program, which starts next January and will include 10,000 patients, aims to keep chronically ill patients out of the hospital. Providers share savings with CMS when they hit their goal. That's an opportunity for remote patient monitoring and consultations for telemedicine-minded providers whose proposals are accepted.
Health care reform's accountable care organization (ACO) proposed rule -- as well as capitated payment programs, both from CMS and many private payers -- also seem to make room for telemedicine, specifically remote patient monitoring to intervene with care before a patient's condition worsens, precipitating an office or hospital visit. Health care reform also introduced a two-year program called Medicaid Health Homes, which Borrelli suggested as a way for providers to introduce telemedicine technology into a provider's reimbursement stream.
The HITECH Act's meaningful use rule promises to give telemedicine a boost, too, said Yael Harris, formerly of the Office of the National Coordinator for Health IT (ONC) and current director of the Office of Health IT and Quality within the Health Resources and Services Administration.
While Stage 1 had "zip" for telemedicine technology, she said Stages 2 and 3 of meaningful use do present opportunities, what with their requirements for secure electronic messaging, personal health records (PHRs) and patient self-management tools.
Harris also sees growing appreciation for the value of telemedicine inside the federal government, she said. This includes the formation of a 30-member, cross-agency telehealth workgroup, of which she's a member. In a recent meeting of the workgroup, a CMS representative said there was a 10-member group in the agency exploring telehealth initiatives. "To know there are 10 people there working together, across all aspects of CMS, is pretty exciting," Harris said.
The HITECH Act's Beacon Community Program also offer room for telemedicine technology, Harris continued. So far, four grant recipients incorporate telemedicine services into their programs.
- San Diego Beacon Collaborative provides smartphone-based care for congestive heart failure (CHF) patients.
- Central Indiana Beacon Community uses remote patient monitoring to measure vital signs such as blood pressure for CHF and chronic obstructive pulmonary disease (COPD) patients. That data is then fed into through a health information exchange.
- Utah Beacon Community offers customized online patient portals and text messaging.
- Southern Piedmont Beacon Community in North Carolina created a public surveillance tool called Asthmapolis, in which asthma patients submit data through Wi-Fi-enabled inhalers. The system aggregates data and sends back localized data to providers, as well as to patients, to enable care.
All these programs, Harris points out, include connectivity to electronic health records. "The future of telehealth is to be integrated into the EHR," she concluded.
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