This month’s telemedicine videocast from the American Telemedicine Association focused on a major change in the population tabulation that directly affects telemedicine reimbursement, as discussed by ATA’s CEO Jonathan Linkous and Gary Capistrant, senior director of public policy.
Federal Policy Changes & Activity
The hot topic was the re-designation of many counties from rural to metropolitan, which resulted in the loss of Medicare telehealth reimbursement. Due to a change to the Standard Metropolitan Statistical Areas, 97 counties newly designated as “urban” will lose reimbursement privileges because Medicare reimbursement for telehealth services is not available to populations in metropolitan areas. On the other hand, 28 counties will gain coverage because they are now designated rural.
While this is a setback for telemedicine and Linkous proposed two ways to deal with the situation: the first, to grandfather in counties that have been redefined as metropolitan; the second is to expand Medicare reimbursement for urban populations. “This really shows the need to do that,” said Linkous.
Also mentioned was the F.I.T.T bill (Fostering Independence Through Technology), which is sponsored by South Dakota Democratic Senator John Thune and Minnesota Democratic Senator Amy Klobuchar. The bill aims to establish a pilot program for home health agencies serving rural communities to use remote patient monitoring.
Capistrant and Linkous also discussed FDA regulations about medical devices, licensure and interstate health commerce, and the need to coordinate the various roles that the federal government plays in healthcare. Linkous points out the very real potential for backlogs—the FDA, Linkous says, has received 100 or so applications but can only process 20 a year.
“The good thing is there’s a lot of innovation in mobile health. The bad is it’s taking a long time to get through regulation, and, number two, you can’t get paid for it.” – Jonathan Linkous, CEO American Telemedicine Association
They also discussed the ongoing issue of licensure, and the burden acquiring multiple state licenses places on telehealth providers. The Federation of State Medical Boards is proposing a form of state reciprocity but, Linkous points out, getting all the states on board could take a long time—a decade or more. He offered the example of the nursing compact, which was started 15 years ago and less than half the states have signed on to date. (The ATA has not endorsed any one approach).
Big Med Developments
Larger healthcare systems are seeing the potential business benefits of telehealth, and are looking to expand their footprint and brand by providing more services to a larger population. Linkous gave the example of the Mayo Clinic Care Network, an affiliation program. They have a goal of reaching 200 million patients by 2020, through both their own hospitals and the affiliation network by using “e-consults”, i.e. telemedicine. Cleveland Clinic also has an affiliate program. “It’s an interesting contest,” says Linkous, noting this is a business decision and cost-reduction tool. Mercy Healthcare is using telehealth for a broad range of services, including stroke, autism, and cardiac care, and they’ll soon be breaking ground for a virtual healthcare center which will house subspecialists and a teaching facility at their headquarters outside of St. Louis.
New Online Education
ATA will be launching an education service on their website with webinars, videocasts, and online courses, with many continuing medical education accredited. The organization is looking to develop a major educational center—online, of course—for telemedicine providers.
ATA’s annual meeting will be held in Austin, Texas, from May 5 to 7. For a free exhibit hall pass, click here to register and enter the code VIPcomp13.
The next This Month in Telemedicine videocast is on April 23.