April’s This Month in Telemedicine by the American Telemedicine Association, hosted as always by Jonathan Linkous, Chief Executive Officer, and Gary Capistrant, Senior Director of Public Policy discussed state and federal updates, collaborations, and quality assurance.
State Licensure Remains a Hot Topic
Gary Capistrant went over the basic situation of licensure, including a proposal that would let Medicare recipients to (virtually) cross state lines for care but would impose a requirement that the patient and doctor have a previous relationship, i.e. an initial consultation in person has to occur. While some states do allow that a legitimate patient-doctor relationship can be established via video, this proposal does not recognize that and could be a “step backward” for telemedicine, plus require states to enforce a prior relationship where they hadn’t done so before.
“In terms of our principles on licensure, we want to be regulated the same as in-person services, not held to a higher standard or a lower standard,” said Capistrant. The ATA has set up a petition. Also, some states are deciding that telemedicine needs regulating but are doing so by treating it as a separate health service, even though telemedicine was already active under the current medical regulations.
Three states have enacted full parity with private insurance: Mississippi, plus Medicaid and state employee benefits; Montana, including parity with private; and New Mexico. Connecticut and Missouri passed parity bills in Senate, which are now moving to their respective Houses. New York recently introduced a parity bill, and Ohio will soon follow suit.
ATA is finalizing state best practices guidelines for home telemedicine and remote monitoring, and in the works: school-based care, telemental health, and more.
A workgroup was recently announced, a joint effort between the FDA, FCC, and Office of National Coordinator. A report is due in January 2014 examining the overlap of some issues that are overseen by the various agencies, including consumer health devices, electronic health records, and clinical decision support.
“It’s a little bit of a mess right now in terms of the regulation and one of the reasons they have this is group is because there’s a little bit of uncertainty amongst the different agencies over who’s taking the lead on what,” explains Linkous.
A big area of activity for ATA is quality assurance, which, although it’s flown under the radar somewhat, is getting plenty of attention now. ATA’s next board meeting will see the approval of the organization’s practice guidelines for online video-based telemental health. “A very important role for ATA is to weigh in and try to get some meaning and some semblance of order to what’s happening,” says Linkous.
ATA’s board has also approved the move towards ATA becoming an accrediting body with the end goal of becoming a reliable information source for consumers. They’re also involved with some trade associations to improve consumer awareness. Linkous: “It’s important that consumers know that if you’re not getting access to telemedicine, you could and you should and you need to ask your doctor about it.”
Next year, look for a cohesive effort by patient and consumer groups to expand telemedicine, including physician communications, consultations, lab results, etc., which should all be accessible online by patients.
The Q&A: A Selection of Questions Asked & Answered
Q: Define telemedicine, telemedicine, etc.
A: I think we should come up with a contest to see who can come up with the most names that relate to telmedicine. E-consults, e-health, telemedicine, telecare, e-care, telepractice, remote care. About 6 or 7 years ago we had a board meeting in Chicago and we talked about changing the name of the ATA. We talked about what we should change it to…we spent about 3 hours of the board meeting [discussing this] so at the end, we just threw our hands up in the air and left it as it is.
We define telemedicine very broadly as providing healthcare to patients or consumers using telecommunications.
Q: How can companies assist ATA in the process of getting legislation passed?
A: ATA has a Circle Membership and Industry Council and we have corporate members representing anything from large, multi-national, multi-billion dollar companies to a small ma and pa [businesses], but all of them have a stake in this. And if there’s a large corporation that has a Washington office with a staff of people who are full-time policy people, yes, please let them get in touch with us. We’d love to talk with them about what they do. Or if you’re an organization that has a consultant online who does work in Washington, or if you’re a small company in another state and you have an area representative…it’s important that you get very active…There’s always things to do at the state level.
ATA’s annual meeting will be held next week in Austin, Texas, from May 5 to 7. For a free exhibit hall pass, click here to register and enter the code VIPcomp13.