American Telemedicine Association’s policy guys, Jonathan Linkous, CEO, and Gary Capistrant, senior director of public policy, are back with another monthly installment of This Month in Telemedicine.
They’re predicting an additional 30 to 40 million Americans will be added to Medicaid roles by next year, and there are now 20 states looking to expand Medicaid coverage to accommodate this surge. Better start preparing now, says Linkous. “I think next year we’re going to see a whole different world, in a few short months it’s happening so the time to gear up is now,” he says.
The Center for Medicare and Medicaid Innovation has just launched another billion dollar funding opportunity. It’s looking for “big, bold projects,” particularly any that will be actionable on a multi-state level. Letters of intent are due by June 28, and the full applications are due August 15.
Austin Meeting Recap
Linkous and Capistrant also discussed the ATA’s recent meeting that was held at the beginning of May in Austin, Texas. During the meeting, the first of four best practices was released. They’re for state Medicaid programs, and the ATA has been working with special interest groups and refining the guidelines, and they should be available soon. They cover specialties such as telemental health, home telehealth and remote monitoring, school-based telehealth, and specialties like diabetic retinopathy.
The ATA also distributed a draft version of their state best practices guidelines, which is now being reviewed by special interest groups. Additionally, a new and expanded version of their toolkit is now available on the ATA website.
“We try and provide more information for you all to use,” says Capistrant. “But also to try and act as a clearing house and identify what the various states are doing so that all the other states can benefit from that without duplicating efforts or trying to draft something from scratch.”
On the federal level, the ATA is very focused on dealing with getting Medicare coverage approved, and some opportunities for Medicaid as well. The bill sponsored by Senator Scott Thompson is working its way through the system, but because that bill is more of a big-picture attempt to solve and clarify telemedicine issues, the ATA felt the need for a bill that would deal with smaller-scale issues that could move quickly and be approved relatively easily. To that end, they’ve been working with Congressman Greg Harp, R-Mississippi, to assemble a package of incremental changes. “Hopefully, [it will be] easier to get support and budget estimates,” said Capistrant. They’re also hoping to be involved in physician payment reform.
As discussed during previous ATA webcasts, 104 counties lost Medicare coverage in February because of redesignation as metropolitan areas. The ATA is working on restoring coverage to the affected counties. The ATA is also working to remove some major barriers, like metropolitan area access, stroke diagnosis, and services for homebound patients that aren’t currently covered by Medicare. Homebound patients present a particularly strong argument, says Capistrant. “They’re not in the position to travel to a doctor’s office, so there’s a compelling clinical case for care in the home.”
There’s bipartisan interest in telemedicine, says Linkous, which is something the ATA has cultivated. “We’ve always made sure this is a bipartisan effort,” he says. “We’ve worked very hard to avoid any type of partisan positioning.” The ATA has had congress people of both stripes approach, and voice support for telemedicine.
In state action, Georgia and Alabama both have proposals from their respective medical boards under review. They’re improved versions of past proposals although still there are still issues: they don’t deal with the full range and diversity of telehealth uses and situations e.g. emergencies, and also interpretative services such as cardiology, radiology, etc. For example, in Georgia, telehealth ICU would require patients to I.D. every health practitioner who had previously served them, which is a burdensome task for all involved.
In the Alabama proposal, telehome care is exempt from rules if delivered by a licensed homecare health agency but community health centers and physician practices are excluded.
The pair also took issue with certain language in both proposals, identifying it as “anti-telehealth”; particularly requirements for prior physician-patient relationships, meaning the physician has to see patient in his or her office first. “That’s a code word for people who want to kill telemedicine,” says Linkous. ”It’s about protecting your market and protecting yourself from competition that telemedicine provides. And when you do that, there are 5.5 million Americans received teleradiology services and they’re gone, they don’t get it anymore because of the prior physician-patient relationship [requirement].”