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Arkansas Telemedicine Law Faces Flak Over ‘Originating Site’ Issue

The state's new rules say a patient has to be in a healthcare setting to have a telehealth visit with a doctor. That doesn't sit well with two of the nation's largest employers.

By Eric Wicklund

- New telemedicine regulations in Arkansas are facing questions over where a patient has to be to have a virtual visit with a doctor.

Executives of Wal-Mart and national trucking company J.B. Hunt say the new law, which is expected to be approved by the Arkansas Legislative Council next month, would prevent employees from using their mobile devices to connect by video with a doctor.

Wal-Mart is one of the world’s largest retailers, and J.B. Hunt is one of the nation’s largest transportation companies.

At issue is wording in the new legislation that defines an “originating site” and a “distant site.” Act 887 of 2015 defines telemedicine as occurring when a healthcare provider, based at a distant site, connects with a patient at an originating site. The new rules stipulate that an originating site be in a healthcare setting, such as a hospital, clinic, doctor’s office or the home of a patient with end-stage renal disease.

At a public meeting organized by Wal-Mart and the AARP this week in Little Rock, Daniel Stein, chief medical officer of Wal-Mart Care Clinics, said the new law would effectively prohibit the Bentonville-based company’s 50,000 in-state employees from using an online platform provided by Doctor On Demand. Rick George, Lowell, Ark.-based J.B. Hunt’s senior director of human services, said his employees would also be prevented from using a similar service when they’re in Arkansas.

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Disputes over the definition of an originating site aren’t new. The Centers for Medicare & Medicaid Services has long come under criticism for its strict interpretation of a “rural” location for originating sites, which affects how a telehealth program might qualify for reimbursement. Earlier this year a coalition of groups, including the American Hospital Association, American College of Physicians and National Coalition on Health Care, lobbied the Senate Finance Committee to relax its restrictions to expand telehealth to more populations.

“Comprehensive changes to the telehealth statute – such as eliminating the geographic location and practice setting ‘originating site’ requirements and removing restrictions on covered services and technologies (including store-and-forward technology and remote patient monitoring) – are needed to realize fully the promise of telehealth for Medicare beneficiaries,” The AHA wrote in its letter to the Senate Finance Committee and its Chronic Care Working Group (CCWG), in which it noted that more than half of the nation’s hospital are now using telehealth technology.

The effort to bring telehealth to Arkansas hasn’t been easy.

With organizations like the American Telemedicine Association ranking the state as one of the worst in fostering and regulation telehealth, state officials, including the State Medical Board and Arkansas Medical Society, had sought to improve their rules.  Earlier this month the medical board signed off on the amended Act 887 of 2015, which would allow clinicians to establish "a proper physician/patient relationship (via) real-time audio and visual telemedicine technology" as long as the platform "provides information at least equal to such information as would have been obtained by an in-person examination."

The act was seen as a “good compromise” between telehealth advocates and state medical officials who want to preserve the doctor’s ability to see a patient in person.

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"There's enough protection here to where I believe the board can feel comfortable that the patients are being protected, which is our No. 1 job," Arkansas Medical Board Chairman Joseph Beck told a local online news service following the board’s vote.

But telehealth advocates, including the Arkansas Medical Society and the Arkansas State Chamber of Commerce, warned that a last-minute amendment to exclude the forwarding of medical records as store-and-forward technology would negate Teladoc, one of the nation’s largest telehealth providers, which does most of its business by phone. They also noted that the definition of an “originating site” might have an adverse impact as well.

This week’s forum proved that point.

State officials said they aren’t above revisiting the issue, but not soon.

State Sen. Cecile Bledsoe, R-Rogers, who sponsored Act 887, said she expects legislators will look at the issue again during its regular session next year. She said the new legislation was “a good compromise,” in that it enables rural Arkansans to have access to telehealth services while ensuring patient safety through a valid doctor-patient relationship.

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David Wroten, executive vice president of the Arkansas Medical Society, said the new rules come at a time when telehealth regulations are across the board.

"When the Legislature passed (the original) law, it was very important to everybody, including legislators, that we go slowly and not just jump out there and have the wild, wild West of people practicing medicine over the telephone with patients they've never seen before," he said.

Dig Deeper:

Feds Urged to Make Telehealth a Standard of Care

Arkansas Telemedicine Proposal a 'Good Compromise'


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