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Legislation, Reimbursement Expand Telemedicine Technology Use

By Vera Gruessner

- Telemedicine technology use is expanding throughout the United States due to new legislative changes, the breakdown of telehealth site restrictions, and the increase in payment parity and reimbursement for telehealth services. Providers are expanding their care across state borders due to the Interstate Medical Licensure Compact and the opportunities afforded by telemedicine technology use.

Telehealth Legislation and Policy

Nadia de la Houssaye, a telemedicine partner with Jones Walker LLP in Louisiana, told about the ongoing legislative changes in the telehealth space as well as the impact of the Interstate Medical Licensure Compact on telemedicine technology use.

New Telehealth Legislation Expands Care

“[Legislative changes are occurring at] both the federal level and at the state level,” de la Houssaye began. “Currently there is an exciting bill, the TELE-MED Act, that I hope passes within the next year. It has support in the Senate and the House. It will allow Medicare participating physicians to treat Medicare patients in all 50 states with a single medical license.”

“The Act is intended to reduce barriers to interstate care while bringing more options to underserved areas and allowing providers to expand their reach, particularly to aging Medicare recipients who need it the most.”

READ MORE: Upstate New Yorkers Beginning to Favor Telemedicine Services

“The only criteria with respect to the TELE-MED Act is that the provider must be a Medicare participating physician or practitioner and the care must be provided to a Medicare beneficiary,” de la Houssaye explained. “In that setting, you can practice telemedicine in your state without obtaining additional state licenses. However, if the provider is treating a non-Medicare patient, the provider would still need to go through the regular licensing process in each state.”

“There is also the Interstate Medical License Compact which has made progress in the last year. The Federation of State Medical Boards completed the model Interstate Medical Licensure Compact in September of 2014 and since then, the required minimum of seven states  joined.”

“As of today, we have 11 states that have enacted the Interstate Medical License Compact including Wyoming, South Dakota, Utah, Idaho, Iowa, Illinois and Alabama. These states are members of the Compact and  there are an additional eight state legislatures that introduced the Compact this past session,” she mentioned.

“There’s an additional 30 state medical boards that have endorsed the Compact and expressed an agreement to join within the next few years. This Interstate Medical Licensing Compact process expedites obtaining a license in every state, however it does not eliminate the need to receive and pay for a license in each state. The states still have complete control over standard of care and regulatory issues.”

Medicare Reimbursement for Telehealth vs. In-Person Care

READ MORE: Blue Cross Blue Shield of GA Offers Maternity Telehealth Program

“A few of my favorite pending Acts at the federal leveldirectly address Medicare access and reimbursement. The Telehealth Enhancement Act of 2015 promotes and strengthens Medicare programs by removing significant barriers to the practice of telehealth by adding to the list of currently originating sites that qualify for Medicare reimbursement,” the attorney stated.

“The Telehealth Enhancement Act of 2015 expands the list of originating sites to include urban critical care hospitals, sole community hospitals, and the most exciting area – home telehealth sites. Also, any of the originating sites under the current law for the treatment of acute stroke [are included in the permitted sites].”

“Essentially, this Act is expanding the borders of telemedicine coverage, while adding more areas of reimbursement. The Telehealth Enhancement Act of 2015 also provides incentives for Medicare’s hospital readmission reduction program.”

Today, hospitals receive payment penalties from Medicare if they have high rates of patient hospital readmissions within 30 days after a patient has been discharged.

“This Act provides hospitals an additional payment for the shared savings achieved from a better than expected performance or outcome in reducing hospital readmissions. Under the current law, there are no incentives for hospitals to regain any amounts that they would have otherwise lost for readmissions,” de la Houssaye explained.

READ MORE: WV Passes Bill to Increase Patient Access to Telemedicine

“This encourages the use of telemedicine especially in the monitoring of post-acute illness or management of chronic health conditions, which can be remotely monitored in the home setting,” the attorney went on.

“After the Telehealth Enhancement Act of 2015, the Medicare Telehealth Parity Act of 2015 was introduced and deals more specifically with reimbursement. The Medicare Telehealth Parity Act removes geographical barriers by allowing providers to engage in telehealth services in rural, underserved, and metropolitan areas. It delineates a three phased expansion of telehealth services over a four year period.”

“The Medicare Telehealth Parity Act of 2015 expands the list of reimbursable services to include remote patient monitoring for chronic conditions such as heart disease, chronic obstruction pulmonary disease, and diabetes. It also includes covered services for respiratory therapists, physical therapists, occupation therapists, speech and language pathologists, and audiologists. The Parity Act would reimburse telemedicine visits as if it were an in-person visit,” she mentioned.

The Challenges Telehealth Providers Need to Overcome

“A hurdle for hospitals is integrating a telemedicine system that goes beyond the traditional telemedicine specialties such as teleradiology, telestroke, and tele-ICU.  Hospitals need to more aggressively integrate telemedicine systems that remotely monitor post-acute illness and management of chronic health conditions, particularly in the home setting.”

“Physician practices are also encountering telemedicine obstacles and are trying to figure out how to integrate the telemedicine delivery platform into an existing practice,” de la Houssaye continued.

“The direct-to-consumer area of telemedicine is exploding and physicians don’t want to lose their patients to virtual visits because they don’t offer telemedicine as a viable delivery option. There has to be a way in which physicians set aside a certain number of hours per day to offer their current patient base virtual visit follow-up.”

Developments and Expansion of Telemedicine Today

 “I started studying and actively engaging in the telemedicine industry 20 years ago,” she explained. “What has amazed me is the direct-to-consumer market and the explosion within that market. For so long, we were promoters of telemedicine and were trying to convince physicians and hospitals that this was an efficient, affordable way to provide efficient quality care, especially to those in rural areas.”

“Now the direct-to-consumer market has taken telemedicine to a new level  – telemedicine is occurring in the workplace, school setting, prison setting in addition to virtual visits on the Internet. Walgreens entrance into the market is huge,” she exclaimed. “An individual can purchase affordable medical devices from Walgreens that allows for remote monitoring of many health conditions.  With its collaboration with MDLive, Walgreens and a broad base of specialized physicians can provide virtual visits that cover almost any area of medicine or client need.”

“Telemedicine is no longer limited to the physician or the hospital setting ,” the attorney concluded.


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