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Telemedicine: It’s Time for Action

June 10, 2014
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The past week was a big one for telemedicine and for Sylvia Mathews Burwell, but moving forward, I’m hoping there are even bigger weeks ahead.

On Monday, the American Telemedicine Association (ATA) and a number of healthcare IT organizations sent a letter to Burwell, the newly minted Secretary of the Department of Health and Human Services (HHS), asking her to waive regulatory restrictions on the use of telemedicine. You might be wondering out loud to yourself: Burwell has only been HHS Secretary for less than a week, what gives? Can’t the ATA give her a minute to move into her new office and relax in her new digs?

No, they can’t.

As Secretary, Burwell has the power to waive those restrictions on telemedicine in the Social Security Act. Those government-based restrictions have slowed the progress of telemedicine adoption, a recent study (also released this week) verified. ATA and those other organizations are taking advantage of Burwell’s newfound power and trying to get her to act immediately on increasing telemedicine usage.

I applaud them as well as the Alliance for Connected Care, which also wrote a letter to Burwell on this subject. There is no time like the present to improve telemedicine care in this country. For the aforementioned study, Kenneth Drude, Ph.D., from the Marshfield Clinic in Marshfield, Wisc., surveyed more than 600 healthcare provider organization administrators that expressed interest in private payer telemedicine reimbursement.

By getting respondents from all but four states (Delaware, New Hampshire, North Dakota, and Vermont), the researchers got a definitive look at the barriers of telemedicine care in the U.S. Quite simply, the researchers conclude, it’s reimbursement. More than 55 percent of the respondents said their organization did not bill for telemedicine services.

Providers are unsure how to bill for telemedicine services, whether or not a private payer will reimburse for telemedicine, and if billing is being done correctly. Medicare and Medicaid, they add, sets the precedent for private payers and that precedent right now is the uncertainty of reimbursement because of disparities in federal and state policies. A good number of providers who were surveyed that provide telemedicine care to Medicare and Medicaid beneficiaries did so without getting reimbursed.  That says it all, as does the fact that two of the top reasons cited for not billing for telemedicine fell on the government payers.

Getting back to Burwell, there is an obvious play here. Waive the restrictions that limit reimbursement for telemedicine to only rural beneficiaries (less than 20 percent of the Medicare population). Are there possible drawbacks to telemedicine care? Yes. There is a legitimate debate going on in states like Florida and Tennessee over the types of practitioners who can utilize this technology and the services that can be delivered on it.  However, those drawbacks are not deal breakers and can be negotiated. Even the most ardent Luddite would have to concede that point.

In April, the Federation of State Medical Boards (FSMB) took a giant step towards increased usage when it approved state guidelines for practicing medicine through the use of telemedicine technology. Many of those concerns were addressed in those guidelines. As noted by frequent Healthcare Informatics interview subject, Joseph Kvedar, M.D., of the Center for Connected Health, in a recent Health Affairs brief: This was the first time the medical community uniformly acknowledged the overall impact of telemedicine.

By setting those guidelines, the FSMB was telling doctors, nurses, and healthcare practitioners across the country to go ahead, that it’s okay to use telemedicine.

It’s time for Secretary Burwell to do the same thing.


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