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Michigan Becomes 25th State to Join Interstate Medical Licensure Compact

January 9, 2019
by Rajiv Leventhal, Managing Editor
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Michigan Governor Rick Snyder signed two bills into law on the last day of December, making Michigan the 25th state to enact the Interstate Medical Licensure Compact (IMLC), an initiative that offers an expedited pathway to licensure for physicians wishing to practice in multiple states.

In 2017, the Interstate Medical Licensure Compact officially began accepting applications from qualified physicians who wished to obtain multiple licenses from participating states. The Compact has been expected to expand access to healthcare, especially to those in rural and underserved areas of the country, and facilitate the use of telemedicine technologies in the delivery of healthcare.

Licensing providers across state lines has long been a challenge, as clinicians who want to treat patients in another state have historically had to apply for and pay for licenses in those states—a costly and time-consuming process. Some state boards have also sought to prevent or limit the expansion of telehealth, citing patient safety concerns.

But under this agreement, licensed physicians can qualify to practice medicine across state lines within the Compact if they meet the agreed upon eligibility requirements. As of December 31, 4,511 medical licenses have been issued and 2,400 applications processed through the IMLC.

The Compact legislation was supported in Michigan by Ascension Michigan, Trinity Health, Michigan Health & Hospital Association, American Society for Dermatologic Surgery Association, and AARP Michigan, among others.

“Ascension Michigan applauds the passage of legislation providing for the state of Michigan to join the Interstate Medical Licensure Compact,” Sean Gehle, chief advocacy officer, Ascension Michigan, said in a statement. “We believe that not only will the Compact facilitate increased access to healthcare for patients in underserved areas of our state, allowing them to more easily connect to medical experts through the use of telemedicine, but also provide for a more streamlined and expeditious process for recruitment of physicians to these same underserved areas.”

Michigan joins 24 states, Guam and the District of Columbia in enacting legislation to join the Compact. These states include Alabama, Arizona, Colorado, Idaho, Illinois, Iowa, Kansas, Maine, Maryland, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Hampshire, Pennsylvania, South Dakota, Tennessee, Utah, Vermont, Washington, West Virginia, Wisconsin and Wyoming.

The initiative remains under consideration in Kentucky, New Mexico and South Carolina.

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AMIA Supports NIST Efforts to Secure Telehealth RPM Ecosystem

January 9, 2019
by Heather Landi, Associate Editor
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Back in November, the National Cybersecurity Center of Excellence at NIST, the National Institute of Standards and Technology, issued a draft paper outlining a project it plans to undertake to provide a reference architecture addressing the security and privacy risks for healthcare delivery organizations leveraging telehealth capabilities, such as remote patient monitoring.

Traditionally, patient monitoring systems have been deployed in healthcare facilities, in controlled environments. Remote patient monitoring (RPM), however, is different in that monitoring equipment is deployed in the patient’s home, according to NIST’s NCCoE. NIST is housed within the Department of Commerce.

These new capabilities, which can involve third-party platform providers utilizing videoconferencing capabilities, and leveraging cloud and internet technologies coupled with RPM devices, are used to treat numerous conditions, such as patients battling chronic illness or requiring post-operative monitoring. As the use of these capabilities continues to grow, it is important to ensure the infrastructure supporting them can maintain the confidentiality, integrity, and availability of patient data, as well as ensure the safety of patients, according to NCCoE.

To address these security, privacy and safety concerns, NCCoE aims to provide a practical solution for securing the telehealth RPM ecosystem. The NCCoE project team will perform a risk assessment on a representative RPM ecosystem in the laboratory environment, apply the NIST Cybersecurity Framework and guidance based on medical device standards, and collaborate with industry and public partners. The project team will also create a reference design and a detailed description of the practical steps needed to implement a secure solution based on standards and best practices, according to the organization.

This project will result in a publicly available National Institute of Standards and Technology (NIST) Cybersecurity Practice Guide, a detailed implementation guide of the practical steps needed to implement a cybersecurity reference design that addresses this challenge.

The NCCoE sought public feedback on the project, which was detailed in a draft released in November called “Securing Telehealth Remote Patient Monitoring Ecosystem.”

The American Medical Informatics Association (AMIA) is one industry organization that has voiced support for the NCCoE project to develop guidance around security and privacy risks associated with remote patient monitoring.

In written comments about the project, AMIA president and CEO Doug Fridsma says he “foresees a future of care delivery and disease management that will rely heavily on RPM,” due to a “confluence of shifting and/or diminished reimbursement, aging and chronically ill population growth, and continued depopulation of rural areas.”

Securing these systems and ensuring trust in the data generated by these systems is an utmost priority, and is at the heart of consumers’ ability to obtain care and manage their health, Fridsma noted in the written comments.

Among its recommendations, AMIA advises the NCCoE to leverage existing mobile infrastructure and health IT standards.

“The ultimate spread, scale, and usage of these RPM tools will likely depend more on the commercial marketplace than the short-and long-term plans of healthcare institutions. Further, patients/consumers will use the tools that they are familiar and fits best into their individual ‘workflows.’ Securing the existing mobile infrastructure where individuals perform most of their day-to-day living will improve the likelihood that healthcare specific tasks will succeed,” Fridsma noted.

Fridsma also noted that AMIA recommends NIST focus on data security and integrity that provides data provenance and supports consistent semantic meaning of the data across RPM manufacturers.

 

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Most Physicians Not Aware of CMS’s Expanded Virtual Care Provisions, Survey Finds

January 7, 2019
by Heather Landi, Associate Editor
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For the first time, starting in 2019, the Center for Medicare & Medicaid Services (CMS) will reimburse healthcare providers for certain virtual care visits with patients, regardless of the patient’s location—a move that has drawn praise from many healthcare leaders as helping to advance telehealth.

On Nov. 1, CMS published its final rule providing updates to the Physician Fee Schedule (PFS) and calendar-year 2019 Quality Payment Program (QPP), and while there were no big surprises as many of CMS’ changes and updates were originally proposed in the agency’s draft rule, published back in July, healthcare industry groups quickly praised the virtual visit provisions contained in the final rule—specifically, reimbursing doctors for virtual check-ins, remote image evaluation, and other technology-enabled services.

CMS officials said that provisions in the CY 2019 Physician Fee Schedule would support access to care using telecommunications technology. Under the final rule, Medicare will pay providers for new communication technology-based services, such as brief check-ins between patients and practitioners, and pay separately for evaluation of remote pre-recorded images and/or video. CMS is also expanding the list of Medicare-covered telehealth services.

However, a recent Reaction Data survey found that two-thirds (67 percent) of physicians and health IT leaders are not aware of CMS’s expanded telemedicine reimbursement announcement. But, 63 percent said the increased telemedicine reimbursement would speed up implementation, adoption and use of telemedicine. Thirty-seven percent said the CMS reimbursement changes would have no impact on adoption timelines.

Reaction Data recently surveyed physicians at community hospitals, academic medical centers, specialty clinics and integrate delivery networks, to gauge who is aware of the CMS news, whether telemedicine is continuing to gather steam, what the adoption rates are and what benefits they are seeing. Eighty percent of respondents were physicians, 6 percent were CIOs, four percent were It managers, four percent were chief nursing officers and 3 percent were directors of information technology.

Half of respondents (53 percent) have not yet adopted a telemedicine solution, while 23 percent have contracted with a telemedicine software/service provider and 24 percent are using a homegrown solution.

 

 

Related Insights For: Telehealth

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Research: Trends Point to Positive Increase in Telehealth Acceptance, Access

December 17, 2018
by Rajiv Leventhal, Managing Editor
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Current events and issues, such as the opioid epidemic, are increasing the need to provide telehealth services

Stakeholders’ recognition of telehealth benefits has continually increased, as doors are now opening for various subsets of medicine, including tele-mental health, according to new research from law firm Epstein Becker Green (EBG).

The 2018 Tele-mental Health Laws survey provides an update to state telehealth laws, regulations, and policies for mental and behavioral health practitioners and stakeholders across all 50 states and the District of Columbia. The survey’s researchers said that in the last few years, “the public’s and the healthcare industry’s recognition of the benefits of telehealth has continually increased. While the shortage of behavioral health providers has long been acknowledged, the use of telehealth technologies, including practice management systems and online patient portals, to provide greater access to behavioral health professionals has increasingly gained traction and continues to gain validation as an alternative model of care delivery.”

What’s more, EBG also found that current events and issues, such as the opioid epidemic, have put more pressure than ever before on federal and state legislators to pass laws that promote access to, and provide guidance for, providers seeking to utilize telehealth services.

The survey revealed various reasons for the increase of access to tele-mental health services, and telehealth services overall, including:

Bipartisan support: The Bipartisan Budget Act of 2018 signed into law in February expanded Medicare coverage for certain telehealth services to beneficiaries who are being treated by practitioners participating in accountable care organizations (ACOs).

Greater advocacy from Medicare & Medicaid: In June 2018, the Centers for Medicare & Medicaid Services (CMS) publicly encouraged states to utilize telemedicine and telepsychiatry to facilitate coordinated care for Medicaid recipients. As of August 2018, 49 states and the District of Columbia provide reimbursement for live video telehealth services through Medicaid fee-for-service programs.  Massachusetts is the only state not yet participating.

The opioid epidemic: Several states, including Indiana, Michigan, and Missouri, have introduced and/or passed legislation that expands remote prescribing of controlled substances for treatment of substance use disorders (SUDs). In October 2018, President Trump signed into law H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (“SUPPORT”) for Patients and Communities Act.

This year’s survey also looked at positive trends in telehealth adoption and usage models, including: school sites and pediatric care; the Department of Veterans Affairs’ expanded telehealth programs (since its rollout, the VA’s telehealth program has onboarded approximately 20,000 new patients and hosts more than 6,000 virtual visits each week); and the promotion of care models for growing aging-in-place populations.

Despite the continued telehealth momentum, several barriers and policy variances do remain, the researchers stated. Some of these include: limited federal guidance on coverage and reimbursement and the lack of meaningful coverage by third-party payors, the report said. To this end, A recent MedPAC survey noted that coverage of telehealth services continues to vary widely across commercial health plans, with most covering only one or two types of telehealth-based services.

“While telehealth parity laws are currently in effect in 39 states and the District of Columbia and are intended to ensure the same coverage of (and in some cases, reimbursement for) telehealth services, there is more work ahead to achieve comprehensive coverage and access. States must continue to enact new parity laws or expand existing ones,” the researchers stated.

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