This NEHI issue brief reveals how the use of tele-medicine in intensive care units is on the threshold of major change, with emerging best practices providing valuable precedents and guidelines for adopting tele-ICU care more broadly around the country. Many of the recent models of tele-ICU care reflect variations in practices that have the potential to make the technology more scalable and accessible in a variety of new settings including county, public, rural and critical access hospitals. In the past few years new product and provider options have emerged, as well as new efficiencies, which together are likely to drive broader adoption of these networks of audio-visual communication for monitoring ICU patients remotely.
WASHINGTON, DC (Lake County News)– On Friday, U.S. Reps. Mike Thompson (CA-5) and Scott Peters (CA-52) introduced H.R. 3507, the 21st Century Care for Military & Veterans Act.
This bipartisan legislation would expand coverage of telehealth services to active-duty servicemembers, their dependents, retirees, and veterans.
Because of provider shortages at local practices, many servicemembers and veterans lack access to a primary care physician, and in rural and underserved communities patients often must travel extended distances to see a healthcare provider.
The bill would establish and expand reimbursement policies covering the use of telehealth services, including essential mental health monitoring, under TRICARE and the VA.
“Often times telehealth provides the best care available and as a wounded combat Vietnam veteran, I understand that our servicemembers, veterans and their families have earned and deserve the best,” said Thompson. “This bill will make sure our men and women of the Armed Forces and their families can get the highest quality care in a timely manner no matter where they live or how far away they are from the doctor they need to see. It’s the right thing to do for those who have sacrificed so much for us.”
“As we look for ways to provide the best-quality care for our servicemembers and veterans, telehealth technologies are increasingly important to the full range of options we should be offering,” Peters said. “We’ve already seen that these technologies create a more responsive and more efficient health care system that provide for better care and lower costs. That’s the type of commonsense approach that can make a real difference in military and veterans communities in San Diego and across the country.”
The legislation introduced today would leverage innovative technologies already in use today – including audio and video conferencing, smart devices, and remote monitoring – to bring the doctor to the patient.
Telehealth technologies, in their various forms, bring a host of benefits including improved patient outcomes, decreased disparities and variations in care, and vastly expanded options for outpatient health treatments.
The VA has already seen both clinical and cost-saving benefits through telehealth technologies, including a 40 percent reduction in bed days and an 87 percent reduction in annual per-patient cost between when compared to existing home-based care programs.
In addition to Peters and Thompson, the bill is co-sponsored by Reps. Gregg Harper (R-MS-3) Peter Welch (D-VT At-Large).
H.R. 3507 has been endorsed by the American Telemedicine Association.
Thompson represents California’s 5th Congressional District, which includes all or part of Contra Costa, Lake, Napa, Solano and Sonoma Counties. He is a senior member of the House Ways and Means Committee and the House Permanent Select Committee on Intelligence. Rep. Thompson is also a member of the fiscally conservative Blue Dog Coalition and chairs the bipartisan, bicameral Congressional Wine Caucus.
CARMICHAEL, Calif. — The doctor isn’t in, but he can still see you now.
Remote presence robots are allowing physicians to “beam” themselves into hospitals to diagnose patients and offer medical advice during emergencies.
A growing number of hospitals in California and other states are using telepresence robots to expand access to medical specialists, especially in rural areas where there’s a shortage of doctors.
These mobile video-conferencing machines move on wheels and typically stand about 5 feet, with a large screen that projects a doctor’s face. They feature cameras, microphones and speakers that allow physicians and patients to see and talk to each other.
Dignity Health, which runs Arizona, California and Nevada hospitals, began using the telemedicine machines five years ago to diagnose patients suspected of suffering strokes — when every minute is crucial to prevent serious brain damage.
The San Francisco-based health care provider now uses the telemedicine robots in emergency rooms and intensive-care units at about 20 California hospitals, giving them access to specialists in areas such as neurology, cardiology, neonatology, pediatrics and mental health.
“Regardless of where the patient is located, we can be at their bedside in several minutes,” said Dr. Alan Shatzel, medical director of the Mercy Telehealth Network. “Literally, we compress time and space with this technology. No longer does distance affect a person’s ability to access the best care possible.”
Dignity Health is one of several hospital chains that recently began using RP-VITA, which was jointly developed by InTouch Health and iRobot Corp. It’s approved for hospital use by the U.S. Food and Drug Administration.
“Hospitals are now using this type of technology in order to leverage the specialists that they have even better and more efficiently,” said Dr. Yulun Wang, CEO of Santa Barbara-based InTouch Health.
Nearly 1,000 hospitals in the U.S. and abroad have installed InTouch telemedicine devices, including about 50 RP-VITA robots launched in May, according to company officials. The company rents out the RP-VITA for $5,000 per month.
When a doctor is needed at a remote hospital location, he can log into the RP-VITA on-site by using a computer, laptop or iPad. The robot has an auto-drive function that allows it to navigate its way to the patient’s room, using sensors to avoid bumping into things or people.
Once inside the hospital room, the doctor can see, hear and speak to the patient, and have access to clinical data and medical images. The physician can’t touch the patient, but there is always a nurse or medical assistant on-site to assist.
On a recent morning, Dr. Asad Chaudhary, a stroke specialist at Dignity Health, beamed into a robot at the neuro-intensive care unit at Mercy San Juan Medical Center in Carmichael to evaluate Linda Frisk, a patient who recently had a stroke.
With his face projected on the robot screen, Chaudhary asked Frisk to smile, open and close her eyes, make a fist and lift her arms and legs — common prompts to test a patient’s neurological functioning.
“If you develop any weakness, any numbness, any problem with your speech or anything else, let us know right away,” Chaudhary told Frisk before the robot turned around and left the room.
“It’s just like being with the patient in the room,” Chaudhary said. “Of course, nothing can replace seeing these patients in person, but it’s the next best thing.”
Frisk, 60, who was flown into the hospital for treatment, said she was surprised when she first saw the robot, but quickly got used to the doctor’s virtual presence.
“You feel like he was right there,” said Frisk, who lives near Merced. “Although I am a little spoiled and like to see him in person.”
Nov 14, 2013 — New Cosponsors
Rep. Cathy McMorris Rogers (R-WAS) and Rep. Scott Peters (D-CA52)
Following closely H.R. 3077, the TELE-MED Act of 2013 more co-sponsors are supporting this important piece of legislation. They are Rep. Cathy McMorris Rodgers [R-WA5] and Rep. Ann Wagner [R-MO2]. The resolution appears to be gaining bipartisan support.
Jonathan Linkous, CEO of the American Telemedicine Association, sent an email update about key regulatory issues reflecting telemedicine:
“OKLAHOMA MEDICAL BOARD INCORPORATES ATA GUIDELINES IN PROPOSED RULES –
Oklahoma is the latest state to incorporate ATA guidelines in policy statements. Other states including New York, North Carolina, and Pennsylvania have also made specific reference to ATA’s telemedicine guidelines. Proposed rules released by the Oklahoma Medical Board specify that physicians practicing telemedicine in the state “must practice telemedicine in compliance with standards endorsed by the American Telemedicine Association (ATA).” The proposed rules go on to endorse ATA guidelines language and are still pending. The Oklahoma board did approve a provision which no longer requires a physician to establish an in-person relationship with the patient prior to using telemedicine. View the ATA standards and guidelines here:http://www.americantelemed.
21st CENTURY CARE FOR MILITARY AND VETERANS ACT –
ATA expects the 21st Century Care for Military & Veterans Act will be introduced in Congress today. This important Congressional plan would create parity in coverage between telehealth and in-person services. It would also allow military and veterans’ healthcare professionals to provide interstate services with one state license. ATA will submit a statement of support once the bill is introduced.
MICHIGAN MEDICAID UPDATES TELEMEDICINE POLICY –
Distance limits between originating and distance-site telemedicine providers are no longer required under Michigan Medicaid fee-for-service. The state Department of Community Health issued a bulletin to clarify and update its existing telemedicine policy. Michigan Medicaid will now cover and reimburse for telemedicine related to: end-stage renal disease, behavior change intervention, behavioral and/or substance abuse treatment, education, inpatient consultations, nursing facility subsequent care, office/outpatient consultations and services, psychiatric diagnostic procedures, subsequent hospital care, and diabetes training services.”
November 5, 2013 – Ojai, CA
by Herb Rogove, DO,FCCM, CEO, C3O Telemedicine
For those interested in seeing a brief composite of federal legislation that may be of significant interest to the telemedicine/telehealth community, the following are the most recent ones of note:
HR 6719 TeleHealth Promotion Act: Introduced by Rep. Thompson (D-CA) late 2012. Goal: To prevent readmission and help with interstate licensing. It was introduced Dec 30, 2012 but not enacted.
HR 3077 TELE-MED (TELEmedicne for MEDicare) Act of 2013: Introduced by Rep. Nunes (R-CA) and Pallone (D-NJ). It was introduced September 10, 2013. Goal: To amend title XVIII of the Social Security Act to permit certain Medicare providers licensed in a State to provide telemedicine services to certain Medicare beneficiaries in a different State. It was referred to the Committee on Ways and Means and the Committee on Energy and Commerce. Additionally, there are currently 25 co-sponsors, some of which have signed on as recently as the end of October.
HR 3306 TELEHEHATLH ENHANCEMENT ACT OF 2013: Introduced by Reps. Gregg Harper(R-MS) and Rep. Mike Thompson (D-CA), along with Reps. Devin Nunes (R-CA) and Peter Welch (D-VT). It was introduced on October 22, 2013. Goal: To promote and expand the application of telehealth under Medicare and other Federal health care programs, and for other purposes:
- Eliminate restrictions on telehealth reimbursement for Medicare patients.
- Adjust Medicare home health payments to account for remote patient monitoring;
- Expand telehealth coverage to all critical access and sole community hospitals;
- Cover home-based video services for hospice care, home dialysis and homebound Medicare beneficiaries; and
- Allow state Medicaid programs to set up high-risk pregnancy networks.
- Encourage ACO’s to use telehealth
The American Telemedicine (ATA) has supported these resolutions.
According to govtrack.us, the prognosis is as follows: The Harper-Thompson bill above has a 4% chance of getting through committee and a 1% chance of becoming a law. This is based upon the past experience in Congress in that only 11% of all bills made it through committee and 3% were enacted between 2011-2013 so far.
These bills, while not the panacea for all that is needed, are a legitimate and bipartisan effort in the right direction. This is where “people power” comes into play. I just emailed my Congresswoman and her aide asking for her to sign on. Now it’s your turn.
A report on MedPage covering the annual CHEST meeting has the results of an eICU in Youngstown, Ohio stating that mortality, codes, and length of stay increased! Ajit Dhakal, MD, of Northside Medical Center in Youngstown, Ohio, and colleagues reported at the CHEST meeting.
- The mortality rate went from 78 to 90 per 1,000.
- The mean length of stay was 3 days before and 3.2 afterward .
- The number of code blues rose from 39 to 54 over the period.
The researchers acknowledged that the lack of benefits could have been hidden by the relatively small sample size and wide standard deviation in both groups.
There were real questions about the eICU methods as well, cautioned Craig Lilly, MD, director of the University of Massachusetts Memorial eICU program in Worcester.
“It wasn’t entirely clear to me that [the authors] was using the same organized software that everyone else is using,” he told MedPage Today, adding that the stated remote monitoring location “is not really a tele-ICU vendor or a known site, so that’s a little odd.”
“Keep in mind that a single hospital with a limited amount of data is not a defining conclusion” emphasized Herb Rogove, DO, FCCM CEO of C3O Telemedicine. “Often abstracts and data presented at meetings such as CHEST are preliminary and often do not undergo the scrutiny of peer reviewed full studies that are published in medical journals” was noted by Rogove.
In the Journal of Ophthalmology, Luis J. Haddock, David Y. Kim, and Shizuo Mukai of the Massachusetts Eye and Ear Infirmary, published an article which highlighted the use of a smart phone, Filmic Pro (an inexpensive app), and a 20D lens that provide high quality fundus examinations.
Filmic Pro Application to set before the examination
The results: an abnormal examination revealing a vasculitis
A group of 64 organizations and businesses has sent a letter to Congress in support of the TELEhealth for MEDicare (TELE-MED) Act of 2013, calling the bill “a solid step in expanding access to care while lowering costs for consumers through telehealth.”
Those signing the letter to bill sponsors Reps. Devin Nunes, R-Calif., and Frank Pallone, D-N.J., include the American Health Information Management Association (AHIMA), the Health IT Now Coalition, The Rural Broadband Association, Wellpoint and Verizon.
State and national business groups including the U.S. Chamber of Commerce, the National Black Chamber of Commerce and the National Association of Manufacturers also signed, as did the Accreditation Council for Pharmacy Education and several healthcare advocacy groups.
The bill, HR 3077, was introduced Sept. 10 and referred to the House Ways and Means Committee and the House Energy and Commerce Committee. It would allow Medicare providers to treat patients electronically across state lines without having to obtain multiple state medical licenses.
“The convergence of medical advances, health information technology, and a nationwide broadband network are transforming the delivery of care to citizens by bringing the health care provider and patient together virtually, especially those in disadvantaged areas,” the letter said.
The letter expresses strong support for the bill’s effort to “remove obsolete policy barriers that prevent Medicare patients from receiving technology enabled, modern healthcare.”
In a letter released shortly after the bill’s introduction, Joel White, executive director of the Health IT Now Coalition, lamented the “hoops and hurdles” providers must jump through to treat Medicare patients across state lines.
“Limiting the number of doctors available in any one state to treat Medicare beneficiaries–who, due to disease, transportation or mobility issues, are often not able to travel long distances to receive the care they need–not only decreases access to care, but also increases costs and harms patient outcomes,” White wrote.
In a Fresno Bee opinion piece, the CEO of the nonprofit community health center Clinica Sierra Vista, talks about his support for the bill.
“Under current law, when it comes to practicing telehealth, physicians’ hands are tied. Health care providers are required to have multiple state medical licenses and adhere to multiple state rules to provide virtual care across state lines,” writes CEO Steve Schilling. “This outdated system of state medical licensure laws is preventing the widespread use of telemedicine and preventing patient access to quality health care.”
Schilling called telemedicine a virtual house call via a tablet or desktop computer, and said the lifting of geographic licensing restrictions for Medicare providers would be welcome news for practitioners and rural residents across the country.