MACRA’s Advancement of Telehealth

From JDSurpra Business Advisor

imgresThe Medicare Access and CHIP Reauthorization Act (MACRA) among many areas looks at telehealth.

Section 106(c): Telehealth

Medicare currently reimburses physicians for certain services provided at certain sites through live video conferencing for eligible Medicare beneficiaries. 42 U.S.C. § 1395m(m). MACRA requires the Government Accountability Office (GAO) to draft two reports to be submitted to Congress within two years of MACRA’s enactment; the first report will pertain to the Medicare telehealth program, and the second will focus on remote patient monitoring technology and services.  The first report on the Medicare telehealth program will evaluate circumstances that help or inhibit the use of telehealth under Medicare and the possible effects of an expansion of telehealth on payment and delivery systems under Medicare and Medicaid.  The second report will examine incentives for adopting patient monitoring technology and services by private health insurance, as well as barriers for adopting this technology by Medicare. This report will also look at which patients and circumstances may receive the greatest benefit from this technology.   Many health care practitioners believe that the time for government studies of telehealth has long passed and legislative action is needed now to expand beneficiary access, particularly in rural areas.



Posted by: C3O Telemedicine News

Posted on: April 29th, 2015

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The Senate and Telehealth

AftScreen Shot 2015-04-24 at 10.43.56 AM copyer watching the two-hour hearing on Advancing Telehealth through Connectivity convened by Senator Roger Wicker (R-Miss), one has to be impressed by both the expert witnesses and the Senate Subcommittee on Communications, Technology, Innovation, and the Internet. The full hearing can be heard at

Witnesses include:

  • Kristi Henderson, Chief Telehealth and Innovation Officer, University of Mississippi Medical Center
    – Mr. Jonathan D. Linkous, Chief Executive Officer, American Telemedicine Association
    – Dr. M. Chris Gibbons, Distinguished Scholar in Residence, Connect2HealthFCC Task Force, Federal Communications Commission
    – Mr. Todd Rytting, Chief Technology Officer, Panasonic Corporation of North America

Key points:

  • Broadband is vital and is the major way to provide telemedicine and its dissemination has languished because of regulatory issues and funding.
  • The FCC needs to re-engage, streamline regulation and act by enhancing Broadband availability.
  • Even metropolitan areas such as in NYC have Wi-Fi issues in high-rise buildings with poor and elderly citizens.
  • CMS needs to remove the barrier of paying only for non-MSA populations. Reimbursement was raised several times and many agreed this was a major barrier to address.
  • Two Senators explored whether telemedicine could have an impact on mental health and drug abuse. The witnesses answered in the affirmative.
  • Some of the Senators were reassured by the witnesses that HIPAA and other patient privacy issues could be protected during telemedicine encounters.
  • The committee members very well understood quality and affordable healthcare delivery through telemedicine. Some of these Senators have very robust eHealth centers within their home states.
  • Mr. Linkous, ATA CEO, said states could help with medical licensure reciprocity as a way to solve the century old problem of interstate practice. He added the federal government could help by supporting these state initiatives.
  • The issue of the need to have another agency oversee all the current agencies that participate in telehealth was raised. Again, Mr. Linkous felt that a high level coordinating committee might be the best answer.
  • Finally, the really good news was that all the members of this bipartisan subcommittee appear to be very enthusiastic supporters of telemedicine.




Posted by: C3O Telemedicine News

Posted on: April 26th, 2015

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Texas Medical Board Restricts Telemedicine

The Texas imgresMedical Board on Friday, April 10th finally decided to severely restrict the practice of telemedicine. In a majority vote with one dissent, the Board upheld the previous decision that requires an established physical encounter prior to a telemedicine visit. Now text, email, chat, or telephone are considered inadequate for the establishment of a physician-patient relationship.


Who is on the Board?   It appears the membership is diversified and accomplished in their respective professions. There are currently 19 members, 12 of which are physicians. The remaining members are three business executives, one real estate banker, one biochemist, and three attorneys.

What does this mean for telemedicine?

  • A significant departure from where the rest of the country (and world) is going.
  • The board’s presumption that telemedicine is not a regulated and safe healthcare delivery system.
  • Challenges the medical literature, which establishes telemedicine as a highly acceptable and safe means to deliver healthcare.
  • The presumption that the only specialty that has a shortage is psychiatry since mental health is the one true exception for the use of telemedicine.

What does this mean for Texans?

  • Texas is the second largest state with 24.7% of its population in small towns and rural areas. That accounts for over 6 million people, which is the size of the state of Tennessee (2010 census).
  • As a result of the new regulations, access to healthcare for over 6 million of these Texans is limited to traveling long distances to seek care.
  • Because the level of poverty is high in these areas, not only the cost of travel but the cost of care in an ED versus the less expensive telemedicine consult is an added burden on an already stressful life.
  • Finally, the citizens of Texas had no say in this decision. The freedom of choice has been significantly curtailed.

Texas has made a decision based upon 19 Texans. It appears the only way that telemedicine is acceptable by the board is in a clinic or hospital setting, which requires a qualified healthcare provider to “assist” in the consultation. If this means only a physician, then again a major barrier exists.

Despite how one analyzes the decision, it would be safe to say that everyone in the telemedicine community supports patient safety and quality of care as the principle of why telemedicine is an important and integral part of our healthcare delivery system. Support for strong regulation is essential and must be part of every states mandate, but the restriction of the practice of telemedicine without thoughtful deliberation deprives Texans of accessible and affordable medical care.




Posted by: hrogove

Posted on: April 11th, 2015

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A Successful Telepediatric Program

picu_jamesA telepediatric cardiac critical care program dealing with children with congenital cardiac problems has shown a significant decrease in length of stay for both the ICU and hospital. This prepublication abstract is at Telemedicine and eHealth.

This unique study whereby UPMC (Pittsburgh) partnered with the Cardiovascular Foundation of Columbia was able to provide post-operative critical care to pediatric patients in the ICU. These children required surgery as they had significant congenital cardiovascular diseases.

While there was no difference in mortality, a good sign that care was the same, the TeleICU component was able to reduce length of stay. In the ICU the LOS went from 17 to 10 days. For the hospital, the LOS went from 28 to 22 days. This is important as the telemedicine patients had a higher acuity.


Posted by: C3O Telemedicine News

Posted on: March 20th, 2015

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In a newsletter released from the ATA from Jonathan Linkous, CEO:IPRqUxyy_normal

According to estimates by ATA, the number of ICU patients in the U.S. that are remotely monitored for at least a portion of the day will reach 550,000 this year. This represents roughly 11 percent of all ICU patients in the U.S. The estimates were reached in consultation with leading providers and vendors involved in providing tele-ICU services. The use of telemedicine for intensive care involves highly skilled specialists including intensivists and critical care nurses that allow clinicians in one center to remotely monitor, consult, and care for ICU patients in multiple distant satellite centers. Estimates of the growth of these remote medical services range from 10 to 25 percent per year. The rapid increase in the use of telemedicine for critically ill patients is a result of a number of factors including shortages in specialty providers, increases in the number of ICU patients (due to the aging of population) and better acceptance of telemedicine by established health systems. Such use has been documented to improve efficiencies, clinical outcomes and financial results. The widespread use of tele-ICU services has had a significant and lasting impact on the way healthcare is delivered. This is a leading indicator that ATA’s vision, that telemedicine will be fully integrated into healthcare systems to improve quality, access, equity and affordability of healthcare throughout the world, is starting to be realized. Last year, ATA adopted Practice Guidelines for Tele-ICU Operations which have since been endorsed by several medical specialty societies. They are available for free on the ATA website.


Posted by: C3O Telemedicine News

Posted on: March 11th, 2015

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Factors Affecting Staff Perceptions of Tele-ICU Service in Rural Hospitals

Telemed J E Health. 2015 Mar 3. [Epub ahead of print]


Perceptions of tele-ICU users are not well studied. Thus, we undertook a study focused on assessing staff acceptance at multiple hospitals that had implemented a tele-ICU system.

Materials and Methods: We designed a survey instrument and held interviews that gathered perceptions on multiple facets of tele-ICU use and administered it to clinical and administrative staff at 28 hospitals that had implemented a tele-ICU system.


  • Respondents were generally positive about all facets of the service.
  • Analyses found no significant differences in comparisons between critical access and larger hospitals or between clinical and administrative/managerial respondents.
  • Respondents at hospitals averaging more tele-ICU use and that had implemented it longer were significantly (p<0.05) more positive in their responses on multiple survey items than other respondents.

Conclusions: Tele-ICU was particularly valued when critical access hospitals retained critical care patients. Tele-ICU can aid rural hospitals, but multiple delivery models are warranted to meet disparate needs.


Posted by: C3O Telemedicine News

Posted on: March 4th, 2015

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Posted by: C3O Telemedicine News

Posted on: March 2nd, 2015

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Study Finds State Licensing Process Can Impede Telehealth Adoption

From California Healthline/iHealth Beat

Adoption of telehealth services across state lines is being hindered by the time-consuming process of obtaining state medical licenses,according to a CO3 study released this month, FierceHealthITreports (Dvorak, FierceHealthIT, 2/26).

For the study, researchers sent a 30-question survey to health professionals across the U.S. who process medical licensure applications (Rogove, C3O Telemedicine study, 2/11).


More than half of respondents said they process more than 100 applications annually (C3O Telemedicine release, 2/25). Of those:

  • 54% said the application process takes longer than 12 hours; and
  • 17% said the process takes four hours to nine hours (FierceHealthIT, 2/26).

After the application process is complete, the amount of time it took to acquire licenses varied among states. For example, it took one to three months to obtain licenses in Indiana, Arizona and Virginia, while it took at least 10 months in California, Illinois and Texas (C3O Telemedicine release, 2/25).

Just 8.3% if respondents said all states were “reasonable in processing the applications,” according to the study.


The authors concluded that state medical license portability “continues … to remain elusive for a solution that will allow for the exponential and timely growth of telemedicine.”

They added, “If there were ever a time for the mission of state medical licensure boards to rally in support of shaping the future of health care delivery by finding a solution for removing a most significant barrier to telemedicine, the time is now” (FierceHealthIT, 2/26).


Posted by: C3O Telemedicine News

Posted on: March 1st, 2015

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Thirty six states introduce 100 telemedicine related bills

According to Jonathan Linkous of ATA in todays Inside ATA:

“It’s only February, but telehealth is clearly a priority to state lawmakers. One hundred telemedicine-related bills have been introduced to define telehealth and telemedicine, redefine licensed provider practice standards, remove artificial barriers or improve coverage and payment options. Some bills seek to improve the telemedicine policy landscape while others risk to severely limit health providers’ clinical decision making and patient choice. ATA members are monitoring state activity using the ATA legislative and regulatory trackers, and seizing the opportunity to educate lawmakers about the clinical application of telemedicine and the unintended consequences of over regulation. Join the ATA State Policy webinar this Thursday, Feb. 26, at 1 p.m. EST, to hear about legislative proposals and possibilities for engagement.”


Posted by: C3O Telemedicine News

Posted on: February 24th, 2015

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What’s the status of the Interstate Medical License Compact?

According to Christopher Cheney of HealthMedai Leaders: “Since the model Compact legislation was finalized by state medical board representatives and released to the states for their consideration at the end of 2014, it has been introduced in 12 state legislatures and endorsed by 26 state medical and osteopathic boards. We expect both counts to continue to grow,” Humayun Chaudhry, DO, president and CEO of theFederation of State Medical Boards, said last week.

So far, the draft has been introduced at statehouses in Iowa, Maryland, Minnesota, Montana, Nebraska, Oklahoma, South Dakota, Texas, Utah, Vermont, West Virginia and Wyoming. The FSMB is tracking the legislation’s progress on the organization’s website.

The Compact also has the support of the American Medical Association, the Council of Medical Specialty Societies, the Society of Hospital Medicine, and many other national and state provider, hospital, and specialty organizations. Consumer and patient advocacy organizations like the South Dakota AARP chapter have also been very supportive of the Compact and its potential for improving access to care.”

Critics of the Compact
The FSMB has lashed out at critics of the Compact, among them Independent Physicians for Patient Independence (IP4PI) and the Association of American Physicians and Surgeons (AAPS). In a letter to the US Senate dated Jan. 26, AAPS called the Compact “little more than a pretext for transferring state sovereignty to out-of-state, private, wealthy organizations” and called for “an investigation of the FSMB to “[evaluate] the very reason for their existence on top of state licensure boards and specialty boards.”

Critical Mass of States Needed to Launch Compact
Several states will have to enact laws codifying the model legislation before the Compact can seat commissioners and launch.

“The model Compact sets a minimum of at least seven states to enact the legislation in order to enable functionality and the creation of an interstate commission. The commission would be charged with the administrative functions of the Compact and be led exclusively by members of participating state medical boards,” Chaudhry says.


Posted by: C3O Telemedicine News

Posted on: February 20th, 2015

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