News
Florida Medical Association Opposes Telemedicine Legislation
Modern Healthcare’s Andis Robeznieks reports the Florida Medical Association, seeking to bolster its case against a telemedicine bill being considered in the state Legislature, released results of a survey showing Floridians are opposed to doctors licensed in other states treating Florida patients via telemedicine.
“Florida patients are strongly opposed, as is the FMA, to allowing out-of-state physicians and practitioners who are not licensed in Florida to not only practice telemedicine, but to prescribe drugs and controlled substances over the Internet,” Timothy Stapleton, FMA executive vice president, said in a news release. “The FMA supports the use of telemedicine and will work tirelessly to ensure that high standards, protections against fraud, and patient privacy are addressed in any legislation.”
Of the poll’s 606 respondents, 57% strongly oppose and 13% somewhat oppose allowing out-of-state doctors licensed in other states to treat Florida patients via telemedicine. Ten percent strongly favored allowing the practice and 16% somewhat favored it.
Tomball, Texas-based Voter Consumer Research conducted the survey Feb. 1-5. Other findings included Floridians overwhelmingly oppose out-of-state doctors prescribing medicines or controlled substances. They also oppose having nonphysician healthcare practitioners practice telemedicine.The Florida Telemedicine Act would create licensure and registration requirements and regulate private insurance andMedicaid reimbursement.“The FMA is opposed to the bill as drafted,” said Erin Vansickle, FMA spokeswoman. “We look forward to working with lawmakers to craft legislation that protects patient safety and privacy, and ensures fair reimbursement for physicians.” She did not detail which provisions of the bill the association opposes.
Vansickle said the FMA’s opposition was not directed toward the state’s annual influx of winter snowbirds, residents who move south for the season but who may stay connected to their home state doctors via telemedicine.
“The FMA has major concerns about the impacts of telemedicine on all Florida patients, regardless of how long they reside in or visit our state,” she said.
The FMA, in its Five Pillar program (PDF) for addressing primary-care physician and nurse shortages, states that it supports telemedicine services for patients and physicians with established relationships and informed patient consent; that it wants physicians practicing telemedicine on Florida patients to hold a state license or telemedicine certificate and to be subject to discipline by the Florida Board of Medicine; and that it supports parity in Medicaid and private insurance reimbursement for face-to-face and telemedicine consults.
In explaining reimbursement, the association document states that “the physician expends the same amount of time, skill and expertise in both.”
Twenty-two states have telehealth bills before their legislatures, according to the American Telemedicine Association.
Telemedicine laws went in effect last month in Arizona and Mississippi. Legislation allowing reimbursement for pediatric mental health services delivered via telehealth technology was signed by Wisconsin Gov. Scott Walker on Feb. 6 and immediately enacted into law.
Commentary: What is not explained are the details of the bill that has pushed the FMA into opposing the legislation. This is another state who has embarked upon the long overdue and much needed portability of medical licensure. The Federation of State Medical Boards is in the process of pushing forward an expedited medical licensure policy. Additionally it would be interesting to see how the 600 plus person survey was obtained and how the questions were presented. Keep in mind that the state of Florida have over 19 MILLION citizens. Somehow 600/19,000,000 does not seem like a statistically significant reason to represent the entire state.
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C3O Telemedicine News
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February 21st, 2014
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Cleveland Clinic: Telemedicine Grows
According to Dr. Peter Rasmussen, neurosurgeon and champion for telemedicine at the Cleveland Clinic, “over 200 stroke consults are provided to rural and surrounding hospitals in Ohio”. Rasmussen believes the accuracy of stroke consults has dramatically increased using telemedicine. The telestroke program has been in existence for four years and it appears that other areas for deployment of telemedicine is in store at the Clinic.
Alumni Connection, Issue I, 2014
Cost utility of hub-and-spoke telestroke networks from societal perspective.
Just released in the American Journal of Managed Care the authors Dr. Bart Demaerschalk, Switzer, Xie, Fan, Villa, and Wu looked at the hub-and-spoke telestroke model and evaluated the societal implications. Their findings were:
- Compared with no network, patients treated in a telestroke network incurred $1436 lower costs and gained 0.02 QALYs over a lifetime.
- Incremental costs decreased from $444 for the first year to -$1436 over a lifetime;
- incremental QALYs increased from 0.002 for the first year to 0.02 over a lifetime.
- A telestroke network became less cost-effective with increasing spoke-to-hub transfer rates
- Conclusions: A telestroke network is cost saving and more effective compared with no network from the societal perspective in most modeled scenarios.
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C3O Telemedicine News
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February 15th, 2014
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The Reliability of Teledermatology to Triage Inpatient Dermatology Consultations
ABSTRACT
Authors
John S. Barbieri, BA1; Caroline A. Nelson, BA1; William D. James, MD2; David J. Margolis, MD, MSCE, PhD1,2,3; Ryan Littman-Quinn, BA2; Carrie L. Kovarik, MD2; Misha Rosenbach, MD
Importance Many hospitals do not have inpatient dermatologic consultative services, and most have reduced availability of services during off-hours. Dermatologists based in outpatient settings can find it challenging to determine the urgency with which they need to evaluate inpatients when consultations are requested. Teledermatology may provide a valuable mechanism for dermatologists to triage inpatient consultations and increase efficiency, thereby expanding access to specialized care for hospitalized patients.
Objective To evaluate whether a store-and-forward teledermatology system is reliable for the initial triage of inpatient dermatology consultations.
Design, Setting, and Participants Prospective study of 50 consenting adult patients, hospitalized for any indication, for whom an inpatient dermatology consultation was requested between September 1, 2012, and April 31, 2013, at the Hospital of the University of Pennsylvania, an academic medical center. The participants were evaluated separately by both an in-person dermatologist and 2 independent teledermatologists.
Main Outcomes and Measures The primary study outcomes were the initial triage and decision to biopsy concordance between in-person and teledermatology evaluations.
Results Triage decisions were as follows: if the in-person dermatologist recommended the patient be seen the same day, the teledermatologist agreed in 90% of the consultations. If the in-person dermatologist recommended a biopsy, the teledermatologist agreed in 95% of cases on average. When the teledermatologist did not choose the same course of action, there was substantial diagnostic agreement between the teledermatologist and the in-person dermatologist. The teledermatologists were able to triage 60% of consultations to be seen the next day or later. The teledermatologists were able to triage, on average, 10% of patients to be seen as outpatients after discharge.
Conclusions and Relevance Teledermatology is reliable for the triage of inpatient dermatology consultations and has the potential to improve efficiency.
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C3O Telemedicine News
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February 15th, 2014
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Study: Younger, Richer, Newer Patients Most Likely to Use Telemedicine
In Becker’s Hospital Review and Written by Helen Gregg
According to this article,
telemedicine is more often used by younger and by the more financially sound and are less likely than the general population to have an established relationship with a primary care provider or other healthcare provider, according to a study in Health Affairs.
- This was a RAND Corporation study of Californians using Teladoc.
- It included an analysis of 3,701 telemedicine encounters.
- Telemedicine was most often used for acute respiratory conditions, urinary tract infections and skin problems.
- Telemedicine patients were less likely to have a follow-up visit than patients who had visited a physician’s office or the emergency department.
- One of the authors suggested that telemedicine may be expanding care access to patients not already connected to a healthcare system.
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C3O Telemedicine News
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February 10th, 2014
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Pediatric Telehealth: Opinions from CTeL
from the CTe
L website
“For many working parents, finding the time to take a sick child to the doctor can be a challenge. But with the rise of telemedicine, including in pediatrics, busy parents are able to connect with providers on demand. Along with more “traditional” telemedicine, which incorporate two-way video, diagnostic equipment, and laboratory tests, many providers are offering treatment to patients via telephone and e-mail—particularly after normal working hours.
This new iteration of “telemedicine” has gotten people’s attention. Patients get instant access to a doctor with virtually no long lines or wait times. And, all from the convenience of the patient’s home.
But, is it safe and is it compliant with state laws and regulations?
The Robert J. Waters Center for Telehealth & e-Health Law (CTeL) explains, to get to that one answer you need to begin by asking more questions. Can the practitioner accurately diagnose over the telephone or web camera? Does diagnosing and prescribing without a laboratory test lead to unnecessary prescribing of antibiotics? Does prescribing without an in person examination and laboratory tests violate state laws and regulations governing practitioner conduct?”
Who is CTel?
The Center for Telehealth and e-Health Law (CTeL) has established itself as the “go-to” legal and regulatory telehealth organization – providing vital support to the community on topics such as: physician and nurse licensure; credentialing and privileging; Medicare and Medicaid reimbursement; and private insurance payment policies.
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C3O Telemedicine News
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February 3rd, 2014
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Improving Stroke Outcomes in Rural Areas Through Telestroke Programs
In the January issue of Telemedicine and eHealth, a public accessible article on the improvement of stroke outcomes in rural areas through telemedicine is reported.
Michael Kulcsar, JD and group from Georgia reviewed statutes and regulations in all 50 states that affect the adoption of telemedicine programs and describe examples of state implemented programs in two states with policies that encourage telestroke use. The review presents evidence of the value and effectiveness of telestroke programs, as well as an explanation of common barriers and facilitators of telestroke, including licensing and credentialing rules, reimbursement issues, and liability concerns. Most states have adopted policies that affect the adoption of telestroke programs. Georgia and South Carolina are examples of states implementing stroke policies using a telestroke model to treat stroke patients in rural areas.
This is an excellent review of the key barriers and a review by state of the major limitations to telemedicine considering since June 2012, 44 states have enacted more than 250 statutes and regulations pertaining to telemedicine. Despite the American Heart Associations recommendation in 2009 to address these issues, eliminating these barriers continues to be an active problem for those involved in providing
telestroke care across the United States.
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C3O Telemedicine News
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February 1st, 2014
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Telemedicine Emerging as Rural ICU Solution: Options
While the high startup costs associated with telemedicine programs have presented a barrier to many rural hospitals, data suggests they contribute to lower costs and lower mortality rates.
“However keep in mind this discussion centers around only the eICU solution which is not the only technology to provide ICU care” according to Dr. Herb Rogove, DO, FCCM of C3O Telemedicine. ICU beds account for about 7% of total acute care hospital beds in the United States but generate 13.4% of total spending, with the cost of an inpatient stay ranging from $2,500 to $4,000 per day, according to the Society of Critical Care Medicine.
The New England Healthcare Institute (NEHI) issued a report in 2012, that there were 54 civilian and government tele-ICU monitoring centers in the U.S. “The NEHI report states “most indicators suggest that use of tele-ICUs is on the threshold of major change” and increased competition among providers is likely to “push tele-ICU care toward a more scalable and potentially more widely available technology,” the report says.
Tele-ICUs are also being promoted as a way to expand the ICU capacity of hospitals to accommodate an aging U.S. population and shortage of intensivists. “It could go a long way to addressing a major problem in that there are not enough intensivists in the health system to care for an aging population of baby boomers,” says NEHI’s Nick King, one of the authors of the report. The NEHI report estimates that per-hospital startup costs range from $100,000 to $200,000, with added expenses for equipment such as mobile carts.”The upfront costs can be an issue, but we’ve demonstrated that health systems can see a return on investment from tele-ICU programs in as little as nine months,” says NEHI president Wendy Everett.The University of Massachusetts was able to reduce its ICU patient mortality rates by 30% during the first year of its program; it also reported a reduction in hospital-acquired infections and other complications that often result in longer hospital stays.John Muir Health in northern California, launched its tele-ICU program in 2007 and after 18 months, reported a 45% reduction in ICU mortality rates and a 54% reduction in the average length of stay (LOS) for ICU patient
Rural adoption
Of the 54 tele-ICU monitoring centers in the United States, only 21 involve rural or critical access hospitals. The NEHI report noted that the key impediments to tele-ICU coverage of rural and critical access hospitals have been the costs of extending and maintaining coverage to a limited number of ICU beds and a lack of bedside clinicians in these hospitals to implement care directed from the tele-ICU.
The NEHI report notes a change in that Missouri-based Mercy Health System, which currently has one of the largest tele-ICU programs in the U.S. covering 480 beds, recently received a federal grant to extend coverage to 24 rural hospital beds. Mercy’s program, launched in 2007, has produced a 30% reduction in ICU mortality rates and a 20% drop in patient LOS that saves an estimated $25 million per year.
Options for Rural Success
Though rural tele-ICU networks are rare, there have been several successful networks that could provide a template for success. In Maine, Maine Health had eight rural hospitals coordinating ICU care through a program established in 2005 (though it was successful, the program was shut down in October 2013 when it ran out of funding).
Avera Health in Washington also sponsors a rural tele-ICU program as well as other telehealth programs.
According to Everett, extending ICU programs to rural hospitals has benefits beyond cost savings and avoidance of a patient’s family and friends traveling several hours to visit them because the local hospital doesn’t have the resources to care for them.
Other Options
C3O Telemedicine is currently providing assistance to Dignity Health in initiating and implementing tele-ICU programs at rural facilities. At the end of 2013, Dignity began a program at Mark Twain Medical Center in San Andreas, California. The concept of Round and Respond will be monitored for the same quality outcomes of the eICU technology reported by NEHI. Dignity has selected the InTouch Robot as it’s technology along with enhanced ICU staff training.
(Annotated from Health Leaders Media, 2014)
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C3O Telemedicine News
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January 31st, 2014
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ATA Update:Telemedicine in 2014 State Legislatures
Presenters:
• Gary Capistrant, Senior Director of Public Policy, American Telemedicine Association
• Latoya Thomas, Project Director of State Telehealth Policy, American Telemedicine Association
Some key legislation is occurring in greater than 20 states pertaining to telemedicine. Here are some of the highlights covered in the webinar on Thursday, January 30th.
- California: There is already legislation for ophthamology and dermatology but now tele-dentistry has been introduced. This applies to store and forward.
- Florida: Private insurance parity is not a strong possibility but license portability may succeed.
- Illinois: Private insurance parity was introduced last year and it appears that the Illinois Senate may have an option. Discussions about language in the legislation appears to be an issue. Perhaps Medicaid payment for their beneficiaries in Illinois may pass.
- Nebraska: Private insurance parity is being discussed.
- South Carolina: It appears there is loss of traction for the private insurance parity bill introduced in 2013.
- Washington State: Private insurance parity language is seeking consensus.
States with existing parity laws who are revisiting the legislation:
- Hawaii: First introduced legislation in 1999 may be looking at two bills with reimbursement improvements.
- Mississippi: Parity law passed in 2013 now includes reimbursement for store and forward as well as patient monitoring.
- Oregon: Parity law passed in 2009 that will now have coverage for self-insured state employee based plans.
Lots happening so far in the first month of 2014. Hopefully another productive year as the ATA leads the charge.
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C3O Telemedicine News
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January 30th, 2014
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Top Telemedicine Webinar: The Monthly ATA Show With Jonathan and Gary
If you are looking for the latest information on telemedicine then don’t miss Jonathan Linkous, CEO, and Gary Capistrant, Senior director of public policy for the ATA. Here are a few highlights of the most recent webinar January 28, 2014:
- Former Senators Daschle, Lott and Breaux are providing leadership for the new Alliance for Connected Health. Involved are the telecommunications companies, retail pharmacies, and others who see the value of telemedicine.
- More states are joining the “parity group” so that Medicaid will reimburse for telemedicine clinical services. These states include Florida, Maryland, Nebraska, South Carolina, and Washington state.
- The ATA website is being updated to keep current on a per state basis regarding parity laws.
- Medicare has expanded coverage to underserved areas on the fringe of MSA’s.
- There are now over 100 Congresspersons who support the Harper bill HR 3306 for Medicare and Nunes bill HR 3077 expanding state licenses ability to provide care in more than a physician’s home state for Medicare patients. It may be that all of these bills may be part of the “Doc Fix” bill addressing SGR.
- FACT: Jonathan Linkous quoted that in October CMS spent $600M on EMR’s and $6M on telemedicine. Consider that!
- ATA believe it is important for all members to be involved promoting the telemedicine bills to their own representatives both at the state and national level.
- ATA will participate in telemedicine conferences in Lima, Peru October 16-18 and November in China.
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C3O Telemedicine News
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January 29th, 2014
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