May 2, 2014
Telehealth has the potential to expand access to healthcare, lower costs, and improve care quality and patient outcomes across the country. However, in order to take full advantage of new technologies and advances in telemedicine, Congress must create a national telehealth framework that breaks down the barriers to widespread adoption, according to industry stakeholders who testified May 1 before the House Energy and Commerce Health Subcommittee.

Witnesses told lawmakers that Medicare should significantly expand reimbursement for telehealth services regardless of geographic location, service type, or real-time nature of the services. At the hearing, Rashid Bashshur, Executive Director for eHealth at the University of Michigan Health System, lamented the fact that the total expenditure on telemedicine service in 2013 by the Centers for Medicare and Medicaid Services was a mere $12 million compared to the billions of dollars spent on broadband and telemedicine infrastructure.

“Reimbursement for telemedicine services has been largely limited to rural areas in order to meet the legitimate unmet needs of rural and remote communities while the unmet needs of large groups/population segments in major urban areas have similar unmet needs,” testified Bashshur. “Reimbursement is also limited to the least efficient modality of telemedicine service, namely synchronous video communication between an originating site and a remote site. Only Alaska and Hawaii are exempt from this stipulation.” He added: “And finally, we are struggling to find the right balance between state-based prerogatives over medical licensing and regulation and the vast potential of competition in improving quality and reducing cost.”

Part of the problem, according to Kofi Jones, vice president of public affairs for telehealth technology vendor American Well, is that the section of the Social Security Act that defines telehealth and how Medicare will reimburse for telehealth services was crafted in 2000. “The outdated language from 2000 says that patients can only receive care if they are in rural area, presenting in a clinical originating site,” testified Jones. “That means patients still have to drive to receive the care they could actually get on this phone in order for reimbursement to take place, and if they live in a city, all bets are off. Considering the wait times to see a provider in some of our nation’s urban areas, this appears prohibitive.”

However, Ateev Mehrotra, a staff physician at Beth Israel Deaconess Medical Center, associate professor at Harvard Medical School and a policy analyst at the RAND Corporation, told the subcommittee that “it is hard to make blanket statements on whether a given telehealth technology is effective or ineffective.” Consequently, Mehrotra argued that this complexity “makes it difficult for Medicare or other payers to make decisions on whether to pay for a given type of telehealth.”

Critics are also concerned that the expansion of telehealth services would unleash the potential for fraud or over-utilization of services, which could significantly increase costs without any corresponding improvement in care quality or health outcomes.

Nevertheless, in a written statement, Health IT Now Coalition Executive Director Joel White applauded the subcommittee for holding a hearing on the issue of expanding access to telehealth and urged lawmakers to support a bipartisan bill, H.R. 3077, the Tele-MED Act, introduced by Rep. Devin Nunes (R-Calif.) and Health Subcommittee Ranking Member Rep. Frank Pallone (D-N.J.) that would allow Medicare patients to be cared for by a licensed provider from any state.

“Instead of the fractured and archaic system of licensure laws that characterizes our current system, Congress should enact H.R. 3077, the bipartisan Tele-MED Act,” said White. “This bill would allow Medicare providers to treat their Medicare patients across state lines, via telehealth, without having to obtain a separate license in the other state.”

Jones believes that ultimately the issue of licensure “will need to be addressed if we are to allow telehealth to reach the potential of balancing provider supply and patient demand–as these two variables do not particularly pay attention to state boundaries.”

The subcommittee is seeking input and feedback on expanding access to telehealth, which should be sent to: telemedicineideas2014@mail.house.gov. The deadline for submissions is June 16.

“Telemedicine holds great promise and I am eager to gain further input from stakeholders and the public about how we can encourage and support this innovative approach to improving healthcare,” said Pallone.


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