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Waters: Telemedicine Boosts Access to Needed Care

A serious car accident left 16-year-old Kim Wolf in a semi-conscious state — unable to speak or even sit up. Kim is from a small town in North Dakota where the closest hospital with the specialty medical treatment she required was more than 100 miles from her home. However, Kim was fortunate; she did not have to travel long distances to receive the care she needed because the hospital in her hometown utilizes telehealth technology.

Telehealth, also known as telemedicine, is a way to provide health care, health information and health education services to patients by using the Internet and specially adapted equipment. Through the use of telemedicine, Kim was able to receive treatment from specialized physicians, from the convenience of her hometown hospital in Ashley, N.D. This care saved Kim’s life, getting her out of the hospital and back to school.

There are many stories similar to Kim’s, where physicians and medical specialists employ telehealth technologies to deliver care to those who ordinarily would not have access to such services. In addition to expanding the health care delivery net, telehealth also prevents delays in treatment, improves patient access to specialists and mental health physicians, improves quality of care and facilitates communication among providers — all while saving our health care system money.

Telemedicine is an important component of the future of health care reform and is the answer to many problems facing our health care system, such as cost and access to care.

As Congress and the administration work to make health care accessible to all Americans, telehealth must be part of this dialogue.

Given the benefits of telemedicine, many people may wonder why more hospitals and physicians are not utilizing these services. There are major barriers facing health care providers.

First, there is a lack of consistent and comprehensive reimbursement policy for telehealth services. Initially, to address reimbursement issues relating to telemedicine, Congress passed provisions within the Balanced Budget Act of 1997 that mandated Medicare reimbursements for telehealth services and funded telehealth demonstration projects.

Three years later, Congress expanded Medicare reimbursement policy through the Benefits Improvements and Protection Act. Unfortunately, BIPA still limited reimbursement for telehealth services to certain geographic areas and specific types of originating sites. While 27 states provide Medicaid reimbursement for telehealth services, many states still do not have comprehensive Medicaid reimbursement policies covering telehealth.

Providers wanting Medicare payment must also contend with the Centers for Medicare & Medicaid Services, which has adopted a conservative approach to “credentialing— telehealth physicians. The CMS position is inconsistent with the standards of the Joint Commission — a private entity that reviews credentials of hospital physicians — for institutional credentialing of telehealth providers. As a result, telehealth providers may be forced to be credentialed at hundreds of hospitals in anticipation that they might be called on to care for patients. This position is creating an insurmountable administrative challenge and financial burden for both hospitals and providers.

To address these issues, Rep. Mike Thompson (D-Calif.) along with Reps. Bart Stupak (D-Mich.), Lee Terry (R-Neb.) and Sam Johnson (R-Texas) have introduced the Medicare Telehealth Enhancement Act (H.R. 2068). This legislation would expand Medicare reimbursement to urban and suburban areas, include funding for additional telehealth facilities and allow for the monitoring of patients remotely. It would also:

• Eliminate the rural/urban designation for telehealth services;

• expand the use of store and forward images;

• enhance participation for home health and remote monitoring programs;

• establish a CMS Telehealth Advisory Committee; and

• address the Joint Commission/CMS credentialing issues.

This legislation is considered to be the most comprehensive and expansive telemedicine bill introduced this session of Congress. Thompson and Stupak have shared with the telehealth community that they, along with their Republican co-sponsors, are willing to work very hard to push for the inclusion of the provisions of this bill into the overall health care reform package.

Passage of this bill would ensure that Americans, like Kim, living in rural and underserved areas have access to quality health care services. The United States is in an unprecedented time of health care reform. Our country, through the use of telehealth technologies, can help make health care available to all people, regardless of age, race and geographical boundaries.

Robert J. Waters is a nationally recognized expert in telehealth policy and partner in the Health Law Department and chairman of the Government and Regulatory Affairs Practice Group at Drinker Biddle & Reath.

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