Uncategorized Archives · mTelehealth

Medicare Must Embrace Telehealth, Reduce Barriers to Care

Dr. M Telehealth — Mon, 21 Sep 2015 16:13:02 +0000

Labeling telehealth as “increasingly vital” to the healthcare delivery system, the American Hospital Association (AHA) urged the Committee on Energy and Commerce to reduce Medicare’s financial and technological barriers to remote care. The letter, addressed to Chairman Fred Upton,follows a report on the growing promise of telehealth to address care disparities, reduce costs, and ease packed calendars for physicians who can easily diagnose and treat certain low-level conditions without the need to see a patient face-to-face.

“Despite recent expansions in covered services, Medicare is behind the private sector and many state Medicaid programs in promoting telehealth,” writes AHA Executive Vice President Rick Pollack. While many states have established parity laws that require Medicaid to cover telehealth services in the same way as private payers do, Medicare has not embraced video and telephone consults in the same way. “Medicare Advantage plans are beginning to provide telehealth benefits that are not covered under Medicare fee-for-service (FFS) rules, leaving the 70 percent of those utilizing FFS with limited access to these technological advances,” Pollack points out.

The expansion of telehealth faces several distinct obstacles, including geographic restrictions that dictate where a patient must be located in order to qualify for telehealth care. Currently, patients must live in a qualified rural Health Professional Shortage Area, which ignores the needs of urban populations that make up the majority of Medicare beneficiaries. In 2013, patients in 97 counties lost access to Medicare’s telehealth services when their areas were redefined as “metropolitan” instead of rural.

“We know that urban areas (particularly inner cities) can also suffer physician shortages, and access to certain specialties (such as psychiatry) can be limited in all geographic areas,” Pollack says. “Further, the almost ubiquitous use of communications technology in American life today has created growing consumer expectations that, where safe and appropriate, health care services also can be accessed remotely, regardless of where the individual is located.”

Medicare also narrowly defines what technologies and services will be covered for reimbursement. It will not pay for store-and-forward technology, nor will it provide reimbursement for many common treatment options. “In 2015, only 75 individual service codes out of more than 10,000 physician services covered through the Medicare physician fee schedule are approved for payment when delivered via telehealth. This constrained list stands in stark contrast to the private payers operating in telehealth parity states,” the letter says.

A discussion draft outlining potential ways to improve Medicare’s telehealth structure does not go far enough in reducing these obstacles, the AHA says. The draft proposes that Medicare expand its telehealth services only if doing so would not add costs to the system, which may not take into account future savings generated by better primary care and sustained patient engagement with the healthcare system. The draft does not address the technology limitations inherent in the current rule structure, and may not be able to adapt and evolve as quickly as the technology is currently doing.

The American Telemedicine Association has also weighed in on the draft, and sees similar problems with the cost containment strategy. “We understand the present political requirement that proposals must not cause a net increase to Medicare spending and do not object to the inclusion of some form of it,” writes ATA CEO Jonathan Linkous. “However, we are concerned that the no spending increase test and process of certifying could be too rigorous to ever be conclusive and result in an endless economic debate and no action.”

“You might also consider alternative means, such as to create a role for Congress’s Medicare Payment Advisory Commission in certifying that any use of telehealth generates no additional costs or offsetting savings,” Linkous adds.

“In conclusion, the AHA strongly agrees with your goal of expanding coverage of telehealth services in Medicare, and appreciates the specification of a mechanism for doing so,” Pollack said. “However, given the growing body of evidence that telehealth increases quality, improves patient satisfaction and reduces costs, we believe a more global approach to expanding Medicare coverage of telehealth is warranted.”

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New York Passes Telemedicine Reimbursement Legislation

Dr. M Telehealth — Mon, 21 Sep 2015 16:12:23 +0000

New York became the 22^nd state to sign into law legislation that will require commercial and Medicaid plans to provide coverage of telehealth and telemedicine services. The law, originally intended to take effect on January 1, 2015, will become effective on January 1, 2016.

In addition to providing definitions for telemedicine (two-way audio video communications, including video conferencing) and telehealth (telephone and remote patient monitoring), the new law defines the scope of eligible distant site providers to include not just physicians, physician assistants, and hospitals, but also dentists, home care and hospice agencies, nurses, midwives, podiatrists, optometrists, ophthalmic dispensers, psychologists, social workers, and speech language pathologists and audiologists.

Although the law does not place any restrictions on the site at which a patient is located at the time telemedicine or telehealth services are provided, it permits insurers to delineate appropriate settings for such services.

In order for telemedicine services to be covered the services must meet the requirements of federal law, rules and regulations for Medicare, except with respect to originating site restriction requirements. Telehealth services will be covered if they are consistent with the conditions set forth in Section 3614(3-c) of the Public Health Law, which governs home telehealth services.

Finally, the law adds telemedicine and telehealth as a covered Medicaid benefit, and expressly precludes the Commissioner of Health from eliminating Medicaid payment for such services, subject to the approval of the Budget Director.

Although the new law casts a wide net with respect to the definition of eligible providers, it will be interesting to see how insurers reconcile this with Medicare’s more restrictive scope, since many of the telemedicine services covered under the New York law, including dental, podiatric, optometry and home health services, are not covered under Medicare. In the meantime, the governor has already agreed to chapter amendmentswhich will be introduced to address, among other things, the scope of telehealth services and certain limitations on telehealth coverage.

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Telehealth/ Telemedicine: An Opportunity for Physicians and Providers to Add a New Line of Service

Dr. M Telehealth — Mon, 21 Sep 2015 16:11:32 +0000

Here’s an excellent article keeping us up to date on Telehealth:

Article By:

Lisa English Hinkle

The cost effectiveness of providing health care via telemedicine or telehealth promises to be an effective tool to increase coverage and reimbursement of healthcare provided remotely or through telehealth. Towers Watson, a national consulting company, recently published a 2014 study that suggests that telemedicine could save $6 billion annually for the health care industry. “Achieving this savings requires a shift in patient and physician mindsets, health plan willingness to integrate and reimburse such services, and regulatory support in all states,” according to Dr. Allan Khoury, a senior consultant at Towers Watson.^[1] Recent studies have assigned significant cost savings generated by telehealth use that include cost savings of $537 million per year for emergency departments using telehealth to reduce transfers and spending reductions of 7.7% to 13.3% per person per quarter in the cost of care for chronically ill Medicare beneficiaries using a health buddy via telehealth.^[2] As the cost effectiveness of providing services via telehealth and telemedicine is proven, Medicare, most state Medicaid programs and commercial insurers are increasing coverage as well as reimbursement for telehealth services. State law requirements for providing telehealth and coverage differ greatly. Consequently, physicians and health care providers should be aware of the complexity of providing telehealth and its requirements, but should also incorporate telehealth services into their practices as a new way of providing services and a new line of business.

Simply defining telemedicine can be tricky, as there is no single definition. CMS defines “telemedicine” as the “provision of clinical services to patients by practitioners from a distance via electronic communications.”^[3]The American Telemedicine Association (“ATA”), a nonprofit organization dedicated to integrating telemedicine into health care systems, defines it as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.”^[4]

In April 2014, the Federation of State Medical Boards (“FSMB”) adopted a model telemedicine policy and defined “telemedicine” as “the practice of medicine using electronic communications, information technology or other means between a licensee in one location, and a patient in another location with or without an intervening healthcare provider.”^[5] On the heels of the FSMB policy, the American Medical Association (“AMA”) approved “guiding principles” regarding telemedicine in June, but offered no single definition. The AMA report instead addresses telemedicine within three broad categories of telemedicine technologies: store-and-forward telemedicine, remote monitoring telemedicine, and real-time interactive telemedicine services.^[6]

At the state level, Kentucky’s Medical Practice Act^[7] defines telehealth as “the use of interactive audio, video, or other electronic media to deliver health care. It includes the use of electronic media for diagnosis, consultation, treatment, transfer of medical data and medical education.” Telehealth is often used as a synonym for telemedicine, but precise definitions, as evident from above, may differ.^[8] Importantly, the Kentucky Board of Medical Licensure (“KBML”) has recently adopted a very helpful policy that accepts the FSMB’s model policy as the accepted and prevailing standard of practice for use of telehealth tools when practicing medicine. In a detailed opinion, the KBML recognizes that a patient/physician relationship via telehealth can be established with the informed consent of the patient, but includes complicated requirements for establishing the patient/physician relationship, obtaining informed consent, providing examination and treatment services, keeping medical records, maintaining patient privacy and prescribing. While recognizing prescribing via telemedicine to be at the professional discretion of the physician, the KBML emphatically points out that all requirements for prescribing whether in person or via telemedicine must be met and physicians will be held to the same standards for in-person prescribing when prescribing via telemedicine. While the opinion does not rule out prescribing controlled substances via telemedicine, all statutory and regulatory requirements must be met. The KBML’s policy specifically states that using an on-line tool alone is not sufficient for prescribing. Thus, Kentucky physicians have guidance from the KBML about telemedicine, but still must address issues like prescribing thoughtfully and carefully as there is no specific recipe for compliance with Kentucky’s prescribing requirements via telemedicine.

It is also interesting and important to note what telemedicine may not be. According to CMS, telemedicine does not include phone calls, emails, images transmitted via fax, and text messages without the visualization of the patient.^[9] On the other hand, the ATA has interpreted telemedicine to include transmission of an evaluative or therapeutic act through any means, method, device, or instrumentality, including emails and phone calls.

Contrary to its definition of what telemedicine is not, CMS has announced an important new benefit that will pay a monthly fee to physicians, nurse practitioners, physician assistants and others to manage the care of patients with two or more chronic conditions starting in January 2015 without face to face communication. Significantly, this new benefit will cover case/care management services for patients with chronic diseases without visualization of patients. To be provided efficiently, these services will require communication via telephone, secure messaging and email. Use of these telehealth tools, however, does not mean that CMS considers the services to be telehealth; consequently, these services do not have to meet Medicare’s telehealth regulatory requirements even though the services meet the ATA’s definition of telemedicine.

Medicare and Medicaid

After a long period of indecision, Medicare announced final requirements for telehealth services in July 2014. To qualify for Medicare reimbursement of telehealth services, a beneficiary must be located in an area outside a metropolitan statistical area or in rural health professional shortage area (“HPSA”). In addition, Medicare “ will only pay for a face to face, interactive consultation service where the patient is present in an approved healthcare facility (hospitals, rural health clinics, skilled nursing facilities, physician offices and community mental health centers), known as an “originating site.” As a condition of payment, an interactive audio and video telecommunications system must be used that permits real-time communication between the provider at the distant site and the beneficiary at the originating site.

Professionals who may receive payment for covered Medicare services include physicians, physician assistants, nurse practitioners, nurse-midwives, clinical nurse specialists, clinical psychologists and clinical social workers, and dieticians or nutrition professionals. In July 2014, CMS released its CY 2015 Physician Fee Schedule which expands Medicare-reimbursable telehealth services to include remote medical services, psychological testing, psychotherapy, prolonged office visits, annual wellness check-ups and non-face-to-face chronic care management as well as psychiatric and behavioral health services. These are welcome changes and cover key areas that have, to date, not been reimbursable. Under the final rule, CMS added codes for psychoanalysis and family psychotherapy as well as codes that will allow mental health providers to report sessions that require more than the one hour visit. In addition, codes for the new management of chronic illness have been issued.

In July of 2013, Kentucky Medicaid issued final rules expanding the coverage of telemedicine services for Medicaid beneficiaries. Although providers are still limited to using only interactive video-conferencing to qualify for reimbursement under Kentucky’s new rules, Medicaid beneficiaries now have access to a broader list of providers and telemedicine services. It is important to note that Kentucky has statutory requirements that include approval of equipment by its telehealth network. Providers have reason to be hopeful about future policy changes that will expand Medicare and Medicaid payment for services provided through telemedicine

While expansion of commercial coverage of telemedicine often depends on whether state law requires parity vis a vis other services, insurers are expanding telehealth coverage to reduce unnecessary costs including urgent care and emergency department visits. Quite simply, attractive cost savings will drive commercial insurers and employers to cover and provide more services via telemedicine. Insurers already often encourage members to access contracted providers to address questions via telephone or email. The expansion of these services to include evaluation and treatment appears logical. The same critical analysis must be undertaken by providers, insurers and managed care organizations alike to determine whether services may be provided under state law through telehealth as well as the requirements for how those services should be performed via telehealth. Issues to keep in mind include state laws addressing telehealth/telemedicine, requirements for equipment, state professional licensure laws and guidance, prescribing laws, location of the patient, privacy, security and confidentiality of medical records as well as other miscellaneous concerns.

Widespread adoption and use of telemedicine is inevitable; so, too, is the potential for noncompliance and a minefield of problems. The requirements outlined just a few of the issues that providers must keep in mind as they establish innovative and exciting telehealth services. Telehealth services are the way of the future and will change the how health care is provided. Providers who incorporate telehealth as a new line of service may have tremendous opportunities to increase reimbursement.

^[1]_{Katie Wike, “Telemedicine Could Save $6 Billion Per Year” Health IT Outcomes (August 15, 2014)}

^[2] _{Laurence Baker Integrated Telehealth and Care Management Program for Medicare Beneficiaries with Chronic Disease Linked to savings, Health Affairs, September 2011.}

^[3]_{76 Fed. Reg. 25553 (May 5, 2011).}

^[4]_{ATA, What Is Telemedicine?, available at http://www.americantelemed.org/learn/what-is-telemedicine.}

^[5]_{Federation of State Med. Bds., “Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine (2014),” available at http://www.fsmb.org/pdf/FSMB_Telemedicine_Policy.pdf.}

^[6]_{AMA, Report of the Council on Medical Service, Coverage of and Payment for Telemedicine, June 2014.}

^[7]_{KRS 311.550(17).}

^[8]_{See The Joint Commission, Hospital Accreditation Standards, Glossary (Oakbrook Terrace, IL 2013).}

^[9]_{42 C.F.R. 410.78(a)(1),(3).}

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House Bill Would Allow ACOs To Expand Use of Telehealth Services

Dr. M Telehealth — Mon, 21 Sep 2015 16:10:04 +0000

As the government continues to add Bills supporting Telehealth, we must wonder WHEN they will start passing those Bills:

Written by Helen Gregg (Twitter | Google+) | September 24, 2014

A new bill that aims to provide additional incentives for accountable care organization successes includes several provisions that would allow ACOs to expand their telemedicine efforts.

Under the bill, ACOs would not be limited by many originating care site restrictions and would be permitted to use store-and-forward telemedicine. The bill would also permit ACOs to engage in remote patient monitoring to better track high-risk patients.

The bill’s sponsors, Diane Black (R-Tenn.) and Peter Welch (D-Vt.) hope the bill will encourage ACOs and help facilitate the transition to value-based reimbursement. “It is unfortunate that the current fee-for-service payment system does little to encourage and incentivize providers and patients to use the most appropriate and effective healthcare options,” said Rep. Black. “By incentivizing providers to focus on improving healthcare outcomes instead of increasing the quantity of services provided, this legislation will help improve care coordination, increase efficiency and mostly importantly, ensure the patient receives the best care possible.”

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Telemedicine Beneficial in Management of Chronic Diseases, Lowering Costs

Dr. M Telehealth — Mon, 21 Sep 2015 16:09:17 +0000

The PROOF continues…….

September 11, 2014 | By Katie Dvorak
There are many uses for telemedicine to manage chronic diseases, and no matter the process, the technology offers beneficial results and costs reductions, according to a recent study.

The study, published online in the journal Telemedicine and e-Health, looks at the impact telemedicine has on cost, quality and access to care, focusing three chronic diseases: congestive heart failure, stroke and obstructive pulmonary disease.

The authors, which include former American Telemedicine Association President Rashid Bashshur (pictured)–executive director of eHealth at the University of Michigan Health System–found that for each chronic disease, a different telehealth approach was needed.

Congestive heart failure: Long-term telemonitoring support is the most efficient and effective model for disease management
Stroke: Telestroke has the most impact–prompt interventions aimed at optimal treatment. According to a 10-year evaluation, telestroke units helped increase the number of rural patients treated and deliver treatment faster over 10 years
CPOD: Telepulmonology is the best treatment, using remote measurement of lung function through telespirometry and teleconsultations between care providers, pulmonary specialists

Because of the different types of telemedicine used for each chronic disease, the study’s authors said a “homogeneous telemedicine landscape now or in the future is beyond reasonable expectation.”

However, the authors said telemedicine shows many benefits in the care of chronic diseases. There were reductions in services, with re-admissions and length of hospital stay declining, and “there often were reductions in mortality,” they said.

The use of telemedicine also allows patients to be more engaged in managing their own health, according to the authors.

To that end, most patients are embracing the use of video appointments and care through telemedicine, according to a recent study also published in Telemedicine and e-Health.

In addition, costs are also reduced because of avoidance of unnecessary services, the authors said. Recent analysis from Towers Watson found telemedicine could save U.S. companies hundreds of millions, if not billions, of dollars in costs.

To learn more:
– check out the study (.pdf)

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Medicare Telehealth Parity Act of 2014

Dr. M Telehealth — Mon, 21 Sep 2015 16:08:07 +0000

August 07, 2014 | Eric Wicklund – Editor, mHealthNews

A new Congressional effort seeks to expand telemedicine by allowing Medicare reimbursement for more treatments – and more people.

The Medicare Telehealth Parity Act of 2014 was introduced in July by U.S. Reps. Mike Thompson (D-CA.) and Gregg Harper (R-MS). If passed into law, the expansion of telehealth services would come in three phases over four years, beginning in counties with populations of less than 50,000 and extending in time to larger counties.

As proposed, the bill would expand the use of Medicare-reimbursed video conferencing and store-and-forward technologies in rural health clinics and health centers. The use of remote patient monitoring for diabetes, congestive heart failure and chronic obstructive pulmonary disease would be included, as well as video conferencing for home health services and agencies, durable medical equipment, home dialysis and hospice services.

In addition, the bill would expand services covered under Medicare to those provided by physical therapists, certified diabetes educators, speech language therapists, audiologists, respiratory therapists and occupational therapists.

The bill has received support from the American Telemedicine Association and the Telecommunications Industry Association. It has been referred to the House Energy and Commerce Committee and the House Committee on Ways and Means.

“We fully support this effort to improve healthcare access and affordability using telecommunications technology,” Jonathan Linkous, the ATA’s chief executive officer, said in a press release. “These cost-saving provisions are critical to improve telehealth coverage and extend care to millions of Americans.”

The bill’s focus on physical therapy services drew support from the American Physical Therapy Association (APTA), which this year passed a resolution supporting the adoption of telehealth in PT as “an appropriate model of service delivery” when provided in ways that meet association standards and guidelines.

“Although Medicare currently allows some telehealth delivery, the system limits reimbursable use to rural areas, and requires beneficiaries to travel to ‘originating sites,’ with no provisions for remote patient monitoring,” the APTA wrote in an Aug. 1 analysis. “The proposed bill would use a phased-in approach to remove those population-based limits and allow the addition of remote patient monitoring for specific conditions. The bill also requires the General Accountability Office to study the use of remote patient monitoring for outpatient therapy.”

The bill’s sponsors said this action would put “telehealth services under Medicare on the path toward parity with in-person healthcare visits.”

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CMS to Begin to Pay for Remote Patient Monitoring in 2015

Dr. M Telehealth — Mon, 21 Sep 2015 16:07:20 +0000

It’s about time and the way that CMS is going to pay for Remote Patient Monitoring is, essentially, like this…..

Services to be covered when provided by telehealth:

Chronic Care Management

———————————

CMS is proposing reimbursement criteria for non-face-to-face chronic care management (CCM) services, defined as a unique, covered service designed to pay separately for non-face-to-face care coordination services furnished to Medicare beneficiaries with two or more chronic conditions. CMS discussed this new policy in 2013 but did not include a specific reimbursement proposal.

The specific code for this service (tentatively called GXXXI) is defined as:

“Chronic care management services furnished to patients with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; 20 minutes or more; per 30 days”

A payment rate of $41.92 could be billed no more frequently than once per month per qualified patient.

Eligible CCM services MUST be furnished with the use of an electronic health record or other health IT or health information exchange platform which includes an electronic care plan that is accessible to all providers within the practice, including being accessible to those who are furnishing care outside of normal business hours and is available to be shared electronically with care team members outside of the practice.

The mTelehealth Remote Patient Monitoring Solution’s clinical platform meets or exceeds all of the above conditions. Any accounts that have physicians or eligible Part B providers that use the mTelehealth Remote Patient Monitoring Solution platform for chronic care management of patients meeting the criteria listed can bill Medicare $41.92 per user/subscriber on a monthly basis, offsetting the monthly service cost. This is a clear and direct ability for providers to get paid for using our mTelehealth platform.

Since this new code GXXXI is covered when provided by telehealth for non face-to-face management and carries its own set of unique criteria, it is a separately identifiable service from 99339, or 99374 (NOT considered “telehealth” or “telemedicine” by CMS) and can be billed separately for qualifying patients.

Another example of this is examined in the following article:

Neil Versel, Contributor

After July ended with what I called a “big week for telemedicine and telehealth,” August started with at least one telehealth company — maybe more “digital health,” but let’s not split hairs here — getting some national TV coverage to discuss an important development in the field.

Bill Smith, president of ALR Technologies, Richmond, Va., appeared Monday on Fox Business Channel’s “Opening Bell With Maria Bartiromo” (though Sandra Smith was in for Bartiromo that day) to discuss something I left out of my post: Medicare reimbursement for telehealth services. ALR makes devices and offers remote monitoring services for people with diabetes.

The proposed 2015 Medicare physician fee schedule, released in early July, would expand the number and types of services eligible for reimbursement when care is delivered remotely. The Centers for Medicare and Medicaid Services has proposed paying physicians for annual wellness visits, psychoanalysis, psychotherapy and “prolonged evaluation and management services.” The latter, for which CMS would pay physicians $41.92 for each remote consultation involving a Medicare fee-for-service enrollee, means care for people with two or more chronic diseases

This is where ALR comes in, as this video illustrates.

Bill Smith shot down Sandra Smith’s worry that there would be more mistakes made simply because the patient is not physically present in front of the remote physician. “You may cut down on mistakes,” Bill Smith said. “A doctor can remotely see a patient’s blood glucose. A lot of doctors don’t know what’s going on, for example, with a diabetes patient between office visits. With remote technology, you have the potential to actually bring real data to the table.”

ALR pulls data from glucose meters, uploads it to a secure website, where clinical professionals working for the vendor look for trends that could indicate the need for medical intervention. “It’s essentially a system for managing and monitoring chronic care, which is what this rule is about,” he explained.

Playing to its audience of people who invest in the stock market, Fox Business listed a handful of large publicly traded medical device companies that stand to benefit from this proposed rule change, but plenty of the action will be among startups and small companies such as Smith’s. ALR is a penny stock, currently valued at 2.7 cents per share in over-the-counter trading.

Expect the final 2015 physician fee schedule to appear in the fall.

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House Bill Seeks to Phase in Medicare Coverage of Telemedicine, Remote Patient Monitoring

Dr. M Telehealth — Mon, 21 Sep 2015 16:06:18 +0000

Is CMS FINALLY going to cover remote patient monitoring?? We may be one step closer…

By: Jonah Comstock | Jul 23, 2014

Representatives Mike Thompson (D-Calif.) and Glenn Thompson (R-Penn.) are set to announce a new telehealth bill soon. Like some of Mike Thompson’s previous telehealth efforts, the bill seeks to amend the Title XVIII of the Social Security Act, the law that has long limited government-reimbursed telemedicine to rural areas and specific use cases.

As Jonathan Linkous, CEO of the American Telemedicine Association (ATA), has told MobiHealthNews in the past, when the Social Security Act was passed telehealth was in its infancy and legislators, worried about abuse or that telemedicine wouldn’t be cost-effective, limited Medicare and Medicaid coverage to very particular cases. Only patients in rural areas could be reimbursed for any telehealth service that required patient-physician interaction, for instance. Those types of arbitrary restrictions have become increasingly obstructive for telemedicine practitioners over the years.

Previous legislation has attempted a sweeping abolition of those restrictions — Rep. Mike Thompson’s last effort, the The Telehealth Promotion Act of 2012, tried to amend the Social Security Act to assert that telehealth must be covered in any case in which the corresponding in-person treatment would be covered. That bill died in committee.

The current forthcoming bill, called the Medicare Telehealth Parity Act of 2014, is more measured, expanding the reach of Medicare in telehealth slowly over four years and establishing efficacy data requirements along the way.

Currently, telemedicine can be reimbursed only in rural areas — areas that fall outside of a designated metropolitan area. Six months after the passing of the bill, it would require Medicare to cover telemedicine in urban areas with a population of 50,000 people or less, and would also expand the acceptable care sites from hospitals and doctors’ offices to include retail clinics as well. Two years after passing of the bill, coverage would expand to urban areas with a population between 50,000 and 100,000, and would add home telehealth to the acceptable care sites. It would also add outpatient services like speech therapy and physical therapy into the category of reimbursable telehealth services. Finally, four years after the passing of the bill, telemedicine would be reimbursable anywhere, regardless of population.

Much of the bill is concerned with remote patient monitoring, defined in the document as home care specifically for people with chronic conditions. The bill would add a new subsection on remote patient monitoring to the very long portion of the Social Security Act that defines all the possible tools that fall under the legal definition of “medical and other health services” (and are therefore reimbursable under Medicare).

“The term ‘remote patient management services’ means the remote monitoring, evaluation, and management of an individual with a covered chronic health condition …, insofar as such monitoring, evaluation, and management is with respect to such condition, through the utilization of a system of technology that allows a remote interface to collect and transmit clinical data between the individual and the responsible physician … or supplier,” the bill says. It goes on to specifically exclude telemedicine by phone calls or emails alone.

Under the bill, the Secretary of Health and Human Services would be responsible for developing and maintaining a set of standards for remote patient monitoring. In addition, within two years of passing the bill, the United States comptroller would be responsible for running a study to determine the efficacy and potential savings to Medicare from telemedicine, as well as to identify potential further use cases for telemedicine technology.

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Why Remote Monitoring Services are Poised for Explosive Growth

Dr. M Telehealth — Mon, 21 Sep 2015 16:05:25 +0000

It’s only a matter of time………

By Ephraim Schwartz, Contributing Editor

The barriers that stand in the way of full-blown adoption of a modern and mobile remote healthcare system require not only advances in technology but a willingness on the part of the healthcare community to change at an institutional level.

There is a palpable resistance to change in many healthcare organizations and medical practices. At its root is that deep philosophical idea, “don’t rock the boat,” and right after that comes, “if it ain’t broke, don’t fix it.” But healthcare is broken, and it will take a combination of Silicon Valley technology and entrepreneurial spirit, along with a full financial commitment on the part of healthcare providers combined with medical research to fix it. It appears all the above is happening.

Already, 3 million patients are using connected home medical monitoring devices, and that is expected to rise to 10.3 million in the U.S. alone in just three-and-a-half years. The total number of patients using connected home medical monitoring devices will reportedly skyrocket at a compound annual rate of 44.4 percent to 19.1 million worldwide.

These statistics include only patients that are being monitored by a professional caregiver, not personal health tracking applications, according to a 2013 mHealth and Home Monitoring Study from Berg Insight, a Swedish research firm that specializes in connected healthcare.

Implantable cardiac rhythm management (CRM) accounts for two-thirds of all patient users, followed by sleep therapy, with the still-nascent telehealth model taking a surprising third-place finish. Telehealth use, in fact, is far more robust in the U.S than in Europe at the end of 2013.

The main driver in the states behind the rapid growth in telehealth and for most remotely connected medical monitors is the higher per-capita cost of healthcare. In the U.S., spending on healthcare was $8,900 per capita in 2012, while spending in the European Union (EU) that same year was $3,500. As a result, savings as a percentage of expenditures when using mobile solutions is far higher in the states than in the EU, according to Lars Kurkinen, a senior analyst with Berg Insight.

What may come as a shock to many in the healthcare industry is the fact that the majority – 70 percent – of remote monitoring in the U.S. and worldwide is still done over POTS (plain old telephone service) voice grade analog systems, PSTN (public switched telephone network) and LANs (local area networks). But that is changing at a dramatic pace.

“The trend toward cellular will further be advanced by the forthcoming digitalization of PSTN networks, which will imply that analog PSTN modems will no longer work reliably,” Kurkinen said. Cellular is now the standard for new medical devices, and Berg Insight estimates that 74 percent of all connections will be cellular by 2018, accounting for 14.1 million total connections, but that is still practically a grain of sand on the beach compared to the total population of the world.

Cellular is also the chief enabler of BYOD (bring your own device). Although cellular smartphones and tablets account for only 1 percent of all healthcare connections today, with 1.7 billion cellular users worldwide, cellular availability is much more prevalent. Cellular is a huge market that will entice add-on manufacturers to create hundreds if not thousands of unique medical diagnosis and monitoring devices to attach to these cost-efficient mobile tools that require no dedicated hardware or subscriptions.

Study after study indicates that when compared to traditional solutions remote monitoring produces better patient outcomes and reduces readmissions to hospitals. The icing on the cake? Patient satisfaction when using remote mobile solutions is at a much higher level than when traditional in-hospital healthcare services are served up.

On the demand side, in the U.S. at least, the impact of the slow but steady march away from fee-for-service to pay-for-performance is an added incentive to healthcare over mobile devices. In the U.S., Kurkinen noted, one can see this in the large number of RFPs for telehealth solutions being issued by hospitals.

“This is specifically related to hospital readmission reduction programs in the U.S. There is a shift in the market where many home care agencies are scaling back their programs or shutting them down. These programs are being replaced by much larger hospital-based programs that will begin to scale in late 2014 and 2015,” Kurkinen noted.

On the supply side, medical device and pharma are using wireless connectivity to enable new services and bolster older services by deploying connectivity to existing devices – such as Merck’s electronic auto-injection RebiSmart, for delivery of its MS drug Rebif.

There is one roadblock that could, in theory, eventually limit the use of these BYOD devices as well as the potential market size for add-on device manufacturers. That roadblock is a lack of interoperability between medical monitoring devices, smartphones and tablets. The issue is being addressed by companies including Qualcomm Life and Apple with its HealthKit. These offerings enable software developers to let another company take care of the connectivity part, making sure that measurement data is collected from medical devices and can be transmitted to caregivers.

Expect connectivity platforms to become the “key enabler” for the exponential growth in mHealthcare software solutions, Kurkinen said.

No crystal ball is required to see mHealth’s future: As the market grows, many more of the major enterprise software companies like Oracle and its chief rival SAP, as well as players such as EMC, Microsof and Salesforce.com, will offer their own connectivity platform solutions. And when they do, the entire healthcare community, from payers to healthcare providers to patients, will be the beneficiaries.

Ephraim Schwartz is a freelance writer based in Burlington, Vt. He is a recognized mobile expert and columnist, having spent 15 years as Editor-at-Large for InfoWorld, half of them covering the mobile space. Prior to that he was Editor-in-Chief of Laptop Magazine.

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Groups Urge Feds to Reimburse ACOs for Telehealth

Dr. M Telehealth — Mon, 21 Sep 2015 16:04:27 +0000

…… Eventually someone in government will listen…….

June 9, 2014 | By Dan Bowman

Saying they want to improve care coordination, several organizations are calling on the federal government to reimburse accountable care organizations for the use of telehealth and remote patient monitoring technologies.

In three letters sent today to incoming U.S. Department of Health and Human Services Secretary Sylvia Mathews Burwell, the groups–which include the Alliance for Connected Care, the American Telemedicine Association, the Healthcare Information and Management Systems Society and the National Association of ACOs–request that a forthcoming notice of proposed rulemaking include coverage for ACOs.

Each of the letters outlines what the groups call “burdensome restrictions” on participants of the Medicare Shared Savings Program under section 1834(m) of the Social Security Act; the rule provides Medicare reimbursement for connected care on a limited basis, which they say disincentivizes its use.

“For ACOs, the existing statutory and regulatory frameworks hinder their ability to better manage care and treat their beneficiary population in less costly care settings,” the Alliance for Connected Care says in itsletter. “These barriers are also counter to the Medicare Shared Savings Program’s goal of ACOs having the ability to coordinate care using telehealth, remote patient monitoring and other such enabling technologies.”

In the letter signed by the ATA, HIMSS and 10 other organizations, the groups maintain that policies should “reflect the dynamic and transformative nature” of health information and communications technology, as opposed to “stifling innovation.”

The ATA sent a similar letter in March to then-HHS secretary Kathleen Sebelius.

Likewise, the letter from the National Association of ACOs–signed by executives from provider organizations, including Danville, Pennsylvania-based Geisinger, Phoenix-based Banner Health and the Marshfield (Wisconsin) Clinic–slams the current legislation in place.

“Those of us working with providers who do not receive reimbursement for connected care services are faced with the difficult decision of assuming financial risk by providing the care for free,” the latter letter says. “For many physician-led and smaller ACOs without access to a lot of capital, it is not even an option.”

To learn more:
– here’s the Alliance for Connected Care letter
– read the ATA/HIMSS letter
– check out the National Association of ACOs letter (.pdf)

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