Clarity Over Health Care Reform Boosts Telehealth Prospects

Accountable care organizations and the Center for Medicare and Medicaid Innovation are driving growth in telemedicine.

The Supreme Court’s decision upholding the constitutionality of the Affordable Care Act brings an added level of certainty to health care reform that should foster growth in the telehealth industry, American Telemedicine Association officials said during a July 17 video conference.

“Certainly the Supreme Court decision was important for telehealth,” said Gary Capistrant, ATA senior director for public policy. “It cleared up the uncertainty about delivery reform so payers, providers and others can more assuredly move forward with capital investments and changes to their workforce ... that will provide value and the kind of restructuring of the health care system that’s necessary.”

Innovation Center Holds Promise

Capistrant also credited the Center for Medicare and Medicaid Innovation, created under health care reform, with providing funding opportunities for telehealth initiatives. (See (Also see "CMS Innovation Center Aims To Promote Sustainable Change In Care Delivery" - Medtech Insight, 14 Mar, 2011.).)

ATA Agenda Items

The American Telemedicine Association outlined its policy and business strategies for the coming months, including work to:

• Update practice guidelines across multiple areas of telemedicine.
• Partner with other groups to help introduce telemedicine-friendly legislation in all states.
• Support federal legislation on telemedicine licensure.
• Address regulatory issues related to Internet prescribing.
• Encourage advances in reimbursement for telemedicine services.
• Work with accountable care organizations to help break down the silos in telemedicine practice.
• Urge the Federal Communications Commission to finalize rules for its rural health program.
• Launch a telemedicine consumer awareness campaign.

The Innovation Center, which has a budget of $10 billion to spend over the 10-year life of the program, has already awarded some of its funds to telemedicine-related projects. (See (Also see "Digital Health In Brief" - Medtech Insight, 14 May, 2012.).)

“We’re going to see a lot more of those kinds of funding opportunities coming forward,” Capistrant assured those who did not make the cut the first time around. He urged potential applicants to take their ideas for health care delivery reform and “make them even bigger, particularly around the area of payment innovation.”

He cited an Innovation Center funding program called Strong Start, which deals with prenatal care for high-risk pregnancies, as an area where telemedicine could make a contribution. The center is taking applications for the awards through Aug. 9.

“One of the things in trying to improve applications for [Innovation Center funding] is to think about where the holes are in what they’ve funded [and] to do something different,” Capistrant said. He suggested providers interested in telemedicine work together to create larger networks, such as a nationwide children’s hospital network, for example.

Capistrant noted that the center has not yet funded anything around tele-rehabilitation, suggesting there could be funding opportunities for both traditional telemedicine-supported rehab services and innovative programs using such tools as the Microsoft Kinect video game system, for example.

Payment Progress

In recent weeks, CMS has proposed new codes for telemedicine Medicare reimbursement. (See (Also see "Digital Health In Brief" - Medtech Insight, 16 Jul, 2012.).) The proposal seems to have come as a surprise to ATA.

“We knew that telemedicine has come to the fore,” said Jonathan Linkous, ATA CEO. “I didn’t realize that CMS was going to actually step forward and do some things that we haven’t even asked for.”

Reimbursement will continue to be a priority for ATA, Linkous told members last week, but he added that some providers are starting to make telehealth equipment purchasing decisions regardless of reimbursement factors “because there are larger forces afoot.”

With the move to accountable care organizations or other payment models where providers are penalized for too many hospital readmissions, for example, there will be more incentives for hospitals to use telemedicine, mHealth and other remote monitoring technologies, Linkous suggested.

“The decisions for [provider] involvement in telemedicine are now coming out of the C-suite,” Linkous noted. “There used to be, and there still is a lot of times, a clinical champion, which is really important for telemedicine. But in many cases, I’m seeing people talk about how the biggest champion for telemedicine in their institution or within the health system is the CEO and the CFO and the Chief Innovation Officer.”

Linkous explained that health system executives are finding telemedicine use critical to their efforts to expand their market areas. And with systems growing larger with the purchase of community centers and nursing homes, he said, “there need to be ways to pull it together clinically so that they can operate as one system that’s seamless from one side to the other.”

Providers joining the Medicare Shared Savings Program as accountable care organizations may be particularly receptive to the benefits of telemedicine. (See (Also see "CMS Touts Growth Of Accountable Care Organization Program" - Medtech Insight, 16 Jul, 2012.).)

Officials with Cincinnati-based Mercy Health Select said the ACO is considering using telemedicine to help with patient follow-up and prevent hospital readmissions.

“The key thing would be that any devices, any medical equipment that can help enable a network to take better care of the patients and provide more value, that’s what’s going to resonate with an ACO,” Paul Hiltz, president of Mercy Health Select, told “The Gray Sheet.”

“Our experience so far is that the vendors in many parts of the health care community are just now starting to understand what ACOs are and how they operate,” Hiltz added.

Other National Priorities

ATA officials were encouraged by the introduction July 12 of a bill to improve the ability of health care professionals to treat veterans using telemedicine. Introduced by Rep. Charles Rangel, D-N.Y., the Veterans E-Health & Telemedicine Support Act of 2012 (H.R. 6107) would allow Veterans Affairs Department health care professionals to provide services using telemedicine regardless of the state in which they are licensed.

“This importantly creates a model for the federal government,” Capistrant said. “It can be applied to other federal agencies, other federal health programs, other federally funded sites.”

Last month, the National Organization of Black Elected Women ratified a resolution calling on Congress to reform telehealth licensure regulations to enable health care providers to “make their expertise available across state boundaries.”

In relation to other federal policy, Linkous raised concerns that the Federal Communications Commission has “largely ignored rural America” when it comes to its recent health care policies. Nearly two years ago, it released a proposed rule on its rural health program, but has yet to finalize it. Linkous suggested the program must be completely revamped.

And Linkous said wording in FCC’s National Broadband Plan calling for extending broadband deployment to all rural communities in the U.S. does not go far enough.

“What you need is broadband out to every person, not to every community, and not to every home,” he said. “We’ve gone beyond that in the past couple of years. The FCC has to catch up.”

Broadband wireless throughout the 50 states is necessary, he added, due to the rapid pace of mobile health applications introduced to the marketplace.

“It’s just really important that we don’t have a two-tiered system for people who can access [the broadband apps] and people who can’t.”

[Editor’s note: This story was contributed by “The Gray Sheet,” your source for in-depth coverage of the medical device and diagnostics industry. For more information call 1-800-332-2181. To register for a free trial, click here/ – no credit card needed.]