Telemedicine

2018 Telemedicine Benchmark Survey Shows Industry Trends

Posted by Health Law Informer Author on March 20, 2018
Telemedicine / No Comments

doctor typing on laptop telemedicineEach year, REACH Health publishes an industry benchmark survey that provides great insight into what telemedicine industry leaders are thinking.  Its most recently published survey is no different.  The 2018 survey was conducted among healthcare executives, physicians, and other professionals during December 2017 and January 2018.  Survey participants spanned the industry with almost half representing health systems and hospitals. Here are some takeaways from the survey:

  • 70 percent of respondents view telemedicine as a top or high priority.
  • About half are taking an enterprise approach to telemedicine, a significant increase from last year’s survey.
  • A majority of organizations plan to increase or maintain investments in telemedicine.
  • Improving patient outcomes and providing access to rural patients were the two top objectives for telemedicine programs cited by respondents.
  • 60 percent view the designation of a full-time dedicated program manager as a key to success of a telemedicine program.
  • Improved patient satisfaction was the most cited contributor to ROI, consistent with the past few surveys.
  • Facility settings that require more specialized treatment tended to have more mature telemedicine programs. Related to that, certain specialties such as stroke, behavioral health, radiology, and neurology, have more mature telemedicine programs.
  • Integrated audio/video for live engagement was the technology feature considered the most valuable to an organization with over 90 percent of respondents agreeing.

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Telehealth Report Offers Glimpse Into Variety and Complexity of State Telehealth Laws and Policies

Posted by Health Law Informer Author on November 13, 2017
Regulations, Telehealth, Telemedicine / No Comments

In the recently published fall update of the fifth annual edition of its telehealth report, the Center for Connected Health Policy, the federally designated National Telehealth Policy Resource Center, provides a current summary guide to telehealth-related laws, regulations, and policies for all 50 states and the District of Columbia, and tracks a number of telehealth trends. The report offers a revealing glimpse into the scope and complexity of state laws and policies governing telehealth. The authors conclude, however, that despite the fact that state laws and Medicaid policies “differ significantly” certain trends are coming into relief. Here are some highlights of the report:

  • 48 states and the District of Columbia provide reimbursement for live video consults in their Medicaid fee-for service programs.
  • States alternate between the terms “telemedicine” and “telehealth,” and in some states, both terms are explicitly defined in statute or regulation.
  • 15 state Medicaid programs reimburse for store-and-forward services.
  • 21 Medicaid programs reimburse for remote patient monitoring.
  • 36 states and the District of Columbia have laws governing coverage by private payers of telehealth services.
  • In the 2017 legislative session, 44 states introduced over 200 telehealth-related pieces of legislation addressing issues such as reimbursement and the standard of care.
  • 30 jurisdictions have telehealth informed consent requirements (depending on the state, may apply to Medicaid only, certain specialties, or to all telehealth transactions in the state).
  • 22 states are now part of the Federation of State Medical Boards’ Interstate Medical Licensure Compact facilitating multi-state licensure for physicians in those states.
  • 32 states reimburse a transmission fee, facility fee, or both.
  • 9 state medical/osteopathic medical boards issue special licenses/certificates related to telehealth.
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TELEHEALTH PARITY LAWS: THE REAL STORY

Posted by Health Law Informer Author on September 06, 2017
Healthcare, Medicaid, Telehealth, Telemedicine / No Comments

State telehealth parity laws, which generally require private payers (and occasionally Medicaid programs) to cover telehealth services if those services would be covered if provided in-person, have long been trumpeted as a means to increase telehealth acceptance.  The argument is simple: given how the availability of health care services is usually directly tied to whether (and how) payers cover a particular service, laws that require payers to cover telehealth services should drive utilization.  A recently published report, however, questions the impact these laws have on telehealth utilization.

The Center for Connected Health Policy (CCHP), the federally funded national telehealth resource center, conducted a five-month study to analyze state telehealth parity laws and the impact these laws may have on telehealth utilization.  In an interesting twist, the report’s authors also interviewed health plan executives to gain insight into how plans cover and reimburse telehealth services, and the issues preventing greater telehealth utilization.  The report should be required reading for all telehealth stakeholders seeking to understand the telehealth reimbursement landscape.

Here are some key general highlights:

  • As of September 2016, 31 states and the District of Columbia have passed telehealth private payer laws.
  • How a parity law is drafted can determine “the expansiveness of reimbursement and can predict telehealth utilization.”
  • Inclusion/exclusion of certain language may create barriers to telehealth utilization by allowing payers to limit the types of services that may be reimbursed.
  • Only 3 states have laws that explicitly require payment parity (meaning payers in these states have to reimburse for telehealth at the same rate as they pay for in-person services).
  • Live video is the modality most often referenced in the parity statutory definition of telehealth. Approximately 70 percent of state parity laws reference store-and-forward, and about 55 percent include references to remote patient monitoring.
  • Only 4 states and the District of Columbia include a site limitation in their parity laws.
  • Unlike the Medicare program, parity laws usually do not include explicit exclusions regarding types of services, types of providers, and geographic locations.

Payer Interviews

As I mentioned, the report’s authors interviewed commercial plan executives, medical officers, and other plan representatives in six states (CA, MS, MT, OK, TX, and VA), resulting in a compelling look into how commercial payers view telehealth.  For plans not participating in interviews, CCHP conducted research regarding their telehealth policies.  Some points to highlight from the interviews:

  • The majority of selected plans only reimbursed for live video. Some plans provide limited reimbursement for store-and-forward, but only for certain specialties.
  • Remote patient monitoring is not being reimbursed by any of the payers that were part of the study.
  • The majority of interviewees confirmed that their plans reimbursed telehealth services at the same rate as in-person services.

Plan interviewees also noted that, notwithstanding the increase in state parity laws, telehealth utilization is generally low.  Among the reasons provided:

  • Patients are reluctant to use telehealth, although once they try it, many respond positively.
  • Patients have a preference to see physicians and other providers in-person.
  • Providers are reluctant to use telehealth for a number of reasons ranging from lack of training, skepticism regarding telehealth, or concerns that they could lose business by providing telehealth.
  • Lack of education and awareness regarding the availability and efficacy of telehealth.

Medicaid

CCHP also spoke with Medicaid representatives and concluded that private payer laws have little impact on Medicaid telehealth policies unless the laws explicitly include Medicaid.  The Medicaid representatives also noted that providers face significant challenges in implementing telehealth programs, including the cost of equipment and billing issues.

Moving Forward

While the report acknowledges the promise of telehealth, CCHP concludes that many obstacles remain, including what it describes as “a broad misconception that, because telehealth private payer laws are in place in many states around the country, telehealth is achieving its promise of providing the same patient benefit and payment as in-person care.” Specifically, the report warns that parity laws “have been weakened by their lack of clarity and often contain clauses that may negate much of the intent of the legislation.”  The report encourages more careful drafting of laws and a more comprehensive implementation plan.  CCHP concludes by asking policymakers to consider, among other things, the following steps:

  • Using explicit language in private payer laws.
  • Ensuring that payment or reimbursement parity language is included in the language of these laws assuming it is the intent of policymakers to have telehealth reimbursed at the same rate as in-person services.
  • Developing a comprehensive Medicaid telehealth policy.

Conclusion

I believe the report is significant for two reasons.  First, it dispels the notion that the existence of state parity laws alone will drive greater telehealth utilization.  As the report makes clear, some of this is due to poorly drafted laws in some states—but I believe that much of the disconnect between parity laws and telehealth utilization is tied to broader issues regarding telehealth utilization generally. The lack of knowledge and education on the part of consumers regarding telehealth, for example, is as big a stumbling block as any other. Second, it appears that while plans have bought into the benefits of telehealth they are cautious regarding how to drive utilization. The report points out that most plans prefer a slower approach to telehealth expansion and favor using methods such as pilot projects to assess potential expansion.

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Telemedicine Benchmark Study Provides Great Insight

Posted by Health Law Informer Author on May 09, 2017
ACA, Healthcare, Hospital, Telemedicine / No Comments

A recent telemedicine industry benchmark survey published by REACH Health provides great insight into where the industry has been and where it is headed. The survey was conducted among U.S. healthcare executives, physicians, nurses and other professionals. Organizations represented in the survey were diverse and included representatives from organizations with a $1 billion or more in revenue (about a third of respondents), and almost half with revenues under $50 million.

 

In reviewing the survey report, there were some significant takeaways:

  • Telemedicine is evolving from a specialty offering to a mainstream service.
  • More than half of respondents consider telemedicine to be a top or high priority.
  • Patient-oriented objectives—including improving patient outcomes, improving patient convenience, and increasing patient engagement and satisfaction—are the three top objectives for telemedicine programs.
  • There is an emphasis on better leveraging specialists with a large majority of respondents ranking this a top or high priority.
  • Nearly half of hospital and integrated delivery network respondents who began their telemedicine programs/initiatives with a departmental approach are transitioning to an enterprise approach.
  • The maturity of telemedicine programs varies widely among service lines and settings of care. Generally, settings requiring highly specialized treatment continue to be more mature than those requiring generalized treatment.
  • Telemedicine technology, reporting and analytics, as well as in-house physicians are viewed as highly important to the success of a program, whereas outsourced physician coverage services less so.

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Telemedicine Liability – The Real Numbers

Posted by Health Law Informer Author on February 28, 2017
Telemedicine / No Comments

stethoscope keyboard and phoneAmidst all the interesting legal and regulatory issues implicated by telemedicine, one issue less discussed is the potential liability exposure associated with telemedicine. Many critics have argued that the nature of how telemedicine services are provided will naturally lead to increased risk for malpractice. Available data does not support the argument—at least not yet.

While not a lot of data exists, the Physician Insurers Association of America (“PIAA”) published a July 2015 article comparing telephone treatment medical professional liability (“MPL”) claims versus overall MPL claims reflected in the PIAA Data Sharing Project (“DSP”)—a very large database of MPL claims. Here are the numbers:

  • Of the 94,228 total claims in the DSP during the period from 2004-2013, a total of only 196 claims were linked with telephone treatment.
  • Of those 196 reported claims, 56 resulted in some form of claim payment.
  • The total indemnity loss related to telephone treatment was only $17 million, compared to $8 billion for the total of all MPL losses.
  • Telephone treatment claims represented only about 0.21% of all MPL losses.
  • The average indemnity loss was also lower for telephone treatment at $303,691, compared to $328,815 for all MPL claims within the DSP.

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The Critical Role of Telemedicine in the Addiction Crisis

Posted by Health Law Informer Author on February 17, 2017
Telemedicine / No Comments

doctor at laptopTelemedicine is now mainstream. Surprisingly, however, one area in which telemedicine has not been used to its fullest capability is drug addiction treatment. As you are aware, the country is in the midst of an addiction crisis.  The statistics are daunting:

Adding to the woeful statistics are the fairly dismal rates of addiction recovery—assuming that such recovery services are even available. Relapse rates are over 50 percent for certain drugs, and higher for opioid addicts. According to one survey, almost 9 percent of the population needs treatment but only 1 percent actually receives it. The National Institute on Drug Abuse notes that effective substance abuse treatment combines treatment medications with behavioral therapy—and traditional treatment is limited by the availability of treatment professionals who often are not available outside of in-person care settings. Continue reading…

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FSMB and ATA Documents Shed Light on States’ Views on Telemedicine

Posted by Health Law Informer Author on February 16, 2017
Telemedicine / No Comments

stack of official documentsOver the past year, the Federation of State Medical Boards (FSMB) and the American Telemedicine Association (ATA) have published documents regarding telemedicine that shed some new light on how state regulatory bodies view telemedicine. Taken together, the documents are generally cause for optimism underscoring the trend towards greater acceptance of telemedicine—but there are some notes of caution as well. By way of quick background, the FSMB represents 70 state medical and osteopathic boards and helps support member boards around the country. The ATA is the largest telemedicine-focused trade association made up of industry leaders and health care stakeholders.

FSMB Survey

According to a survey report issued in December 2016, telemedicine is currently the most important regulatory topic to state medical boards. The survey was completed by 57 of the 70 medical and osteopathic medical boards in the country. Interestingly, 75 percent of boards chose telemedicine in their survey responses as one of the most important topics “making it the topic impacting the largest number of boards.” Seventy percent chose resources regarding opioid prescription. The five most important issues were:

  • Telemedicine;
  • Opioid prescribing (resources related to);
  • Physician licensure compact;
  • Physician re-entry to practice; and
  • Medical marijuana.

Surprising in these survey results is the degree to which telemedicine continues to be top of mind for state boards despite the slew of state activity that generally facilitates greater use of telemedicine (discussed more below in the ATA Gaps Report section). A reasonable explanation is that despite all the recent progress in law and policy, many state boards continue to be uneasy about telemedicine.  What that ultimately means for the industry will bear watching. Continue reading…

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Will Congress Come Together for Telemedicine?

Posted by Health Law Informer Author on February 05, 2016
Healthcare, Medicare, Telehealth, Telemedicine / No Comments

Consistent with what we have been seeing in our own practice, and consumers’ growing demand for better access to telemedicine services, a bi-partisan movement is growing in both houses of Congress to expand telehealth services, improve health outcomes, and reduce healthcare costs. On Wednesday February 5, 2016, U.S. Senators Brian Schatz (D-Hawaii), Roger Wicker (R-Miss.), Thad Cochran (R-Miss.), Ben Cardin (D-Md.), John Thune (R-S.D.), and Mark Warner (D-Va.) introduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (s. 2484), which seeks to overhaul Medicare’s treatment of the practice of telemedicine and its related technologies. Companion legislation was introduced in the House of Representatives by U.S. Reps. Diane Black (R-TN), Peter Welch (D-VT), and Gregg Harper (R-MS). According to the Senate bill’s sponsors, the CONNECT for Health Act would:

  1. Create a bridge program to help providers transition to the goals of the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) through using telehealth and RPM without most of the 1834(m) restrictions contained in the aforementioned Senate bill;
  2. Allow telehealth and Remote Patient Monitoring to be used by qualifying participants in alternative payment models, without most of the aforementioned 1834(m) restrictions;
  3. Permit the use of remote patient monitoring for certain patients with chronic conditions;
  4. Allow, as originating sites, telestroke evaluation and management sites; Native American health service facilities; and dialysis facilities for home dialysis patients in certain cases;
  5. Permit further telehealth and RPM in community health centers and rural health clinics;
  6. Allow telehealth and RPM to be basic benefits in Medicare Advantage, without most of the aforementioned 1834(m) restrictions; and
  7. Clarify that the provision of telehealth or RPM technologies made under Medicare by a health care provider for the purpose of furnishing these services shall not be considered “remuneration.”

So far, the following organizations have publically endorsed the bill:

  • AARP
  • ACT | The App Association
  • Airstrip
  • Alliance for Aging Research
  • Alliance for Connected Care
  • Alliance of Community Health Plans (ACHP)
  • Alzheimer’s Foundation of America
  • America’s Essential Hospitals (AEH)
  • America’s Health Insurance Plans (AHIP)
  • American Academy of Neurology (AAN)
  • American Academy of Physician Assistants (AAPA)
  • American Association of Diabetes Educators (AADE)
  • American Heart Association/American Stroke Association (AHA)
  • American Medical Association (AMA)
  • American Medical Group Association (AMGA)
  • American Nurses Association (ANA)
  • American Occupational Therapy Association (AOTA)
  • American Osteopathic Association (AOA)
  • American Psychological Association (APA)
  • American Society of Nephrology (ASN)
  • American Telemedicine Association (ATA)
  • American Well
  • Anthem
  • Association for Ambulatory Behavioral Healthcare
  • Association for Behavioral Health and Wellness (ABHW)
  • CAPG
  • Cerner
  • DaVita
  • Federation of State Medical Boards (FSMB)
  • Hawaii Medical Service Association (HMSA)
  • Health Care Chaplaincy Network
  • Healthcare Leadership Council (HLC)
  • Healthcare Information and Management Systems Society (HIMSS)
  • Intel
  • Kaiser Permanente
  • LifeWIRE
  • NAADAC
  • National Association for Home Care & Hospice
  • National Association for the Support of Long Term Care (NASL)
  • National Association of ACOs (NAACOS)
  • National Association of Community Health Centers (NACHC)
  • National Council for Behavioral Health
  • National Council of State Boards of Nursing (NCSBN)
  • National Health IT Collaborative for the Underserved
  • Personal Connected Health Alliance (PCHA)
  • Population Health Alliance
  • Qualcomm Incorporated (and Qualcomm Life)
  • Telecommunications Industry Association (TIA)
  • The ERISA Industry Committee (ERIC)
  • The Evangelical Lutheran Good Samaritan Society
  • The Jewish Federations of North America
  • Third Way
  • University of Mississippi Medical Center (UMMC) Center for Telehealth
  • University of Pittsburgh Medical Center (UPMC)
  • University of Virginia (UVA) Center for Telehealth

The full text of the bill can be found here.

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The American Medical Association Releases New Telemedicine Recommendations

Posted by Health Law Informer Author on July 09, 2014
Telemedicine / No Comments

Recently, the American Medical Association (AMA) released a report on telemedicine (Report) that, among other things, (i) outlines coverage and payment rules; (ii) summarizes various specialty society practice guidelines/position statements; and (iii) presents its own position and recommendations regarding the role of telemedicine in the provision of health care. The Report provides a current overview of barriers (e.g., reimbursement and licensure) that prevent further implementation of telemedicine in the provision of health care in our society, and it also emphasizes the importance of ensuring quality of care, patient safety, and coordination of care. The AMA’s publication of this Report will hopefully continue the important dialogue regarding the promise of telemedicine.

Look for an upcoming more detailed client alert analyzing this Report, other updates concerning telemedicine, and the general role of telemedicine in our healthcare system.

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