Business

POLICY: Current law restricts millions of Americans’ access to telehealth services.

Members of the Alliance for Connected Care include former senator Tom Daschle of DLA Piper, from left to right, Andy Mekelburg of Verizon, Krista Drobac of DLA Piper, Sam Marchio of WellPoint, Debbie Garza of Walgreens, Michael Drobac of Akin Gump and Brian Files of CVS Caremark. The group is lobbying for greater access to telehealth services. (Jeffrey MacMillan/Capital Business)

Members of the Alliance for Connected Care include former senator Tom Daschle of DLA Piper, from left to right, Andy Mekelburg of Verizon, Krista Drobac of DLA Piper, Sam Marchio of WellPoint, Debbie Garza of Walgreens, Michael Drobac of Akin Gump and Brian Files of CVS Caremark. The group is lobbying for greater access to telehealth services. (Jeffrey MacMillan/Capital Business)

October 19, 2014 Editor’s note: A previous version of this story incorrectly described the Medicare Telehealth Parity Act of 2014. This version has been modified.

Several of the nation’s largest pharmacies and health-care companies are urging lawmakers to expand the types of telehealth services that can be covered by government insurance programs, arguing that an outdated federal law is limiting the number of Americans who can access telemedicine.

Under current law, only telemedicine services offered through rural hospitals and clinics are covered by Medicare, according to a section of the Social Security Act that regulates how Medicare reimburses for telemedicine.

At the time Congress passed the statute in 1999, telemedicine was seen as an issue for people who didn’t have easy access to care, said Krista Drobac, a health-care lobbyist at DLA Piper who is representing the group of pharmacies and health-care companies, the Alliance for Connected Care. But in the years since, telemedicine has evolved to include retail clinics such as CVS’s Minute Clinic that are common in cities and suburbs, where patients can get medical advice from nurse practitioners outside the realm of a traditional doctor’s office.

While some commercial insurance plans reimburse retail clinics, Medicare does not — making it harder for the roughly 49 million Americans who are on Medicare to seek those services.

journal of retail medicineReps. Mike Thompson (D-CA) and Gregg Harper (R-MS) in July co-sponsored a bill, the Medicare Telehealth Parity Act of 2014, that would make visits to health-care sites in metropolitan areas covered under Medicare.

“Covering it more would mean more people would receive the services,” Drobac said.

The Alliance for Connected Care includes CVS Health, Walgreens, Verizon, insurer WellPoint, telehealth companies Teledoc and HealthSpot, medical device maker Welch Allyn, medical products manufacturer Cardinal Health, and others. DLA Piper is working jointly with health lobbyists at Akin Gump.

The group is pushing for Congress to change the law to allow telemedicine to be substituted for in-person care. That would mean if a patient sought telehealth care at a retail clinic, and that prevented them from having to later go to the emergency room, Medicare would pay for the retail clinic visit. If the patient first went to a retail clinic and later still had to go to the emergency room within 48 hours, Medicare would reimburse for the telemedicine but not the in-person visit. The idea is that many health problems can be resolved by an initial telehealth visit that would take away the need for an in-person visit, Drobac said.

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The idea has drawn some criticism. The American Medical Association cautions that telemedicine must be carefully regulated to ensure that the quality of care is not less than that of an in-person visit, and recommends that doctors delivering telemedicine be licensed in the same state as the patient. Some state medical boards have gone further, saying that telemedicine be provided only by a patient’s primary care provider, or requiring a patient and a doctor to have a prior face-to-face consultation before telemedicine can be provided.

The idea has drawn some criticism. The American Medical Association cautions that telemedicine must be carefully regulated to ensure that the quality of care is not less than that of an in-person visit, and recommends that doctors delivering telemedicine be licensed in the same state as the patient. Some state medical boards have gone further, saying that telemedicine be provided only by a patient’s primary care provider, or requiring a patient and a doctor to have a prior face-to-face consultation before telemedicine can be provided.

SOURCE: http://www.washingtonpost.com/business/capitalbusiness/current-law-restricts-millions-of-americans-access-to-telehealth-services/2014/10/17/4c529cc0-53c5-11e4-ba4b-f6333e2c0453_story.html

1 reply »

  1. This whole thing does not pass the smell test, folks.

    Why the angst over regulation and “who pays who”? Look at the list of “concerned” participants? The Alliance for Connected Care includes CVS Health, Walgreens, Verizon, insurer WellPoint, telehealth companies Teledoc and HealthSpot, medical device maker Welch Allyn, medical products manufacturer Cardinal Health, and others.

    Does anyone think this alliance will not use legislation/regulation to carve out the best cut of meat for themselves or set them up as purveyor, arbiters of telehealth or somehow preferred provider status of Medicare and other payment sources?

    The AMA’s position is likewise ludicrous. A telehealth visit is of course not equivalent to an in-person visit. It will never be, nor does it have to be to be effective. It is just different and has its own place. Nearly have of primary care visits don’t require any sort of physical exam, just a careful exchange of information and discussions.

    People use electronic communication media in all other aspects of their lives. Isn’t it time we allow the doctor and patient to figure this out within their relationship. Can anyone make a serious case that we don’t have enough regulatory mechanisms in place to police this adequately at the state level? A broader definition of Patient-doctor relationship and defining reciprocity where needed could be handled state by state without disruption in anyone’s care.

    This is a charade to gain control and favored status by a few big players. Same old story: use lawmakers and regulators to smooth the way for your business plan while making it harder for the competition to break in or disrupt.

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