ATA covers range of telemedicine initiatives

“Big med telemedicine” is the idea of healthcare expanding, almost a “Walmartization” of healthcare, said Jonathan D. Linkous, CEO of the American Telemedicine Association (ATA), during the group’s This Month in Telemedicine videocast on April 23.

Linkous cited several healthcare organizations that are expanding their networks across the country. For example, Mayo Clinic’s Care Network touches the lives of 200 million people. By developing affiliates all over the country, Mayo will continue to expand, Linkous said, and provide e-consults. “Telemedicine is a tool as we expand these networks to a nationwide scope.”

There are two proposals at the federal level, said Gary Capistrant, ATA’s senior director of public policy. Congress approved the Servicemember Telemedicine eHealth Portability Act (STEP) about 18 months ago. STEP allows for healthcare professionals to need just one state license to practice anywhere within the Department of Defense network. The Telehealth Promotion Act of 2012, sponsored by Rep. Mike Thompson (D-Calif.), would increase federal support and payments for telehealth services nationwide. If passed, the bill would increase access to telemedicine within Medicare, Medicaid, the Children’s Health Insurance Program, TRICARE, federal employee health plans and the Department of Veterans Affairs.

Another proposal would allow Medicare beneficiaries to go across state lines but would put in place a prior doctor-patient relationship, said Capistrant. On a state level, some states have said that relationship can be created by video and some say that is not allowed. “We have made it clear to proponents of that legislation that we are strongly opposed. It would be a step backward from what’s in place for the Defense Department,” he said.

“In terms of our principles on licensure, we want to be regulated the same as in-person services,” Capistrant added.

On a state level, “this has been the most active year on telehealth legislation ever.” Three states this year have enacted full parity on private insurance and/or Medicaid and proposals in Connecticut and Missouri have passed parity bills in their Senate. Bills have been introduced in Ohio and New York. “We’re seeing a lot of enactment this year and also setting up for next year.”

Capistrant also discussed several smaller issues and opportunities. For example, the ATA wants to give hospitals positive incentives to reduce hospital readmissions by helping them get compensation for their out-of-pocket expenses. He also mentioned the CMS Innovation Center’s recent bundling initiative that does not include telehealth coverage—yet.

The ATA also is looking at provisions to cover rural healthcare and how it can protect the many counties that have been reclassified from rural to metropolitan. About one million people in those areas have lost their Medicare coverage as of the end of February, Capistrant said. “We’re looking to grandfather in those counties so those areas that have ever been covered always are.”

Quality assurance has been another area with lots of activity, said Linkous. “The number of services available is booming and there’s an important role for the ATA to weigh in and try to get some meaning and semblance of order to what all is happening.” The ATA board approved the idea of the group getting involved in accreditation for online web resources. “There is nowhere for consumers to go,” he said. “This is a wide open area and one we feel it’s important to come in and see what we can do to establish quality assurance.”