ATA: 'Explosion of opportunities' for telehealth

Healthcare is “on the verge of an explosion of opportunities for telehealth,” according to Gary Capistrant, senior director of public policy for the American Telemedicine Association (ATA), who spoke during the organization’s monthly webinar.

Implementation of “huge provisions” of the Affordable Care Act, momentum of innovation in payment and services and leveraging of the substantial financial investment in broadband, EHRs and health information exchanges are all “coming together in a positive way for telehealth,” Capistrant said.

He also provided an update on the legislative package for telehealth that has been in the works. “The package is still in flux,” he said. The idea, Capistrant explained, is to create a package both parties can support so that the Congressional Budget Office will estimate the costs. They hope to include the ability to fit telehealth into existing payment innovations, such as bundling initiatives and accountable care organizations; as well as Medicare improvements to address the 104 counties that were recategorized from rural areas to metropolitan areas and therefore lost some funding.

“The package should be ready for much more serious consideration later this fall when Congress has to deal with the physician payment reform issue,” Capistrant said.

Another legislative issue is the bill proposed by Congressman Devin Nunes (R-Calif.) that deals with allowing Medicare beneficiaries to be served via telemedicine across state lines even though a provider might not be licensed in the state in which the beneficiary resides. “An early draft had a prior patient-physician relationship requirement. We made clear our opposition and discussions are ongoing.”

Another big topic for telemedicine is new funding. Capistrant said the Center for Medicare & Medicaid Innovation (CMMI) presents “an explosion of opportunity” in the form of its $1 billion budget earmarked for open-ended innovation. The industry has a rare opportunity to submit a proposal that supersedes state statutes, he said. Applicants must submit a letter of intent by the June 28 deadline.

Capistrant provided updates on state activity related to telehealth. Virginia, for example, approved funding from the CMMI to take on recipients who are dually eligible for Medicare and Medicaid and provide services to them statewide. “Hopefully, that will include some services in the home.”

Deadlines associated with the Affordable Care Act also impact telemedicine. Some 14 million people are expected to be newly covered once health information exchanges go live come Jan. 1, 2014. Some of those exchanges include telehealth. 2014 will be an interesting year for telemedicine, said Jonathan Linkous, ATA’s CEO.  “We’re going to have a crunch of people that will be on Medicaid and we’ll start to roll out those services to millions more people starting Jan. 1.” He also mentioned the sustainable growth rate bill about which “Congress has pledged to really do something this year—but they say that every year. If there is a change, telemedicine will be an important part of it.”

The American Medical Association (AMA) recently approved two resolutions: the organization’s telecommunication group passed a resolution to work with the ATA and the group plans to work on licensure and professionalism in healthcare and telemedicine. Based on AMA’s past stance on telemedicine, “it’s a new day,” said Linkous. “It’s clear that providers and allied providers and healthcare workers all see that telemedicine is really the way it’s going.”

Capistrant said a court ruling out of North Carolina is relevant to the state licensure issue. A state medical board provision prohibited nondentists from providing teeth whitening services but an appeals court overturned that regulation. “They overturned that ruling because [the court] believes that the structure of the medical board was essentially a violation and it was hailed as a victory for health competition,” he explained. “We’re not out of this yet but it’s interesting to see that the Federal Trade Commission has now really come out looking at state medical boards and saying ‘don’t act to block competition.’ That’s directly relevant to the work we’re doing on state licensure. We’re hopeful that this can be worked out amicably by all the providers in a way that opens up telemedicine services.”