The global ‘state of telehealth’ according to Dr Topol: work in progress

Are we approaching a ‘tipping point’ in telehealth and telemedicine within 5 to 10 years? While telemedicine (doctor-patient, hospital-hospital video consults) and even telehealth (patient monitoring generally at home) are becoming more common, Drs Eric Topol and E. Ray Dorsey see the tip coming within the decade in their New England Journal of Medicine (NEJM July, subscription required) article, moving from the early adopters to the majority. But there are still substantial barriers: interstate licensing, fragmented care, spotty state and Federal reimbursement including Medicare, wireless coverage enabling mobile monitoring, the future of the doctor-patient relationship, even the potential for narcotic abuse. They also need to move into the private sector. Somewhat misleading are the 2 million telehealth visits counted by the Veterans Health Administration; it includes the larger programs in store-and-forward information transfer and clinical video consults versus in-home telehealth.

Three trends they see paving the way to ubiquity:

  1. Moving beyond providing access to being driven by convenience and reducing cost
  2. Not just for acute conditions, but for monitoring chronic and episodic conditions (although vital signs monitoring, which is the core meaning of telehealth, has been doing so since the early 2000s)
  3. Migration from hospitals and satellite clinics to in-home and mobile applications

While the two doctors caution on risks, including breaches, they see telemedicine and telehealth increasing the delivery of care in the next ten years and spreading globally. Healthcare Informatics, Qmed

State by State report on telehealth laws and policies (US)

A comprehensive scan of telehealth laws and Medicaid [grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/05/State-telehealth-laws.jpg” thumb_width=”150″ /]program policies is available from the recently released report from the Center for Connected Health Policy, part of the Public Health Institute, a California based non-profit. This fourth annual review, State Telehealth Laws and Medicaid Program Policies,  provides a current summary of telehealth policies and laws in all the states and the District of Columbia.

As we have covered in many previous articles, states are actively pursuing legislation to implement their own set of telehealth policies. This report is supposedly an up to date summary of these laws and regulations as of March 2016.

Some significant findings highlighted by the authors are
– 47 states and Washington DC provide reimbursements for some form of telemedicine video conferencing. This number is unchanged from last year.
– 9 states reimburse for store and forward services (e.g. medical images, documents and pre-recorded videos. Primarily sent between medical professionals)
– 16 states offer reimbursement for remote patient monitoring, unchanged from last year

The report is complemented by an interactive map located here.

2016: will telehealth catch on or stagnate, due to factors out of control?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/11/Robert-Graham-Center-logo.jpg” thumb_width=”150″ /]Updated. Reviewing the Robert Graham Center study summarized by Editor Chrys last week, René Quashie of Epstein Becker Green, perhaps the leading law firm in the health tech area, opines that despite the great progress made by telehealth (telemedicine/virtual consults, but also remote patient monitoring), “state legal and regulatory issues, reimbursement, and provider training and education continue to be serious barriers to wider adoption of telehealth. And until the landscape evolves to address these barriers, telehealth adoption is likely to stagnate despite the great promise of telehealth holds as a tool to improve quality and access.” Yes, that old FBQ* (actually the top two) continues to be as true now as five years ago. While in closing Mr Quashie puts his trust in the ‘pull’ factor of consumers and patients “who will continue to demand better access and more innovative delivery models outside the conventional office visit,” this Editor is far less sanguine, despite having used a virtual consult app recently. It was turned to more out of sheer frustration–time pressure (work, travel), being unable to secure a timely visit with a specialist (no one seems to be taking new patients!) despite good (non-Obamacare) medical coverage, and a condition which was eminently photographable (plus $40 at hand). National Law Review  * The Five Big Questions (FBQs)–who pays, how much, who’s looking at the data, who’s actioning it, how data is integrated into patient records.

Then again, if you read Health Populi and believe Gallup’s polling (based on a slightly skewed question), a majority of Americans aren’t thinking about delivery models or telehealth at all. They’re unhappy, and would like to hand the whole hot mess over to the government when asked if “government is responsible for ensuring that people have health insurance.” Yet the Affordable Care Act, now two years in, was supposed to do exactly that by forcing everyone to pay for a healthcare policy or else pay a punitive tax. Too many did the math; the tax penalty was cheaper, especially for those Young ‘n’ Healthy Invincibles with slim purses and other things to spend on. They were the ones who were expected to pony up premiums, use few services and generally prop up the system.

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/11/shockedshocked.jpg” thumb_width=”150″ /]Now the American populace are shocked, shocked to find that out-of-pocket costs are way up and access is down. The same Health Populi article cites Fair Health’s spring 2015 consumer survey, finding that 33 percent of American patients felt that their out-of-pocket costs were ‘much more than expected’, with an additional 17 percent in the ‘somewhat’ category–a total of 50 percent. The contradiction of government control versus spending (and actuarial) reality is, in this Editor’s opinion, not going to be solved easily or well.

As to the wisdom of government involvement, there’s another developing and embarrassing ACA Big Fail(more…)

Telehealth reimbursement makes legislative progress in Texas, US House

In Texas, telehealth reimbursement as part of the state Medicaid program passed their House resoundingly (120 to 5!) and moved to the state Senate. (In Texas, if your bill makes it through the scrum that is their House, the Senate moves expeditiously.)  HB (House Bill) 2641 would authorize Texas’ Health & Human Services Commission (HHSC) to extend reimbursement for home telemonitoring (telehealth) services under the state Medicaid program from September this year for four years. Health care providers in Medicaid would be reimbursed for review and transmission of electronic health information. The caveat of course is that it is ‘feasible and cost effective’–it is designed to be expenditure neutral. The bill also includes extensive stipulations on health information exchanges based on national standards (ANSI) as well as amending the health and safety code for immunizations and other health conditions. The ‘criminal offense’ pertains to protected health information breaches as a misdemeanor. Telehealth inclusion in Medicaid is positive as this state insurance plan serves the poorest and often sickest, as well as many federal Medicare ‘dual eligibles’. Texas, being a large state, also sets trends (including the most reluctant to adopt cross-state telemedicine licensure.)  Text of HB2641

Would that telehealth reimbursement have the same chance in that large, exceedingly deliberative body called the US House of Representatives. HR2066, the Telehealth Enhancement Act of 2015, is similar to a bill that expired in committee in the last session. It was introduced (more…)

Telemedicine getting out of the waiting room–perhaps

Will reimbursement by insurance payers and private employers (presumably self-insured) and a greater comfort level with the video consult mean that telemedicine will finally step out of the waiting room? This Economist article (free registration may be required) with high points from a recent Rome conference seems to not be able to make up its mind, though it tries to be positive. Taking a comparative view, Israel leads with ‘relatively lax guidelines’, with doctors able to e-prescribe and perform referrals to specialists online. China’s health-care reform focuses on telemedicine“, but Peteris Zilgalvis, a health official at the European Commission pointedly states “If you have a chaotic system and add technology, you get a chaotic system with technology” (Editor’s emphasis). The US is somewhere in between (more…)