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Can Congress Catch up with Telemedicine?

by Allen L. Gee, MD, PhD, FAAN, neurology specialist

Talent, technology and time have historically been barriers to delivering health care in rural communities where the altitude’s greater than the number of people. In Wyoming, where I practice, not every community can support basic health care, never mind medical specialty care. Surgeons in our region frequently fly to outreach clinics, compressing three hours of driving into 45 minutes of flying. Capturing surgeries at the outreach clinic more than offsets their flying expenses. Medical specialists like myself cannot afford airplanes and don’t get our travel time compensated – as a result, so many communities and patients – too many – do not have easy access to a breadth of medical care.   

Telemedicine bridges this geographic barrier to health care, enabling us to deliver care remotely, to people that would otherwise not receive it.

The capabilities and cost of telemedicine are rapidly coming in line to support its use across a variety of medical disciplines. High definition cameras are affordable. Video streaming is clear without huge delays and are even bridging across platforms.  

Recently, I was on a panel at a HIMSS state chapter meeting with fellow telemedicine champions who have acted as advocates for decades, acquiring grants and supporting the use of telemedicine in their rural regions – their work has helped many people.

During our discussions, it occurred to me that technology capabilities and affordability have, in the last few years, outdistanced and outperformed all that these people have accomplished in their decades of work. There’s some sadness in this realization, but I know it also portends some excellent opportunities to bring health care to more patients in need. And the government, thankfully, is recognizing that value.

A recent legislative draft provided by a bipartisan group of eight members of the House Energy and Commerce Committee, proposes to give the U.S. Department of Health and Human Services (HHS) more freedom to reimburse providers for telemedicine, as long as the services meet certain requirements, such as providing unmet medical needs or reducing costly services.

Telemedicine advocates support the draft but, much like my co-panelists, are challenged by the mindset change necessary to embrace the dramatic shift in telemedicine’s function, efficiency and cost-effectiveness.

Joel White of Health IT Now states, “Unfortunately, the bill has to be constructed in a way to ensure the Congressional Budget Office (CBO) is satisfied expenditures don't increase. While the rest of the world races to adopt telemedicine because it saves money and improves health outcomes, the CBO continues to view telemedicine through the same luddite lens most grandparents reserve for tablets and smart phones.”

Mr. White makes a great point about the technology – however, telemedicine is more than its technology. Telemedicine is connecting patients and information with the right provider at the right time, no matter where the expertise resides, and it should be used beyond just rural communities. I have colleagues in neurology who cannot get reimbursed for telemedicine care because they are not in rural areas; yet there is not adequate neurology coverage where they are delivering care.

It is unclear how “unmet medical needs or reducing costly services” will be administratively defined. But if quality-proven health care can be delivered anywhere via telemedicine, HHS should reimburse the work. Unfortunately, as is often the case with rapidly developing capabilities like telemedicine, the bureaucratic regulations impose barriers to realizing the results initially desired. It does feel like we are pedaling in deep sand while the opportunities are racing past.  

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