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Ascending The Hill to Advance Telemedicine

by Andrew O'Hara, Founder and CEO of Chiron Health

As a new partner of athenahealth’s More Disruption Please (MDP) program, I jumped at the opportunity to join other MDP partner CEOs (26, to be exact) and athenahealth leadership last week on Capitol Hill to meet with lawmakers. This was our chance to get out there and teach the policymakers a thing or two about telemedicine!

So what were our goals? First and foremost, to educate legislators about the on-the-ground realities of our respective industries. With 26 companies represented, this ran the gamut from administrative health IT tools to clinical decision support to telemedicine, like my organization. While some groups talked to policymakers about the barriers to interoperability and the dangers of the potential FDA regulation of health IT, my group of telemedicine-related CEOs were mostly interested in recommending sensible telemedicine policy that can help move the industry forward. Here’s the kind of information we share with policymakers – and anyone that is interested in our corner of the health care delivery world. 

Quick Telemedicine Primer

There are two major forms of telemedicine:  Real-time video conference visits and asynchronous (or non-real-time) communication between providers and patients, also referred to as “store-and-forward.” My company, Chiron Health, does the former. We integrate directly into the athenahealth network, enabling providers to conduct HIPAA-compliant video visits with existing patients, often for follow-up care.

Our friends at Hale Health (also an MDP partner that spent the day on the Hill) are an example of asynchronous telemedicine – they enable patients to communicate with providers – sharing symptoms, photos, and videos – via secure messaging.

Telemedicine Reimbursement Policy

There has been a ton of recent attention in D.C. around telemedicine, primarily due to its potential to improve patient access and drive efficiencies and cost savings in care delivery. As a result, lawmakers are taking a serious look at policies that would encourage its adoption. With that in mind, most of the discussions in our Congressional meetings revolved around the Medicare telemedicine reimbursement policy.

While Medicare reimbursement for telemedicine has been in place since 2000, two major provisions in the policy have significantly limited its use:

  1. The patient must be located in a rural Health Professional Shortage Area (HPSA) or in a county outside of a Metropolitan Statistical Area (MSA). This essentially limits reimbursement opportunities to services provided to patients in rural areas only.
  2. The patient must also be located at a qualified originating site, defined as physician offices, hospitals, skilled nursing facilities, and other similar settings. This does not include the patient’s home. A little strange that a patients must travel to a location to receive remote care, don’t you think?

These reimbursement policies may seem ridiculous, but they did make sense at one time. For the last 20 years or so, the prevailing model of telemedicine has been a hub-and-spoke approach: patients in remote areas travel to rural telemedicine clinics to connect with specialists in urban hospitals. We like to call this “Telemedicine 1.0.” The patient would sit in front of a $50,000 telemedicine “cart” and a clinical staff member would present him or her to the physician at the distant site.

This approach is pretty silly today given that 90% of these consults are simply a conversation between the provider and patient, and only require a webcam and an Internet connection.

Where is Telemedicine Heading?

We arrived in Washington trying to answer this question: How can we work with lawmakers to align Medicare reimbursement with a modern form of telemedicine? We like to call this, you guessed it, “Telemedicine 2.0.” Patients are in their homes, using their own devices to securely communicate with providers.

Thankfully, policymakers didn’t have to rely on us just telling them it was a good idea. We brought strong evidence from private payers proving that this form of home-based telemedicine is working effectively – improving patient access and consequently, outcomes, while lowering overall costs. We shared stories of patients from across the country, who were thrilled to avoid the hassle of taking off work, sitting in traffic, and spending time in a waiting room full of sick people, just to follow up on lab work or adjust a medication dosage. 

Today, 26 states have laws mandating private payer reimbursement for services delivered via telemedicine (see the map below from the American Telemedicine Association). Most important, these reimbursement mandates are not subject to the same originating site restrictions as Medicare. Patients can be seen from home (or work), and both physicians and mid-level providers can be fully reimbursed – usually as a Level 3 or Level 4 office visit. 

State Telemedicine Reimbursement Policy

There you have it – I arrived in Washington, D.C. as an eager CEO, and left as a jaded lobbyist! In all seriousness, though, this was a fantastic opportunity to get involved in the legislative process and share some of the challenges and opportunities we face in an exciting new area of medicine. I highly recommend that others interested in pushing telemedicine forward, or any other health IT initiative, do the same. It matters. And it works.



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Comments

Submitted by Jeremy Thompson - Thursday, October 29, 2015

I must say that it had to have been an interesting meeting. It's great to read about people like yourself that actually get involved in the process in order to bring about positive change in our country. I like the idea of Telemedicine 2.0. I hope you don't mind but I will be borrowing that phrase. I look forward to the future of Telemedicine 2.0. Jeremy

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