Telehealth is a hot issue on Capitol Hill these days.
“In ten years of working on Capitol Hill, I haven’t seen an issue get as much momentum as quickly as telehealth,” says John F. Williams, III, Managing Partner of the Washington D.C. office of Hall Render, Killian, Heath & Lyman. “There is bipartisan support to address telehealth issues.”
Telehealth is generally defined as any live use of telecommunications technologies to support the provision of health services, while the term telemedicine more specifically refers to the use of live video feeds to diagnose and treat patients. Medicare has provided a benefit for telemedicine services for patients in rural Health Professional Shortage Areas (HPSAs) since 2001. Rendering medical professionals are compensated the same professional fee they would receive for the equivalent non-telemedicines encounter, while the operator of the originating site where the patient is located is compensated about $25 per encounter.[1]
As a national healthcare law firm with 160 attorneys, Hall Render is keenly aware of the telehealth issues that affect its hospital and health system clients.
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“We kept hearing repeat questions from clients concerning telehealth issues. Particular issues came out of clients’ desires to deploy telemedicine and hitting roadblocks,” says Michael T. Batt, an attorney in Hall Render’s Indianapolis office. “Instead of telling clients no, we try to help them navigate rules. When rules don’t make sense, it makes sense to try to change the rules.”
Williams, Batt, and Hall Render attorney Jeffrey W. Short believe the biggest telehealth issues, like cross-border medical licensing, reimbursement, physician credentialing, and medical malpractice liability, are not easily solved. Instead, they have targeted three practical, everyday issues causing barriers to telemedicine that can be easily fixed. They believe focusing on practical, budget-neutral solutions will yield the highest likelihood of success.
The three targeted issues are:
- Create a new exception, or telemedicine statute amendment, that allows health systems to gift telemedicine equipment to physician users – Like the EHR donation exception, allowing health systems to donate telemedicine equipment to independent physicians will increase the adoption of telemedicine, while not increasing federal spending. Just like EHRs, independent physicians are unlikely to purchase telemedicine equipment on their own.
- Amend the Civil Monetary Penalty law, or telemedicine statute, to allow hospitals to provide home health monitoring equipment to patients – While this amendment will not increase federal spending, there is scientific evidence indicating that live, post-acute monitoring of discharged patients reduces readmissions rates over 50%.[2] This change will remove the technical violation that currently exists under the Civil Monetary Penalty law.
- Remove all geographic restrictions, enabling urban telemedicine visits to be covered by Medicare – Like rural communities, urban areas are also subject to health professional shortages, as well as inclement weather conditions. For instance, local telemedicine access could improve Medicare beneficiary safety in New York City during winter weather. Preliminary indications are that this issue will be decided based on how the change is scored by the Congressional Budget Office. If the change is determined to be budget-neutral, this issue may be addressed. If this change in projected to increase federal spending, the issue is dead in the water.
Hall Render representatives have had several conversations with Congressional Staffer Robert Horne of the Energy & Commerce Committee and even prepared legislative language for the proposed changes. Williams, Batt and Short hope the language will be included in the 21st Century Cures bill scheduled to be introduced by Committee Chairman Fred Upton in January.
“We’re looking for some base hits,” says Batt. “Taking care of everything in one fell swoop is perhaps too daunting.”
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John F. Williams, III, is an attorney and shareholder with Hall, Render, Killian, Heath & Lyman, P.C. in Washington, D.C. He can be contacted by email at jwilliams@hallrender.com or by phone at (202) 442-3780.
Michael T. Batt is an attorney and shareholder with Hall, Render, Killian, Heath & Lyman, P.C. in Indianapolis, Indiana. He can be contacted by email at mbatt@hallrender.com or by phone at (317) 977-1417.
Jeffrey W. Short is an attorney and shareholder with Hall, Render, Killian, Heath & Lyman, P.C. in Indianapolis, Indiana. He can be contacted by email at jshort@hallrender.com or by phone at (317) 977-1413.
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[1] Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule, CY 2015. II.E Provisions of the Final Rule with Comment Period for PFS, Medicare Telehealth Services. http://www.ofr.gov/OFRUpload/OFRData/2014-26183_PI.pdf
[2] The Role of Remote Care Management in Population Health. April 4, 2014. http://healthaffairs.org/blog/2014/04/04/the-role-of-remote-care-management-in-population-health/