U.S . Telemedicine Public Policy

U.S. TelemedicinePublic Policy

Gary Capistrant

September 25, 2014

Columbia, SC

Some Problems Addressed

Barriers of time and distance

Professional shortages

Disparities in access to care

Quality of care

Hospital readmits, ER overuse

Costs of delivery

Convenience and patient choice

Public Policy Goals

Knock down government barriers

Promote “value” innovative payment and service models

Address care delivery problems• Cost, access, outcome, productivity

Major Government Roles

Rendering

Reimbursement

Regulation

Research

Resources

Readiness and recovery

Innovative Pay Models

TweaksValue-based purchasing

Pay for performance

ReformsBundling (services, time)

Case-mix

Sharing (risk, savings, gains)

Salary-based

Reference pricing, indemnity

Medicare Today

36.6M in fee-for-service

15.7M in Medicare Advantage

1.9M in Special Needs Plans (SNPs)

Medicare FFS Barriers

Limited live videoOnly rural counties (20% of beneficiaries)

Limited originating sites

Limited providers

Only specific procedures

No store & forward

No remote patient monitoring

Medicare Bills

S. 2662 (Thad Cochran) /

H.R. 3306 (Gregg Harper)

Telehealth Enhancement Act

H.R. 5380 (Mike Thompson)

Medicare Telehealth Parity Act

Rural  Telehealth

Enhancement Act, Cochran (S. 2662) / Harper (H.R. 3306)

Medicare Telehealth Parity Act, Mike Thompson (H.R. 5380), Phase 1 of 3

Store-and-forward for—    

Critical access hospitals ♦  

Sole community hospitals ♦  

Federally-qualified health centers   ♦

Rural clinics   ♦

Into homes for--    

Kidney dialysis (video and RPM) ♦  

Hospice patients ♦  

“Homebound” patients ♦  

Physician recertifications for home health care

♦  

Metro FringesTelehealth Enhancement Act, Cochran (S. 2662) / Harper (H.R. 3306) 

Medicare Telehealth Parity Act, Mike Thompson (H.R. 5380), Phase 1 of 3 

All critical access hospitals ♦  

All sole community hospitals ♦  

Restore coverage for 104 counties that lost it in 2013

♦  

Video for metro counties with < 25,000 population

♦  

Video and store-and-forward for metro counties with < 50,000 population

  ♦

All BeneficiariesTelehealth Enhancement Act, Cochran (S. 2662) / Harper (H.R. 3306)

Medicare Telehealth Parity Act, Mike Thompson (H.R. 5380), Phase 1 of 3

Hospital readmissions: shared savings for a hospital beating its reduction benchmark

♦  

For accountable care organizations ♦  

For bundled payments ♦  

For medical homes    

Medicare counterpart for Medicaid “health homes” for chronic care

♦  

Authorize specialty care oriented ♦  

Stroke diagnosis ♦  

Federally-qualified health centers – video and store-and-forward

  ♦

Remote patient monitoring for--    

Congestive heart failure   ♦

Chronic obstructive pulmonary disease   ♦

Diabetes by federally-qualified health centers   ♦

More covered providers    

Diabetes educators   ♦

Therapies – PT, OT, RT, speech & hearing   ♦

50 State Medicaids Today

All cover imaging

45 states cover something41 telemental health

18 home telehealth

14 remote patient monitoring

11 store-and-forward

Comprehensive risk-based managed29.1M (51%)

26 states with >50% of recipients

State Ratings – Coverage and Reimbursement

SC ProgressPARITYMedicaid C

MEDICAID COVERAGE & CONDITIONS OF PAYMENTDistance or Geography Restrictions AInformed Consent APhysician-provided Services BMental/behavioral Health Services BPatient Setting CEligible Technologies CTelepresenter C

INNOVATIVE PAYMENT OR SERVICE MODELSState-wide Network ✔

HCBS Waiver ✔

SC OpportunitiesPARITY

Private Insurance U

State Employee-based Plan U

MEDICAID COVERAGE & PAYMENT

Eligible Providers U

Home Health U

Rehabilitation N/A

INNOVATIVE PAYMENT OR SERVICE MODELS

Medicaid Managed Care  

Medicare-Medicaid Dual Eligibles  

Health Home  

Corrections  

Medicaid Best Practices for Telehealth Uses

Telemental and Behavioral Health

Stroke

Managed Care

High-Risk Pregnancy

Rehabilitation

Patient Monitoring & Home Video

School-based

Store-and-forward

Medicaid Prospects

Parity – urban, store-and-forward

Managed care flexibility

Focused initiatives

Specialty – at-risk pregnancies, autism

Chronic - health homes

Sites – home, school-based

Private Insurance

Obamacare HIE parity

Today21 states + DC w/parity

7 w/10+ years experience

Many insurers choose to cover

Prospects29 w/o parity

14 with 2014 proposals

State Ratings – Physician Practice Standards

SC Telemed Practice Rules

PHYSICIAN STANDARDS & LICENSUREPhysician-patient encounter ATelepresenter AInformed Consent ALicensure & Out-of-State Practice C

INTERNET PRESCRIBING POLICY OR STATEMENT

✔

Federal Interstate “One State License” Model

Defense -- STEP Act (H.R. 1832)

enacted December 2011

Pending

VA: VETS Act, H.R. 2001

Medicare: TELE-MED Act, H.R. 3077

Other Major Regulatory

FederalFDA on medical devices and software

FCC on universal services and net neutrality

HIPAA privacy and security

DEA for controlled substances prescribing

ONC/CMS electronic health records and health information exchange

StateProf licensure & practice rules at both ends

Market Opportunities

Mobile and home

Specialty care

Urban

Provider productivity

AmericanTelemed.orgATAwiki.org

Gary Capistrant

Senior Director, Public PolicyGCapistrant@AmericanTelemed.org

202-233-3333