Healthcare Matters

A recent story published by CQ HealthBeat reported that experts from the Institute of Medicine (IOM) are saying that continued integration of telemedicine into our health care system is not the slam-dunk that most of us think it should be. The story’s title says it all: “The Promise of Telemedicine Runs Into Reality,” but I believe it is more like a self imposed and completely unnecessary constraint.

Despite the fact that 10 million + patients in the US are direct beneficiaries of telemedicine each year, taking telemedicine off the bench and making it integral to our health system will remain a challenge until (drum roll here) the government gets off its duff and takes care of a few vitals. Changes in reimbursement policies are front and center. As I have reported previously, one of the reasons no one seems to be making any money in telemedicine is because “getting paid” remains a challenge. Add-in state licensing regulations and the need for cross-state reimbursement solutions and well, it gets messy rather quickly. And it doesn’t help that the industry likes to talk about tele-surgery using robots instead of focusing on hardening systems that leverage the ubiquity of inexpensive personal devices. You got to start somewhere right?

In late June, Representative Charlie Rangel introduced the ‘‘Veterans E-Health & Telemedicine Support Act of 2012’’ or the ‘‘VETS Act of 2012’’ which amends the U.S. Code so that health care professionals will be able to treat veterans using telemedicine technology. That’s a practical step in the right direction, but was it really necessary? Specifically, the legislation clears the way for health care professionals to provide telemedicine services to veterans regardless of whether the care professional or patient is located in a facility owned or operated by the Federal Government. Now think about that. Essentially, we had to develop and pass legislation that makes it OK for telemedicine services to be delivered to a patient who isn’t co-located with the physician or hasn’t traveled to another government owned facility.

Beyond intuitive, it is self-evident that labor shortages and our new care delivery models (ACOs, PCMHs) are going to rely on telemedicine. These models will not only drive further use of the technology, but they should force Federal and State governments to acknowledge that their own ideas about the future of care delivery (administratively, operationally and clinically) already rely on networks. Thank goodness the multi-state practice of telemedicine is finally being addressed from a reimbursement perspective, but that aside, wouldn’t life be easier if we simply accepted the intrinsic nature of telemedicine and reimburse for care provided, without adding some unnecessary layer of distinction?

—Tom Finn