Telemedicine, Telehealth & Mobile Health: The Future Is Today Kim Harvey Looney, Waller Lansden Dortch & Davis LLP Michael F. Schaff, Wilentz Goldman & Spitzer PA Sidney Welch, Kilpatrick Townsend & Stockton LLP American Health Lawyers Association Annual Meeting - 2015
Agenda Landscape for Telemedicine Description of Telemedicine vs. Telehealth Key Terms How Telemedicine is being used Opportunities for Telemedicine Barriers to Telemedicine Public and private payor reimbursement Reimbursement [Medicare & Medicaid] State Telemedicine Law Developments OIG Advisory Opinion 2
Agenda Licensure & Telemedicine Telemedicine Credentialing [Medicare & TJC] Telemedicine Stakeholder Work HIT Interoperability Telemedicine Privacy & Security Recent Federal Legislative Developments Telehealth Projections Mobile Apps and FDA Regulation Potential Tax Issues Associated with the Provision of Telemedicine 3
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Landscape for Telemedicine Innovation Several emerging trends are setting the foundation for advancements in telemedicine: Healthcare providers are moving to reimbursement arrangements that require: o better health outcomes o lower overall costs. An ever-growing demand exists, both from payors and patients, for innovative health information technology solutions and data-driven approaches. Policymakers have a serious concern about patient access to care and healthcare provider shortages. 5
Landscape for Telemedicine Innovation Triple Aim: Objective of National Health Reform: o 1) Increased Access; o 2) Improved Health Outcomes; o 3) Reduced cost Example: A neurologist diagnoses a stroke patient in a distant site via telemedicine Assume the nearest neurologist is 500 miles away. It would take hours to transport a stroke patient that far, which means that the medication could not be administered on arrival. But with telemedicine, the patient can be seen by a neurologist in a matter of minutes. Transport costs drop dramatically. Increased Access. Improved Outcome. Reduced Cost. Consumer Satisfaction: 2015 Consumer Survey indicates that most consumers favor telemedicine, especially those in the 18-44 year old range. In fact 11% of young adults between 18-34 said they would even switch doctors to get video access. (American Well, Telehealth Index: 2015 Consumer Survey) 6
What is Telemedicine? Medicare 1395m(m)(1) and CMS Telehealth 2015 Fact Sheet Two-way, real-time interactive communication between the patient and distant site physician or practitioner; but not communication via telephone, email, or fax. 7
The Federation of State Medical Boards (FSMB) defines the practice of telemedicine as the practice of medicine using electronic communications, information technology or other means between a licensee in one location, and a patient in another location with or without an intervening healthcare provider. What is Telemedicine? 8
The American Telemedicine Association (ATA) defines telemedicine as the use of medical information exchanged from one site to another via electronic communications to improve a patient s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology. What is Telemedicine? 9
What is Telehealth? Sometimes used interchangeably with telemedicine, but sometimes used differently- depending on the State Generally broader and encompasses more modalities The remote delivery of a broader set of health care services using information technology, including remote patient monitoring, prescription writing and patient education For Example: New York defines Telehealth as Delivery of health care services by means of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means (NOTE: MAY NOT FIT UNDER MEDICARE DEFINITION) 10
Key Telemedicine Terms
Key Terms Distant site - the location where the distant site practitioner (or remote provider) is located (JETSONS DR. RACLEY S OFFICE). Originating site - the location of the patient at the time the service furnished by Telemedicine occurs. (JETSON S HOUSE) Remote Provider or Distant Site Practitioner the provider who provides services via telemedicine who is not at the same location as the patient. (JETSONS DR RACLEY) Store-and-Forward - Transfer of data from one site to another site through the use of a camera or similar device that records an image that is sent vie telecommunication to another site for consultation. (DOESN T APPLY TO JETSONS EXAMPLE, SINCE OCCURRED IN REAL TIME) Telepresenter or Provider Extender- The provider or support personnel at the originating site who assists the remote provider. (IF NP OR PA WAS AT THE JETSONS HOME)
How is Telemedicine Being Used? A number of medical specialties, including dermatology, behavioral health, and others, use telemedicine as a way to improve and coordinate patient care. To allow home bound patients to receive care in the home setting. To facilitate the provision of mental health consultations to patients with access to care issues. To improve the provision generally of health care in rural areas. To reduce health care costs by providing remote monitoring technologies, particularly for patients with chronic conditions. 13