“Sen. Tom Udall (D-New Mexico) anticipates introducing a bill this spring to make it easier for physicians to practice telemedicine in many states instead of applying for a separate license for each state.The bill, which is still being drafted, would streamline licensure portability across state lines, according to Fern Goodhart, Udall’s legislative assistant.

“Telemedicine is medicine, just practiced virtually,” she said at a Jan. 31 Capitol Hill briefing sponsored by the American Telemedicine Association (ATA), which advocates for use of remote medical technologies.

Legislation may be needed because the private sector market has not generated medical license portability, even with the increasing adoption of health IT and networking capabilities, she said.

Physician licensure has been a barrier to telemedicine because digital health care does not stop at state borders. A physician, who may supply treatment remotely, must obtain a medical license in each of the states where patients receive care via telemedicine, said Jonathan Linkous, ATA CEO.

“It’s time we explore nationwide licensure reform that will help to increase consumer choice, improve safety and cut costs,” he said. States have the same basic licensure requirements.

Telemedicine is critical for access to quality care in rural areas, said Deanna Larson, vice president for quality and e-care initiatives for South Dakota-based Avera Health, which offers services across seven states in a primarily rural region of the country.

The isolation also means that there is not a large enough population to support specialists in the area.

“These services are vital,” she said. Tele-health has enabled the health plan to avoid $4 million in unnecessary transfer charges and admissions to hospitals.

Larsen has assigned two employees just to do the lengthy paperwork for licensure. “I’d rather have them working with patients,” she said.

Federal agencies that provide health care, such as the Veterans Affairs and Defense Departments, offer license portability for their physicians. In addition, the Fiscal Year 2012 National Defense Authorization Act, which President Barack Obama signed into law, incorporated the Service members’ Telemedicine and E-Health Portability (STEP) Act.

It overcomes some barriers to state licensure for telemedicine so service members can expand the private healthcare professionals available to them in a different state from where they are residing or posted, such as for mental health care, according to Darrell Owens, legislative assistant for Rep. Glenn “GT” Thompson (R-Pa.), who introduced the legislation.

“We will be collecting data to show that this model works,” he said.

The bill that Udall is developing would streamline licensure with a unified set of standardized data in a comprehensive and interoperable database of primary source verified credentials, Goodhart said. It could include claims history, hospital privileges, criminal background check with a unified application. The information would only have to be entered once.

“You can think of it as a national practitioner database or unified provider database or a federation-based credential verification source on steroids with improvements,” she said. Ultimately, telemedicine could have nationwide or federal licensure, state reciprocity or mutual recognition and registration, Goodhart said.”

C3O Editors note: In the original article, it was misquoted that he is the Senator from Utah (his father) rather than New Mexico. His contact information is: Washington, DC
110 Hart Senate Office Building
Washington DC, 20510
(202) 224-6621

Among them:

• Reimbursement for services provided through telehealth should be made based upon medical effectiveness and utilization and not based upon or limited to particular delivery platforms or locations.
• The Medicare law should be expanded to allow anything currently covered by Medicare to be reimbursed when provided through telehealth by appropriately licensed or credentialed providers otherwise eligible for Medicare reimbursement.
• A telemedicine payment methodology should be provided so that a professional fee is paid to all providers necessary to that particular encounter, including a technical fee to the facilities to cover costs associated with the technology at rates to be determined by the HHS Secretary.
• A separate Medicare billing code for telehealth consultations should be implemented to assist in monitoring the use of telehealth.
• A federal policy should be adopted to allow telemedicine providers to receive deemed status and to allow for healthcare facilities receiving telehealth services to perform credentialing by proxy. If a provider is already credentialed at a Medicare participating facility, that credential would be sufficient for providing telemedicine services at another facility.

With national organizations such as NRHA along with the American Telemedicine Association and others, eventually the forces pushing for national policy change will occur. It appears that the Obama administration and many legislators are understanding the need and are supportive. Hopefully, this important component of  healthcare delivery will not become a victim of partisan disequilibrium.

“Twenty-four patients and 26 family members completed the survey. Ninety-two percent of respondents were comfortable with the robot, and 84% believed communication was “easy.” Ninety percent did not perceive the robot as “annoying” and 92% did not believe that “the doctor cared less about them” because of the robot. Ninety-two percent of respondents supported the continued use of the robot.”

The study concluded that both patients and families looked upon telepresence as both positive and helpful in their treatment.

You may have also noted that C3O Medical Group has now been renamed C3O Telemedicine. While the name may have changed, C3O is still the same – Connected, Compassionate, and Collaborative.

Welcome aboard and please provide us with your suggestions and opinions.

Herb Rogove, DO, FCCM, FACP – Founder and CEO

“While attending a meeting for the Colorado Hospital Association in Vail, CO, Mr. Brad Cochenennet, CEO of Pagosa Springs Medical Center, began to experience stroke-like symptoms.  Mr. Cochenennet was rushed to Vail Valley Medical Center, a 58-bed facility in the heart of the Rocky Mountains.  Once there, the attending physicians determined that Mr. Cochennet required an immediate examination from an expert neurologist.  At this point, Dr. Chris Fanale, a neurologist at Swedish Medical Center in Englewood, “beamed in” to conduct a stroke assessment of Mr. Cochenennet’s condition via an RP-Lite.”

This story, as seen on the NBC news video again illustrates that no matter the geographic location or hospital size, expert physicians can provide immediate access for a critically ill patient. In this case, it was the executive who understood the value of telemedicine and then he received the life saving intervention himself.