By Cyril Tuohy
Telehealth may be the health care industry’s equivalent to the financial services industry’s phone-based or Internet-based financial advisor.
Proponents point to telehealth as a way to hold down health care costs. But, like some parts of the insurance industry, the telehealth movement is up against a thicket of state-based regulations and entrenched interests from a variety of constituencies: the telecommunications industry, technology companies, lawmakers, doctors, nurses and allied health providers.
Telehealth is the term for the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.
Issues around telehealth raise all sorts of questions about payment, services, fairness, equal access and even survival.
“What if you want to talk to a provider in a different state? Do we have the capacity to make telehealth services accessible in both rural communities and urban centers? What policies need to be changed? What needs to remain in place?” said Sen. Bill Nelson, D-Fla., chairman of the Senate Special Committee on Aging, which held roundtable discussion on telehealth recently.
State-based licensure requirements remain the largest impediment to the rapid adoption of telehealth.
Doctors and nursing groups at the Senate hearing reiterated their support for state-based licensure as the cornerstone of patient protection. They also spoke out in favor of enabling states to enforce medical practice laws, and for state medical boards to regulate the delivery of telemedicine services.
“Physicians must be licensed in the state where the patient receives services and the [American Medical Association] opposed federal legislation that would preempt or waive licensure and medical practice laws for telemedicine encounters,” University of California, San Francisco, dermatologist Jack Resneck Jr., said in written testimony on behalf of the AMA. Resnick is a member of the AMA board.
Telehealth, Resneck said, must support health care delivery that serves the patient and “facilitates team-based communication.”
Resneck was among several expert witnesses invited to testify at the discussion, which was titled “Harnessing the Power of Telehealth: Promises and Challenges?”
Kathy Apple, chief executive officer of the National Council of State Boards of Nursing, spoke out again legislative proposals in Congress that would change the location of the practice of medicine and require only one state license to practice in all 50 states. She said that any effort to nationalize state licensure would “undermine the authority of state boards of nursing” and patient protections.
With all the communications technology available today, it’s surprising that telehealth hasn’t progressed further, some health care policy analysts said.
“The lack of formal integration of telehealth and remote patient monitoring into clinical caregiving, frankly, baffles us,” Alice B. Borrelli, director of global health care policy with Intel Corp., said in prepared remarks.
“Rather than asking if virtual care is effective, we should be asking how to use these technologies through best practices for programs that will provide personalized care for the patient,” Borrelli said.
Care Innovations, Intel’s joint venture with General Electric, explores new ways of delivering health care using videoconferencing, touchscreen interfaces, biometric data capture and electronic health records. When used by qualified clinicians, the program has been shown to improve patient behaviors, cut emergency room visits and keep patients out of the hospital.
Steve R. Ommen, medical director for the Center for Connected Care at the Mayo Clinic, said using phones, secure messaging networks and remote monitoring devices saves time, improves medical outcomes and reduces chronic medical conditions.
Telehealth was also cited as a tool to help families provide long-term care.
With the nation aging quickly, the number of people giving care and the number of people receiving care from a family member will grow, said Gail Gibson Hunt, president and CEO of the National Alliance for Caregiving.
From a financial perspective, long-term care is a unique area of the health care system because so much of it is not reimbursed. The National Alliance for Caregiving claims there are 65.7 million Americans who qualify as caregivers.
Cyril Tuohy is a writer based in Pennsylvania. He has covered the financial services industry for more than 15 years. Cyril may be reached at [email protected].
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