ABA 15: Telemedicine movement gaining steam

Telemedicine will become increasingly important as the healthcare system moves away from fee-for-service reimbursement and towards value-based care, according to experts at the American Bar Association Health Law Section's Annual Washington Health Law Summit this week.

"There's a lot of pending legislation [to expand telemedicine and reimbursement]. There's a lot of interest on the part of Congress, especially regarding interoperability and EHRs. It's really about interoperability of EHRs other than Meaningful Use," explained Robert Jarrin, senior director of government relations for San Diego telecommunications firm Qualcomm.

Some initiatives, such as the Meaningful Use program, already contemplate more use of telemedicine. For instance, Stage 3 of the program includes objective 6 regarding care coordination and patient engagement, which requires patients to be able to view, download and transmit electronic records, secure messaging between patients and providers and the incorporation of patient generated health data, which can all be accomplished by use of telemedicine, Jarrin points out.

The Medicare Access and CHIP Reauthorization Act (MACRA), with its Merit-Based Incentive Payment System (MIPS) also contemplates the use of telehealth and remote monitoring as part of care coordination and clinical improvement, Jarrin added.

Unfortunately, previously EHR vendors didn't want to integrate telemedicine into EHRs.

"But if you don't capture that, you're missing the opportunity to manage the patient and decrease redundancy," pointed out attorney Nathaniel Lacktman, with Foley and Lardner. "Consumers want on-demand, easy access and low-cost care," he added.

Telemedicine is not without challenges, however. Providers need to watch for several legal issues, such as state licensure concerns, practice standards, state fee-splitting prohibitions, the corporate practice of medicine, and anti-kickback statutes.

"If you're giving out i-Tunes cards to reward patients to checking in [via telemedicine] for their diabetes, you're dealing with the anti-kickback statute and civil monetary penalties law," warned Lacktman.

Still telemedicine has great potential for providers to improve outcomes at lower costs, pointed out Natasa Sokolovich, executive director of telehealth at the University of Pittsburgh Medical Center and senior director of the Affiliated Physician Services Health Services Division.

Her health system had almost 16,000 telemedicine visits last year and is looking to expand its use of telehealth further.

"ONC has been myopically focused on EHRs. But what happens with a person when he leaves the hospital? Wouldn't it be good to monitor?" noted Jarrin.