Meaningful Use is not the right model for a telemedicine incentive program

Telemedicine has been receiving a lot of media attention recently, with initiatives in Congress, the Federation of State Medical Board's Interstate Licensure Compact now ready to launch, and more health insurers than ever paying for it.

So I'm a bit surprised that a recent proposal published in Telemedicine and e-Health has garnered so little attention, positive or negative. 

The authors, from the Colorado Telehealth Network, Colorado Access, and other organizations, propose that the Meaningful Use incentive program be used as a "national framework" for integrated telemedicine and create a tiered incentive program to increase provider participation in telemedicine. The "integrated telemedicine model" would parallel the Meaningful Use program and be comprised of three stages, just like the ones in Meaningful Use: first adoption, then improved clinical processes and then improved outcomes. 

The authors predict that the model would improve access to care and improve care quality. And since reimbursement is still pretty limited, they suggest funding the incentive program with Section 1115 waivers, which fund Medicaid and CHIP pilot projects.

I can just see the red flags going up.

For one, the Meaningful Use program model might not be a perfect fit for telemedicine. Why does telemedicine need a three tiered incentive program? Why does it need any tiers? Hasn't it been hard enough to create the clinical quality measures for Meaningful Use? How would one measure the outcomes in telemedicine, where the provider is literally removed from the patient? Would there be enough return on investment for all of the effort it would take to create the three tiers specific to telemedicine? And who would be in charge of that? At least the Meaningful Use program had a national coordinator and two congressionally created committees.

Telemedicine also has unique problems, such as state law and medical license restrictions, online prescribing problems and security issues that the authors don't even mention. Telemedicine also has turf battles among clinicians; how would the Meaningful Use model deal with these problems?

The proposal itself is also inherently limited. The suggestion that it be funded by Section 1115 waiver money indicates that the projects would be intrastate only. However, one of the biggest draws of telemedicine is the ability to provide patient care over state lines. How much more telemedicine would really occur, particularly in smaller states or towns on state borders?

There's also the argument that telemedicine is already on a roll, and doesn't need such an incentive program.

What's more, how good is the Meaningful Use program as a model anyway? The proposal refers to the "success" of the Meaningful Use program. Yes, the program spurred EHR adoption; but the authors of the proposal are, by their own admission, only looking at Stage 1 of the Meaningful Use program. Stage 2 has been shaky, and, and Stage 3 is still theoretical, so the success of the program as a whole is yet unknown. It's also complicated and has created its own share of problems.

Telemedicine has great potential to increase access to care, lower costs and improve health. But using the Meaningful Use program as a paradigm to increase telemedicine? I'm not sure about that. - Marla (@MarlaHirsch and @FierceHealthIT)

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