Licensing, Billing Language Critical to Telehealth Success, Lawmakers Told
To realize the potential of telehealth services, Congress must help set a definition, solve restrictive licensing procedures, protect the privacy of data transfers and alter outdated payment and reimbursement language of Medicare, witnesses told the House Subcommittee on Health Thursday. Within the decade, “telehealth will simply become healthcare,” said Kofi Jones, vice president-public affairs of telehealth company American Well. Congress can aid the process through encouraging research and by crafting legislation to ensure the entire population -- urban dwellers, not just rural residents -- can receive telehealth treatment, said Ateev Mehrotra, a professor of healthcare policy at Harvard Medical School.
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Various bills pending in the House would touch on different aspects of the witness panel’s suggestions. Federal agencies, including the FTC and Food and Drug Administration, have taken steps to address the privacy concerns and definitional ambiguities, witnesses said. They said none of the efforts have resulted in new laws. “An aging population and an expansion in healthcare coverage means that more Americans will be using healthcare,” said subcommittee ranking member Frank Pallone, D-N.J. “We need to be actively working to leverage technology."
Telehealth is a vague term, said Mehrotra: It “essentially means using technology to deliver care in a method other than a face-to-face visit.” Industry has urged the government to explain exactly how it defines telehealth as it applies to things like healthcare software and mobile health apps, said Mehrotra. He cautioned the subcommittee from too specific a definition. Any legislation defining telehealth too specifically “runs the risk of being outdated quickly,” he said. Telehealth’s rapid expansion points to regulatory overlap between agencies including the FDA and FTC (CD April 4 p8), with some wanting the commission to have sole oversight.
The Telehealth Modernization Act (HR-3750) partially addresses the issue of lack of guidance from the FDA, attempting to establish a codified federal definition for telehealth and provide principles from which states could develop policies. At Thursday’s hearing, American Well’s Jones cited the bill, which Reps. Doris Matsui, D-Calif., and Bill Johnson, R-Ohio, introduced in December (http://1.usa.gov/1mCyJy4). The current “patchwork” of state laws, with differing telehealth definitions, have “prohibited the deployment of telehealth,” Jones said.
Varying state regulations also hinder doctors from providing telehealth services across state lines, said Pallone. Medicare providers licensed in one state may not be allowed to treat patients electronically in another, he said. Witnesses echoed Pallone’s concern. “Ultimately, the issue of licensure will need to be addressed,” Jones said. Pallone and Rep. Devin Nunes, R-Calif., introduced the Tele-Med Act (HR-3077) in September, which would give Medicare providers some leeway to practice electronically across state lines.
Medicare’s language on interstate healthcare delivery isn’t the only factor withholding telehealth services, said Rashid Bashshur, University of Michigan Health System executive director for ehealth. Medicare procedures contain restrictive language for billing and reimbursement for telehealth services, he said. Medicare’s telehealth “use in this country is extremely limited,” he said. In 2013, only $12 million was billed for Medicare telehealth services, he said. “So, basically, it’s not being used for Medicare,” interjected Rep. Joe Barton, R-Texas. “Because of the restrictions based on it, yes,” Bashshur responded.
Rep. John Dingell, D-Mich., asked whether Alaska and Hawaii -- exempt from these billing rules -- use more telehealth as a result. “Yes,” Bashshur concurred, agreeing with Dingell the two states could be a model for the rest of the country on Medicare billing language.
The Telehealth Enhancement Act of 2013 (HR-3306) aims to recraft the telehealth language in Medicare and Medicaid rules and rectify this issue, said a sponsor, Rep. Gregg Harper, R-Miss. Research is still nascent on the benefits of remote patient monitoring, said Mehrotra. “We need more population-based quality measures."
Lawmakers also showed concern for telehealth’s privacy effectiveness. “Many of the telehealth platforms” are now compliant with the privacy requirements in the Health Insurance Portability and Accountability Act, said Jones. “It is the emerging standard."
The FTC has been touting its growing research focus on health data privacy, hiring noted health data flow researcher Latanya Sweeney as chief technologist (CD April 21 p8), and organizing a May 7 seminar on the issue. Thursday, the FTC said she will give the event’s opening presentation on health data sharing (http://1.usa.gov/1lDDxnp). “Many of these products and services help to empower people to be healthier, but what happens to all that data,” asked a Thursday blog post (http://1.usa.gov/1o75uno) by FTC Attorney Kristen Anderson of the Privacy and Identity Protection Division. “Who has access to the information and what are they doing with it?” The seminar will add to the FTC’s research on these issues, Anderson said.
At the hearing, lawmakers said Congress could help advance telehealth privacy. Rep. Michael Burgess, R-Texas, recalled having a medical professional tell him, “You've gotta define privacy and stop changing your minds every three months.” Pallone acknowledged “we have a lot of work to do, but I hope that we can still find common ground.”