The Latest in Remote Presence.

Yulun Wang, Ph.D., Chairman & CEO of InTouch Health and President-Elect of the American Telemedicine Association

By Yulun Wang, Ph.D., Chairman & CEO of InTouch Health

The need to provide high quality healthcare to everyone, while reducing costs, has reached a crisis level where it is a major focus at the highest government level.   More and more politicians and healthcare leaders are realizing that telemedicine is clearly a cornerstone of the solution.  This is tangibly seen by the increasing number of healthcare systems that are adopting telemedicine, by the growth of ATA, and by industry investing in telemedicine products and services.  I believe that telemedicine is now reaching an “inflection point” where the industry will grow at an exponential pace.  We are realizing that if one can bring the right clinical expertise, to the right place, at the right time, to make the right medical decision in a cost effective manner; quality can be improved while cost lowered.

Although the concept of telemedicine is simple and elegant, implementing telemedicine can be complex and messy.  This is not unexpected as fundamental change in any industry is never easy and without obstacles.  As one works to implement telemedicine in order to benefit from this enabling technology, one quickly uncovers the many challenges in actually building telemedicine programs.   Barriers created by existing payment structures, regulatory policies, IT architectures, corporate boundaries, resistance to change, and technology limitations, all need to be overcome.   It is these barriers or challenges, coupled with the significant potential value that can be created, which makes telemedicine ripe for innovators and entrepreneurs.   I believe that with persistent innovation, usually accompanied with the risk of capital, entrepreneurs can overcome these barriers and unleash the benefits of telemedicine into our healthcare delivery system.

To succeed in creating positive change I believe in the “divide and conquer” theory.  Trying to orchestrate a singular fundamental change to our healthcare delivery system to incorporate telemedicine systemically is too monumental a task, and will likely fail.  The pathway for entrepreneurs to innovate successfully is to find appropriately sized healthcare workflow challenges which can benefit from telemedicine solutions, and then work to gain adoption by healthcare providers.   With adoption, the entrepreneur can continue to build on that success and expand the vision and market opportunity.

As the telemedicine industry grows, applications are partitioned into two broad categories differentiated by the health status and location of the patient.   The first category we call “acute care telemedicine”, in which telemedicine is used to enable remote clinicians to immediately diagnose and treat sick patients.  These patients may be very sick and require immediate help from a specialist who is difficult to access.   The second category can be called “chronic disease management telemedicine”, where telemedicine is used to periodically and regularly monitor and manage a person’s chronic illness.

The needs of the telemedicine solution and the economic model vary greatly across these two categories.    Telemedicine solutions for acute care must enable a remote clinician to be interactively present in the patient environment and gather pertinent medical information through examination and data access to form a medical decision. Often, this decision can have significant (e.g. life or death) consequences.   If the remote clinician is the physician-in-charge, then the system must enable the physician to lead and establish dominion over the complete environment.  Conversely, telemedicine for chronic disease management generally does not require acute medical decision making, and the interactions are more coaching and mentoring in nature.    These solutions often connect healthcare providers into patient’s homes and therefore must scale cost effectively to a single patient/single system mode.

Telemedicine entrepreneurs should identify opportunities where they can innovate manageable-sized solutions that create significant value for the healthcare providers.  Still change is always difficult, particularly in the field of medicine where process and procedures are honed and perfected over decades to insure every patient receives consistently high quality care.   Therefore the solution must solve the problem in its entirety for adoption to occur.  For example, solutions should not be limited to technology alone, but rather need to be coupled with clinical protocols, business plans, training and implementation services, regulatory assistance, and even the ongoing monitoring and measuring of the solutions impact.  The level of multi-disciplinary depth and detail required to facilitate a change can tax even the most persistent entrepreneurs.

Healthcare is in a seismic state of transition that hasn’t been seen for many decades.  The fundamental goal of changing from “fee for service” to “fee for value”, and competitive pressures re-aligned to drive continued improvement of the quality/cost value curve, is enabling telemedicine to transition from a research topic to mainstream medicine.   Generational changes like these happen infrequently, and should be embraced by adventurous entrepreneurs.  We are at a time when the need for innovation and entrepreneurism in telemedicine is at a maximum!

A bill before the Indiana state legislature requires Medicaid to reimburse for telemedicine services provided to all rural health clinics.

For those of us who’ve been waiting for meaningful telemedicine legislation at the state level, there’s cause for celebration. Eight states and the District of Columbia have already introduced bills this year aimed at expanding telemedicine reimbursement from both Medicaid and private insurers. And the ATA estimates that another ten states will follow suit in coming months.

Much of the proposed legislation draws heavily from the ATA’s recommendations for what constitutes a model telemedicine bill. This succinct document gives lawmakers some statehouse-friendly language on how to expand telemedicine coverage by health plans, HMOs, Medicaid and home health.

Legislators in Mississippi and New Mexico deserve kudos for introducing two new bills, presumably to widen the discussion to ensure that the final bill is comprehensive. The bills would require all health insurance plans to cover telemedicine services to the same extent as those provided in-person.

In Florida, House bill 499 would require both health insurers and Medicaid to provide coverage for telemedicine services, and would extend Medicaid telemedicine coverage to home care. A bill in Indiana goes a step further, requiring Medicaid to reimburse for telemedicine services provided to all rural health clinics.

Proposed legislation in the state of Washington would greatly reduce hospital compliance requirements when granting privileges or associations to telemedicine physicians. And the South Carolina bill has language requiring both individual plans and HMOs to provide telemedicine coverage.

It’s looking like 2013 will indeed be a watershed year for far-reaching telemedicine legislation. You can feel the momentum in states both red and blue. Politicians are very sensitive to the winds of change, so now’s the time to contact your state legislators and keep the pressure building. This could be our year!

It’s not often that a new bill introduced in the U.S. House of Representatives has the ATA shouting “Hallelujah!” But that’s the response so far to a recent measure sponsored by Rep. Mike Thompson (D-Calif.). It may be the most sensible and comprehensive telemedicine legislation ever introduced in the halls of that gridlocked chamber.

The Telehealth Promotion Act of 2012 (H.R. 6719) brilliantly addresses the two chief roadblocks in telemedicine: reimbursement and licensure. Plus it goes much further, calling for some long-needed improvements to existing programs. If enacted, Thompson’s bill would extend the benefits of telemedicine to nearly 75 million Americans by increasing access through Medicare, Medicaid, the VA, Children’s Health Insurance Program, and other federal programs.

ATA chief executive Jon Linkous has called the bill “a panacea for federal involvement in telemedicine, eliminating archaic barriers and expanding opportunities for remote healthcare.” Here are some key provisions in the bill:

• Ensuring that no federally covered benefit can be excluded because it’s furnished via telemedicine

• Allowing telemedicine providers in all federal health plans to be licensed solely in the state where they’re physically located and would be free to treat eligible patients anywhere in the nation

• Providing new incentives for hospitals that lower readmissions with telemedicine

• Exempting ACOs from telehealth fee-for-service restrictions

• Creating a Medicaid telemedicine option to handle high-risk pregnancies

We need to do more than applaud Rep. Thompson’s boldness and vision. Now is the time to urge your U.S. representative to join in this common-sense effort to remove the biggest obstacles to telemedicine. Let your elected leaders know that telemedicine has the power to dramatically decrease federal health spending. That’s music to the ears of legislators on both sides of the aisle.

Thompson’s bill is smart and far-reaching. His colleagues can help restore some of the tattered credibility on Capitol Hill by swiftly passing it this year.

When we recently spoke with the ATA’s CEO Jon Linkous, he said there are plenty of unlikely allies helping to champion telemedicine. On the surface, some of these alliances are head-scratchers. But if you reflect for a moment, you’ll see that telemedicine companies share a common cause with these groups:

NOBEL/Women – No, this isn’t a group of prize winners like Madame Curie. The acronym stands for the National Organization of Black Elected Leaders/Women. They come from the ranks of both state and federal government, and they’re passionate about improving the quality of health care in urban communities. Many people assume that telemedicine mainly benefits rural patients, but many inner-city folks are equally underserved. Many NOBEL women are already sold on the benefits of telemedicine, and they know how to get things done in the halls of power.

Trial lawyers – They’re not the most beloved group inAmerica, but they’re quickly helping to establish telemedicine as a standard of care. In Linkous’ view, attorneys’ efforts may ultimately be more fruitful than trying to get laws passed. Several large hospitals have already had to make large out-of-court settlements because attorneys argued that by not offering telemedicine, the facilities didn’t provide the needed level of care to stroke patients.

Hospitals that do national branding – Linkous notes that highly regarded health systems like The Cleveland Clinic and the Mayo Clinic Care Network are promoting their telemedicine programs in national branding campaigns. When prestigious organizations start practicing and promoting telemedicine nationwide, the rest of the healthcare field takes notice.

If you’re a telemedicine crusader, it’s easy to feel like the Lone Ranger sometimes, but take heart.  You have a host of powerful new allies.  Reach out to them, and be grateful for their help.

As you might expect, American Telemedicine Association CEO Jon Linkous has many insights on telemedicine’s biggest challenges and its winning strategies. This blog will examine one of the challenges, and next week we’ll look at the unlikely allies who are helping advance the cause of telemedicine.

When we spoke to Jon recently, he felt that poorly informed state medical boards constitute telemedicine’s biggest hurdle at the moment. They’re still basically clueless about many aspects of telemedicine, and that’s why the rules concerning multi-state licensure are still in the Stone Age.

But Linkous rightly maintains that medical board bureaucrats (like all bureaucrats) can eventually change their minds if they get the proper education and persuasion. The key here is consistent, ongoing outreach to medical boards – and we all have a role to play.

Be an advocate for telemedicine at your state’s next medical board public meeting.

Every state medical board (and some states have more than one) hosts a monthly meeting open to the public – with schedules released far in advance. So it’s quite easy for telemedicine advocates to get on the agenda in their respective states. Like Woody Allen once said, “Ninety percent of success is just showing up.”

It’s really that simple. First, find out what your state board’s telemedicine policies are by clicking on this link: http://www.fsmb.org/pdf/grpol_telemedicine_licensure.pdf

Then use the link below to find the address and meeting schedule for your state board:

http://www.fsmb.org/directory_smb.html

Many of the board officials know less about bandwidth than your teenagers, so be patient. You may encounter people who think that if Hippocrates didn’t need telemedicine, neither should we. But don’t forget that many modern legislative miracles – like the Americans with Disabilities Act – were the result of many years of persistent plugging and nonstop education.

We all need to double-down in our efforts to educate state medical boards. This is one battle that can’t be won by giving it a “tele” prefix. You must be present to win.