Survey Reveals Positive Views For Telehealth, Part II

From Ross Perot to the fictional J.R. Ewing from Dallas, business people rule the roost in Texas. And their powerful voices are providing strong tailwinds for telehealth in the Lone Star state.

The Texas Association of Business (TAB) recently published a report called “Telemedicine: The 21st Century Answer To The Call For Better Healthcare.” In our previous blog, we discussed why patients across Texas are pumped about the prospects for telehealth. Now let’s take a look at what influential business leaders are saying:

  • A Texas-size 77% favor using telehealth to diagnose common medical conditions.
  • 70% feel that access to providers has gotten more difficult in recent years.
  • 18% of Texas companies surveyed already offer telehealth as part of their health benefit programs.
  • Of that 18%, a unanimous 100% of the companies plan to continue offering telehealth benefits – and 24% plan to expand their current programs.
  • 66% received positive feedback on telehealth from their employees – and not a single employer received negative feedback.

States like Texas, California and New York are early adopters who greatly influence initiatives in the other 47 states. It’s not surprising that those three states have already passed telehealth parity laws, encouraging holdout states like Utah and Wisconsin to join their ranks.

When the Texas business community wants something, they get it – usually without delay and they’re demanding a wider use of telehealth technology. Why would J.R. Ewing drive from Dallas to Ft. Worth to see a specialist when telehealth is available?

Skype Is Still Scary

It’s hard to believe that some health systems are still relying on Skype for remote consultations. This Microsoft-owned technology is great for chatting for free with a friend in Sweden, but it’s not even close to being HIPAA compliant.

Hoala Greevy, CEO of an encryption company called Paubox, recently concluded that “Skype is not HIPAA compliant, and if you’re a covered entity (hospital system or payer), stay away from it.”

The HIPAA Omnibus Rule requires all healthcare providers and their associates that transmit Protected Health Information to have Business Associate Agreements (BAAs) in place. But Microsoft doesn’t have any BAAs for Skype. In fact, one Oklahoma doctor was recently sanctioned for using Skype, mainly because there wasn’t a BAA covering its usage.

Then there’s the issue of data security. Skype was hacked last year by a group calling itself the Syrian Electronic Army. Despite that ominous name, the hack wasn’t exactly sophisticated. CNN reported that it was a simple “phishing” scam, where Skype users clicked on an email link and revealed their names and passwords.

Bear in mind that the average cost of a data breach is now roughly $3.8 million. The cost per compromised record is highest in healthcare: about $363 per record. So even a relatively small breach of 500 patient records would cost over $180,000 (not counting possible lawsuits), and the hospital’s name would get listed on Health and Human Service’s infamous “Wall of Shame.”

In an era when there are superb, HIPAA compliant telehealth networks, it’s hard to fathom why any health system would take the huge financial risk of using Skype.

Communication software isn’t “free” if it leaves an organization vulnerable to multi-million dollar data breaches and regulatory penalties. Don’t give your CFO and legal staff an unnecessary headache. Steer clear of Skype.

Doctor with notebook

FDA Cleared Devices Only

Navigating the OIG for Telemedicine

As hospitals are rapidly adopting acute care telemedicine it is easy to see why healthcare organizations are reaching out to attorneys well versed in telemedicine law.

The Office of the Inspector General (OIG) vigorously enforces the Anti-Kickback (AKB) Statute intended to root out fraud and abuse in the healthcare system. It is worthwhile noting that the OIG issued an advisory statement that recognized the cost-saving potential of telemedicine and indicated they would not prosecute any hub/spoke relationship that balances what each party contributes. Nonetheless, these hub/spoke contracts must be carefully constructed with regard to federal AKB law.

When properly structured based on legal advice and appropriate intention, a hub hospital can in most cases subsidize a significant portion of a spoke hospital’s acute care telemedicine program with very low AKB risk.

Healthcare organizations should be very careful in crafting these contracts since a violation of AKB law is a criminal offense that can result in fines and even jail sentences. Every detail of a hub/spoke contract should be thoroughly evaluated by legal professionals with expertise in telemedicine and e-health law.

And please remember: this is NOT legal advice. It’s just a blog letting you know that the AKB waters can be successfully navigated. But please don’t make that journey without legal counsel.

Bipartisan Agreement…Amazing!

The 2013 Congressional agenda was marked by gridlock and disagreement on many fronts. That’s why it’s encouraging that 2014 is starting in a more gracious, bipartisan spirit – especially when it comes to telemedicine.

A lot of the credit goes to Sen. John Thune, the South Dakota Republican who could be a surprise contender for the 2016 Presidential nomination. But Thune is getting a lot of help from Senate Democrats like Oregon’s Ron Wyden and Michigan’s Debbie Stabenow.

Early this year, the Senate Finance Committee took two bold and unexpected moves: approving Thune-authored amendments that would improve Medicare coverage for telemedicine services. The first lifts restrictions on the use of telemedicine for any health system using an alternative payment model (such as ACOs) beginning in 2017. The second establishes a Medicare demonstration program for remote patient monitoring by home health agencies and other entities.

The proposed lifting of restrictions on ACOs and medical homes is a huge victory for telemedicine advocates because it would allow those entities to have the same telemedicine flexibility enjoyed by Medicare’s managed care plans.

The two amendments ensure that Sen. Thune’s Fostering Independence Through Technology Act (S.596) and other measures can move forward this year. It’s heartening that legislators from both sides of the aisle are becoming ardent telemedicine supporters. So here’s the Bipartisanship Honor Roll with regard to telemedicine:

Republicans – Thune, Roberts, Enzi.

Democrats: Wyden, Stabenow, Rockefeller, and Casey.

Telemedicine advocates have worked tirelessly to advance these amendments, and we salute the Senate’s “Magnificent Seven” for working together as colleagues, not combatants.

Strange Bedfellows Indeed

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.