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More About the Telemedicine Bill Introduced by Rep. Thompson

Thanks to Jonathon Linkous and Gary Capistrant, we now have a better understanding of the comprehensive telemedicine bill, H.R. 6719, introduced by Congressman Mike Thompson.

Linkous is the President of the American Telemedicine Association (ATA) and Capistrant is the Senior Director of Public Policy for the ATA. During a Webcast for ATA members yesterday, they unpacked the bill.  There are two important sections of the comprehensive telemedicine bill which will be reintroduced in the new session of Congress by Thompson sometime in the next couple of weeks.  The first has to do with Medicare and reimbursements which have disincentivized telemedicine for years.

Presently, the law regarding Medicare reimbursements restricts them to physicians seeing patients 25 miles outside metropolitan areas in underserved medical areas.  For a metroplex like Phoenix which stretches through the Salt River Valley and beyond, that means a doctor in Surprise (on the northwest of Phoenix) cannot see Medicare patients telemedically in Queen Creek (on the southeast) and be reimbursed, even though the distance is 75 or 80 miles.  As a result doctors who have satellite offices in the Phoenix area have to split their hours - three days a week at one location, two days at the other.  Telemedicine would not only let them see patients at either location, in-person or telemedically on the same day, but it would also encourage other physicians to open satellite offices in large metropolitan areas, thus expanding the access to healthcare.

Medicare also discourages remote patient monitoring.  Eleven years ago, when the reimbursement legislation was signed into law, the "medical home" was theoretical; now, it appears to be a fait accompli.  The storing and forwarding of medical images is only reimburseable in Alaska and Hawaii.  H.R. 6719 would clear away these restrictions and more.  Instead of saying what will not be reimbursed like the current Medicare law, Thompson's bill would simply state that if Medicare reimburses for an in-person medical treatment, it will reimburse it for telemedicine because it is all healthcare.

I think this part of the bill is a no-brainer.  Other parts make sense, but they will likely face opposition from stakeholders like state medical boards.

The bill seeks to redefine the location of "medical practice."  Currently, the accepted standard by medical boards around the country is that the physician is practicing medicine where the patient is; thus, the physician must have a valid state license there, or otherwise he (or she) is practicing medicine illegally.  The Thompson bill would borrow a concept from the recently approved STEP Act which allows a physician to see any Department of Defense patient anywhere in the country, as long as the doctor holds a valid license in at least one state.  In other words, the medical practice would be where the doctor is located, not the patient.  This change would allow a physician to see patients telemedically wherever they are, no additional state license would be needed.

Here's why this concept poses a problem for state medical boards. Medical board budgets are directly or indirectly related to licensure fees.  In Arizona, for example, the medical board retains 90% of the biannual licensure fee for staffing, for license investigations, and for investigations of complaints against doctors.  Of the some 21,000 licensees, about a third do not practice medicine in the state.  Some may have moved into administration positions. Most live and practice somewhere else, but maintain their Arizona licenses.  If the medical practice location is redefined, multiple licenses become unnecessary and the medical board will undergo a sizeable budget cut.

In other states, licensure fees go into the state's general fund.  Medical boards present a budget to lawmakers and receive an allocation from their legislatures.  They would face a similar budget cut if there was a sudden drop in licensees in other states.

The other problem that a redefinition presents concerns jurisdiction.  A medical board can only investigate complaints against its licensees.  For illustration, if a North Carolina-licensed doctor commits unprofessional conduct with a patient in Tennessee whom he sees telemedically, the Tennessee Board of Medical Examiners would be unable to investigate the case.  The North Carolina Medical Board may never know that one of its licensees has done something harmful to the patient.  If it were notified, investigating the complaint might require unbudgeted expenses and produce unexpected delays, and therefore be too expensive and ineffective.  Of course, this is all hypothetical.  The number of telemedicine-related complaints around the country is very, very small, perhaps because of licensure restrictions.  But who knows how many there might be in the future if Congress redefines the location of a medical practice.

We may know more about the reaction of medical boards to the Thompson bill this spring in Austin, Texas.  The ATA has extended ATA2013, its international meeting, an extra day.  On May 8th, ATA members will meet with lawmakers and medical board representatives from around the country.


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