Telemedicine Bill Is a Good First Step
Democratic Congressman Mike Thompson of California, a member of the House Ways and Means Subcommittee on Health, has introduced a bill in the U.S. House that may have a chance of passage. Everyone should understand this is only the first step, albeit a significant one, but there is no guarantee that it will get through the House. (See below for an Update.)
The Telehealth Promotion Act of 2012, officially known as House Resolution 6719, would establish a federal support and payments policy for telemedicine. Since 2001, Medicare has had these foolish abritrary location restrictions that discourage physicians from seeing patients telemedically. Medicare reimbursements for telemedicine have only been available to physicians who see patients located 25 miles outside a metropolitan area in a medically underserved area. And a telemedicine process called "store and forward" which relates to medical images is only reimbursed in Alaska and Hawaii. Neither of these restrictions makes a bit of sense, especially when you understand why Medicare administrators demanded they be included in the law: they thought that physicians would "overuse" telemedicine. Somehow, they convinced the Government Accounting Office that even with the restrictions reimbursements for telemedicine would run $30million a year the first five years, when in fact research by the Center for Telemedicine and eHealth Law (CTeL) shows the total cost of telemedicine reimbursements from 2001 t0 2012 was only $20million.
Still, the fear of uncontrollable spending haunts any "new" program on Capitol Hill, and it may be tough convincing other lawmakers in the House, especially Republicans, who are sharpening their pencils to cut federal spending in exchange for raising the debt ceiling. In the two weeks since Representative Thompson introduced the bill on December 30th, I haven't seen any stories about Republicans signing on as co-sponsors. Could that be because the Library of Congress has not received the bill from the Government Printing Office? Perhaps. I "googled" it and found it on the GPO's Web site
. (If it were a bill that I introduced, I would certainly feature it on my Web site. If you go to Thompson's Web site
, however, there is no mention of it as of the time this post was published - nothing - nada, even though the "Latest News" and "Press Releases" sections have been updated as of January 4th.)
The other aspect of the bill is an extension of what the VA is already doing regarding physician licensing and credentialing. Let's say a physician is licensed by the Vermont Board of Medical Practice. He can work at any VA medical center outside Vermont without holding a license from the state medical board where his office is located. Seeing patients off federal property is a no-no, unless the physician has the license for that state. Telemedicine allows a veteran to go to a CBOC (Community Based Outpatient Clinic) and see his doctor telemedically, instead of driving in to the medical center in a large urban area.
The proposed legislation would remove the licensure restrictions for federal employee health plans, the Children's Health Insurance Program, and TRICARE as well as the VA. This is the part of the bill that could run into opposition from state medical boards and/or the Federation of State Medical Boards (FSMB) once its impact on state licensure funding is understood. But this measure at least doesn't immediately aggravate the FSMB like the proposed draft that Democratic Senator Tom Udall of New Mexico began floating in 2011. He never introduced his plan for a "tandem medical license" because it called for more government spending and another layer of federal bureaucracy; thus, no Republican member signed on. His own state's medical board opposed it. The best thing you can say about Udall's bill is that it did draw some attention to telemedicine nationally.
UPDATE: Since Representative Thompson introduced the bill on the last day of the 112th Congress, it doesn't carry over to the 113th which convened January 3rd. During a Webcast to ATA members, Jonathan Linkous, President of the American Telemedicine Association (ATA), pointed out that unlike other telemedicine legislation introduced in the past, Thompson's is a comprehensive bill aimed at removing healthcare restrictions. He called it a "stake in the ground" and "a very important step forward" that Thompson would reintroduce soon. Gary Capistrant, Senior Director of Public Policy for the ATA who was also on the Webcast, said the idea was to "put some specifics out there" so that other lawamkers would "pick up parts and repackage them" in legislation.