Telehealth is exploding in both popularity and use as it has shown to be convenient, affordable and of high quality. On both a federal and Tennessee level, the field of telehealth continues to gain attention and garner changes in the law.
In Tennessee, a telehealth bill (HB0699) was signed into law by the Governor on April 24. The legislation is in response to the Tennessee Board of Medical Examiners’ attempt to issue rules governing telemedicine in 2014. Those proposed rules contained several controversial elements, including a requirement that physicians must conduct a face-to-face examination prior an initial telehealth encounter. In addition, the proposed rules allowed only real-time patient encounters and mandated follow-up, in-person visits at least every fourth encounter or annually.
If enacted, the telehealth bill would define “telehealth” or “telemedicine” broadly to mean “the use of real-time audio, video, or other electronic media and telecommunications that enable interaction between the healthcare provider and the patient, or also store-and-forward telemedicine services . . . for the purpose of diagnosis, consultation, or treatment of a patient in another location where there may be no in-person exchange.” Moreover, the bill restricts the Tennessee Board of Medical Examiners from establishing more restrictive standards of professional practice for telehealth than are permitted by the telehealth bill.
And, in Texas, the Texas Medical Board voted on April 10 to limit severely the ability of physicians in the state to provide two fundamental components of primary medical care via telemedicine – telemedical diagnoses and telephonic or video drug prescriptions.
On a federal level, in a move that took more than a decade to accomplish, on April 14, the U.S. Senate voted to repeal the sustainable growth rate (SGR) formula that adjusts Medicare payments to physicians. The bill was signed into law on April 16 by President Obama. Members from both sides of the aisle praised the passage of the bill, known as the "Medicare Access and CHIP Reauthorization Act of 2015" (MACRA).
The SGR plan addresses telehealth in several ways. First, MACRA addresses reimbursement for telehealth in alternative payment models. Although Medicare Part B generally reimburses for remote patient visits only when the healthcare facility is located in a health professional shortage area or an area outside of a metropolitan statistical area, MACRA would allow Medicare telehealth reimbursement in other areas through “alternative payment models” established by CMS, such as so-called “next generation” ACOs. Second, MACRA requires CMS to implement a “merit-based incentive payment system” where physicians could receive a payment adjustment based in part on scores in performance categories that include clinical practice improvement activities. This provision creates the potential for providers to receive incentives for coordinating care through remote monitoring or telehealth despite the fact that Medicare reimbursement may not otherwise be available. Finally, MACRA portends the positive future for federal and state telehealth reimbursement by instructing the GAO to complete studies and issue reports on telehealth services in Medicaid and Medicare and on remote patient monitoring technology within two years of the legislation’s enactment.
April 2015 certainly saw some showers of federal and state legislation that are just part of the unleashing of the rapid gush of telehealth across the landscape of healthcare.