Bill seeks to expand use of telemedicine

It’s a trend, but a slow one

Sen. Kent Conrad (D-ND) has introduced the Comprehensive Telehealth Act of 1999, which would force the Health Care Financing Administration to expand its current policy of reimbursing physicians who use telemedicine technology to treat Medicare beneficiaries.

One of the bill’s main goals is to reverse a HCFA decision to restrict reimbursement of telemedicine services to so-called "teleconsultations," which involve real-time interaction of physician, consulting physician, and patient. Many telemedicine experts say this policy prohibits the most useful form of telemedicine — the capacity to "store and forward" case information to a consulting physician anywhere in the world.

HCFA is reportedly concerned that reimbursement of store-and-forward telemedicine technology would create more opportunities for fraud and abuse in the Medicare program.

Conrad also is lobbying HCFA to expand its definition of telemedicine to include store-and-forward technology, arguing that this was the intent of Congress in the Balanced Budget Act of 1997, which launched a demonstration of the technology and its use in health professional shortage areas.

Provisions in Conrad’s legislation include:

Reimbursement of telehealth services. This provision would require HCFA to reimburse under Medicare all regular services, even if these services are received using telehealth technology.

Licensure. While not proposing that the federal government pre-empt state-level licensing of health professionals, Conrad wants the Secretary of Health and Human Services to "look into easing the licensing burdens of telehealth practitioners who now are forced to be licensed in every state they administer telehealth services."

Reports to Congress. This provision calls for a coordinated study effort among the Office of Advancement of Telehealth, the Department of Agriculture, and the Veterans Administration, along with regular reports to Congress on the development of the service.

Development of telehealth networks. The bill would authorize grants and loans administered by the Office of the Advancement of Tele health to spur the development of local multi-use telehealth systems.

Current telemedicine spending modest

Current industry estimates place the maximum reimbursement level for existing services from U.S. telemedicine programs at only $4.2 million in 1997.

According to Global Telemedicine Group in McLean, VA. the present telemedicine reimbursement landscape looks like this:

    — Ten states (Arkansas, California, Georgia, Iowa, Kansas, Montana, North Dakota, South Dakota, Virginia, and West Virginia) reimburse telemedicine expenses under Medicaid, provided the health care agency or institution can document that the use of telemedicine saved the agency money. However, as there is no standard reimbursement fee, it is up to each state to determine how much it will pay.

    — Medicare operates four demonstration sites in West Virginia, Iowa, North Carolina, and Georgia. Experts contend these findings will alter HCFA’s current stance against home telemedicine reimbursement.

    — Commercial insurers have sometimes been reimbursed for home telemedicine when those services are bundled with conventional services.

    — A few states have passed legislation relating to telemedicine. However, as of mid-1998, none has specifically targeted coverage for home telemedicine.

    — Certain HMOs have started telemedicine programs for selected members, typically those with chronic diseases. To date, no long-term initiatives have been taken.

Total 1998 and 1999 telemedicine service payments are estimated to be less than $10 million annually, according to Feedback Research Services, a Jacksonville, OR, research group that follows telemedicine issues.