When the Ford Motor Company announced plans in mid-May to partner with at least three companies to develop healthcare apps for the company's car-based platform, telemedicine experts around the country offered a hesitant smile. Could this be the big break they've been waiting for?
Could telemedicine finally gain mainstream attention?
Long thought to be stuck in the realm of academic medical universities and small-scale pilot projects, telemedicine – and telehealth, and mHealth, and all the other names being used for this wide-ranging healthcare field – may be turning a corner, thanks to some high-profile implementations.
Telehealth has become a favorite topic of conversation for, among others, the nation's chief technology officer, Aneesh Chopra, who spoke at last year's American Telemedicine Association (ATA) conference. This year, ATA's 16th international meeting and exposition, held May 1-3 in Tampa, Fla., drew close to 5,000 attendees, placing it among the top 10 healthcare-related conferences in the nation. And telehealth has attracted the attention of the Centers for Medicare & Medicaid Services (CMS), which recently relaxed its rules on credentialing to allow hospitals to engage in telemedicine-based consults with physicians in other parts of the country.
"CMS' new rules will truly help patients receive the care they need, no matter where they live or where their doctor is located," said Dale Alverson, MD, former ATA president and medical director of the Center for Telehealth and Cybermedicine Research at the University of New Mexico's Health Sciences Center. "By eliminating the overly-burdensome credentialing and privileging rules in Medicare, CMS has shown its growing support of telemedicine."
The CMS ruling is expected to boost a program overseen by the Department of Health and Human Services' Health Resources and Service Administration, which has awarded grants to the Federation of State Medical Boards to help states set criteria to allow physicians to practice across state lines. According to an HRSA report issued to Congress, cross-state licensing "is seen as one element in the panoply of strategies needed to improve access to quality care services through the deployment of telehealth and other electronic practice strategies." To date, eight states have established licensing criteria.
Add to that separate projects by UPMC, Kaiser Permanente, the Mayo Clinic, the University of Miami and the Ford announcement (Toyota and GM are expected to announce similar projects soon), and telemedicine may finally be finding the spotlight.
Missing: Monetary Incentive
Ironically, while the ATA was trumpeting CMS' decision, a panel discussion at the May conference was taking the federal government to task for not including telemedicine or telehealth in the meaningful use program – thus depriving healthcare providers of valuable financial incentives contained in the HITECH Act.
There's "no real inclusion for telemedicine and telehealth" in the incentives designated by the American Recovery and Reinvestment Act for adoption of healthcare IT, said Neal Neuberger, executive director of the Institute for e-Health Policy and president of Health Tech Strategies.
Neuberger called on the Office of the National Coordinator for Health IT (ONC), headed by Farzad Mostashari, MD, to set the stage for increased acceptance of telemedicine.
"I think we need a grand vision that takes the long view as far as transforming healthcare outcomes, quality, efficiency, cost, and access," he said.
To be fair, the HITECH Act did include some consideration for telemedicine in the Beacon Community Program. According to Yael Harris, director of the HRSA's Office of Health IT and Quality, four community-based collaboratives in San Diego, Indiana, Utah and North Carolina, have received funding to incorporate telemedicine technology into programs.
The question of cost – not only of paying for telemedicine projects, but finding the reimbursement value – continues to plague the industry. Some vendors, like Arizona's Stat Health, are targeting businesses with an online doctor service in hopes of convincing them that paying a telemedicine fee will reduce employee health insurance and lost productivity costs over the long run. Others are exploring "pay-per-consult" plans, in which physicians set a price for their services, whether they're delivered online, by text message, or in person.
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