My CMS News and Ideas on Telemedicine in Florida

October 20, 2015

What Exactly is Telehealth?

Filed under: Uncategorized — cbondsullivan @ 12:59 pm

20 October 2015

Pinning down a definition of Telehealth versus Telemedicine can be quite difficult – even though it seems pretty apparent what we are talking about. But it isn’t. Here are some of the definitions attempted in Florida in the last year. These are important because they will tend to describe the boundaries within which doctors practice:

American Telemedicine Association – What is Telemedicine?

…telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.

Florida Senate – SB 1646 – 2014 Legislative Session

“Telemedicine” means the practice of medicine through the use of advanced communications technology by a telemedicine provider at a distant site…

CS/SB 478: Telehealth  and CS/HB 545: Telehealth  – 2015 Legislative Session

(a) “Telehealth” means the use of synchronous or asynchronous telecommunications technology by a telehealth provider to provide health care services, including, but not limited to, patient assessment, diagnosis, consultation, treatment, and monitoring; the transfer of medical data; patient and professional health-related education; public health services; and health care administration…

Florida Board of Medicine – 64B8-9.0141

“Telemedicine” means the practice of medicine by a licensed Florida physician or physician assistant where patient care, treatment, or services are provided through the use of medical information exchanged from one site to another via electronic communications.

Each of these definitions puts a somewhat different spin on the use of telecommunication technologies by doctors. Each definition adds something of value, but each is limited by its own perspective. A different approach to defining telehealth might be sought in the use cases for telehealth. It is the application of the technologies of telehealth that describes what telehealth is, not necessarily the technologies….

October 15, 2015

Entering a New Telehealth Season in 2015

Filed under: Uncategorized — cbondsullivan @ 7:20 pm

The Telehealth scene in Florida is starting to heat up as 2015 draws to a close. In the Florida Legislature, two bills, CS/HB 545 & CS/SB 478, had passed their committee hearings, and were heading toward consolidation when the legislative session ended.  According to Senator Arthenia Joyner, who sponsored telehealth bills in 2014 and 2015, a new telehealth bill will be on the floor in the 2016 session of the Florida Legislature.

In September, Florida TaxWatch held its second Cornerstone Telehealth Conference in Orlando to shine a light on policy issues in telehealth and to recap the legislative efforts to craft a telehealth bill in 2015.  TaxWatch has been active for several years tracking the movement of telehealth bills through the Legislature. As good summary of the 2015 legislative session in Florida can be found here:

At the beginning of October, the FCC came to Florida, holding meetings in Miami and Jacksonville. The goal was to promote broadband for telehealth. The meeting in Miami was held for vendors and the one in Jacksonville was for providers. I attended this one and it yielded some eye-opening use cases for the benefits of telehealth. I will report on this conference in later blogs. Of course, the first question is “Why is the FCC addressing Telehealth?” More later…

In December the Southeastern Telehealth Resource Center will be holding the Second Annual Telehealth Summit in Winter Park.  This meeting brings anyone interested in Telehealth together for a day and a half. Topics on the agenda include policy, outcomes, payment models and legal issues in telehealth, a poster session for telehealth researchers and a technical telehealth hands-on demonstration lab after the conference. More later…

April 9, 2014

Who Gets to Be a Telemedicine Provider in Florida?

Filed under: Uncategorized — cbondsullivan @ 7:09 pm

Senate Bill 1646 was heard before the Senate Appropriations Subcommittee on Health and Human Services on April 9, 2014. Senator Bean provided an amended bill that altered a number of differences to bring it more in line with the House Bill 751. The new language was an attempt to resolve an interesting discussion that is shaping up in the Legislature over who gets to use telemedicine services and who doesn’t.

The initial Senate bill included all health care professionals as providers of telemedicine services. After several hearings this language was restricted to MDs and DOs only, much to the dismay of the Advanced Registered Nurse Practitioners (ARNPs) and Physician Assistants (PAs). The House had a different idea and allowed medical and osteopathic doctors, chiropractors, podiatrists, optometrists, nurses and dentists health care professionals to provide clinical services over a telemedicine link. Senator Bean’s amendment was an attempt to take the two competing bills and integrate them into an acceptable bill that the entire Legislature could vote on. During today’s committee hearing there was clear push back from radiology and other professional medical groups against letting anyone but a doctor provide telemedicine services.

A major sticking point with the “who gets to be a telemedicine provider” debate was the issue of out-of-state doctors. This debate has swirled around liability insurance, lawsuits, having to be licensed in Florida or being affiliated with a Florida hospital. There was a clear sentiment that neither the Florida Legislature nor the Florida Board of Medicine would have control over out-of-state doctors. Senator Bean’s amendment softened the requirements that had been included in the original bill, not requiring the out-of-state doctors to carry liability insurance or pay a fee to practice over telemedicine in Florida. An interesting argument by one of the committee members was that medical practice in Florida should be done by Florida doctors, overlooking the obvious benefit of telemedicine that would allow consultation services to medical experts anywhere in the country.

Opening up telemedicine services to doctors only did not seem to bother the committee. Reducing the controls over out-of-state doctors did create problems. Senator Bean’s amendment received an unfavorable vote, and the language as passed by earlier committees was passed – along with an amendment to limit the ability of out-of-state doctors to practice telemedicine with Florida patients.

This is just one of a number of interesting debates surrounding this bill. Next in line for discussion will be: “who gets to pay for telemedicine services.”

March 27, 2014

Telemedicine Issues in the Florida Legislature

Filed under: Uncategorized — cbondsullivan @ 3:09 pm

Both the Florida House and Senate committees have voted to move their respective telemedicine bills on for further consideration this Legislative session. From the support they have garnered, it looks as though the State of Florida will see a change in the law that will require reimbursement for telemedicine services.

The initial bills introduced into the Legislature equated a telemedicine visit with a face-to-face visit with a physician for purposes of reimbursement.  The focus of the bills was on defining telemedicine and establishing who could use – and be reimbursed for – the service. In subsequent debates, this focus changed, in part because of expected agendas of different players but also because the differences between a telecommunicated office visit and an in person encounter started to become clearer.

As everyone who has implemented an electronic health record system into a physician’s practice, technology is disruptive and a change agent. It is not neutral. The use of telecommunications-based technology can dramatically increase the geographical accessibility and reach of both physician and patient, which changes the face-to-face relationship between doctor and patient. Telemedicine allows for detailed visualization when used with advanced video capabilities and increased medical information if complemented with a health information exchange feed.

It is quite interesting to watch how certain issues have come up for discussion in both the House and Senate. These have addressed:
1) Eligibility for telemedicine services
2) Health plan reimbursement equivalency
3) Prescribing over telemedicine
4) Out-of-state physicians offering telemedicine services
5) Malpractice insurance for telemedicine

There is a lot to write about. More to come.

March 15, 2014

The Florida Legislature Mulls Telemedicine in the 2014 Legislative Session

Filed under: Uncategorized — cbondsullivan @ 5:36 pm

The idea of telemedicine as a viable extension of health care treatment is starting to be noticed among Florida’s politicians. Both the Florida House and Senate have submitted bills to promote the use of telemedicine services by mandating that health care insurers treat a telemedicine visit as equivalent to a face-to-face office visit and reimburse a doctor accordingly. Of course there are any number of points of debate, which will presented in the days to come. But right off the top are: Who gets to provide telemedicine services? Doctors only or other clinical professionals like ARNP? Are the insurance payments equivalent or will each health care provider contract for telemedicine reimbursement separately? Can controlled substances be prescribed over a telemedicine visit? These and other questions will surely be addressed in the weeks to come.

The House has introduced a bill: HB 751. The Senate has introduced SB 1646. These bills have major differences in length, depth and number of issues addressed. To give an example of the differences, here is the way both bills define Telemedicine Services:

House Bill 751

(a) “Telemedicine” means the use of synchronous or asynchronous telecommunications technology by a telemedicine provider to provide health care services. The term does not include audio-only telephone calls, e-mail messages, or facsimile transmissions.

Senate Bill 1646

(11) “Telemedicine” means the practice of medicine through the use of advanced communications technology by a telemedicine provider at a distant site in compliance with federal and state privacy and confidentiality requirements and encryption standards. Services provided through telemedicine may include patient assessment, diagnosis, consultation, treatment, prescription of medicine, transfer of medical data, or other medical-related services. The term does not include audio-only calls, e-mail messages, or facsimile transmissions. Telemedicine includes telehealth and telemonitoring.

If telemedicine reimbursement is to become law this session, these two bills will have to be integrated and then pass the vote of both chambers. If one or the other bill passes – or a combination of the two – the resulting statute will be a game changer for health care in Florida.

More to come.

Telemedicine Matters

Filed under: Uncategorized — cbondsullivan @ 3:55 pm

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