A generally accepted maxim in health care: Where Medicare goes, the rest of the country follows.
If a bipartisan effort in Congress is successful, Medicare and the rest of the country are headed for wider, deeper use of telemedicine.
Only about 20% of the country's Medicare beneficiaries have access to telemedicine because of restrictions limiting funding to rural areas, according to legislators. The Medicare Telehealth Enhancement Act introduced last week would expand Medicare reimbursement to the other 80% of the country and encourage in other ways the remote monitoring of patients using telecommunications technology.
Co-authored by two Democrats and two Republicans, HR 2068, coupled with funding for telemedicine expansion in the American Recovery and Reinvestment Act, could usher in a new era for telemedicine in the U.S.
"We certainly hope so," said Gary Capistrant, senior director for public policy of the American Telemedicine Association. "We definitely like this bill and see it as a continuation of previous efforts to deal with restrictions on Medicare funding."
In addition to lobbying for HR 2068, the American Telemedicine Association intends to argue its case before the Senate Finance Committee, which is dealing now with the first wave of arguments over comprehensive health care legislation.
"Medicare will play an important part in the overall health reform debate, and we plan to be making suggestions to [Senate Finance Committee Chair Max] Baucus [D-Mont.] and his committee during that debate to make sure telemedicine is incorporated," Capistrant said.
'We Need To Use Smart Innovations'
Two Democratic representatives -- Mike Thompson from California and Bart Stupak from Michigan -- co-authored HR 2068 with two Republicans -- Sam Johnson from Texas and Lee Terry from Nebraska.
"As health care becomes more expensive, we need to use smart innovations such as telemedicine technology to help lower costs and expand access for all Americans," Thompson said in a prepared statement.
"Allowing doctors to remotely monitor a patient who has congestive heart failure not only helps the patient stay healthy, it also reduces costly visits to the emergency room. The Obama administration has indicated that telemedicine will be an important part of their health care reform agenda, and I look forward to working with them to expand access to this important technology," Thompson said.
Last summer, Congress passed the Medicare Improvement for Patients and Providers Act, which included provisions expanding the types of facilities authorized to provide telemedicine services. This bill is aimed at expanding Medicare's geographic and demographic designations for telemedicine.
"Where you live shouldn't determine the quality of health care you receive," said Johnson. He added, "Technology has advanced to allow doctors to take care of patients in any location. It's time to modernize Medicare to make it even more accessible."
Where Telemedicine Has Shown Promise So Far
Telemedicine has been shown to be effective in providing better management of chronic diseases, reducing emergency department admissions and lowering costs in some instances. Telemedicine proponents say it also can play an important role in addressing physician shortages in rural areas by bringing physician specialty services to remote and underserved communities. In addition, faster diagnoses enabled by telemedicine can get patients care more quickly, proponents say.
However, limits on Medicare reimbursement for telemedicine services prevent the technology from spreading, legislators said.
"Telemedicine is a critical piece to the future of health care," Terry said, adding, "By using telemedicine we can increase the efficiency of health care while keeping costs down especially to our rural areas of the country."
According to the four lawmakers, the bill would:
- Eliminate geographic restrictions on reimbursement for telemedicine;
- Authorize $30 million in telehealth grant and resource funding by creating a new grant program worth $10 million, and reauthorizing two existing programs -- the Telehealth Network Program and the Telehealth Resource Centers Program -- each with $10 million in funding;
- Expand coverage of telehealth services to home health services and remote patient monitoring; and
- Expand eligible health care providers to include all Medicare providers.
ARRA Funding Another Boost
The economic stimulus package specifies substantial resources for the promotion of telemedicine and the establishment of infrastructure to make it work.
ARRA includes $7.2 billion to support broadband deployment, including telemedicine and educational systems.
"There's no question that the stimulus bill will help telemedicine expand, but there are some questions about the details of how exactly it's all going to happen," Capistrant said, adding, "We're helping our members understand what the opportunities are in the stimulus funding, but we're also waiting for various agencies to come out with specific guidelines."