4/16/2008
The Centers for Medicare & Medicaid Services (CMS) has published a new regulation establishing Part D e-prescribing standards for four types of information. The new rule will go into effect on April 1, 2009. According to HHS Secretary Mike Leavitt, establishing standards for e-prescribing under Medicare's prescription drug program will help pave the way for the widespread adoption of e-prescribing throughout the medical community.
This regulation applies to:
- Formulary and benefits: This standard will enable doctors and other prescribers to find out information on what drugs are covered by a Medicare eligible individual's prescription drug benefit plan
- Medication history: This standard will enable doctors, other providers, as well as dispensers to communicate about prescribed medications a beneficiary has taken or is taking including those prescribed by other providers
- Fill status notification: This standard will enable doctors and other providers to receive an electronic notice from the pharmacy or other dispenser telling them that a patient's prescription has been picked up, not picked up, or has been partially filled
- Provider identifier: The final rule requires providers, dispensers, and Part D sponsors to use the NPI to identify individual healthcare providers in Part D e-prescribing transactions.
For more information, please visit
www.cms.hhs.gov/EPrescribing.
(Source: Federal Telemedicine Update, April 7, 2008)
4/16/2008
The Federal Communications Commission has extended for three years the eligibility of certain rural health care provider organizations to receive subsidized funding of their telehealth/telemedicine initiatives under the federal telecommunications universal service program. The FCC in March 2005 changed its definition of "rural" health care facilities and temporarily grandfathered some organizations that technically no longer qualified for the subsidies. The FCC has extended that grandfather period to 2011, according to a final rule published April 10 in the Federal Register.
Acting under a request from the American Telemedicine Association, the FCC noted "in its petition, ATA identifies multiple health care facilities that participate in telehealth communications networks in Nebraska and Montana that would be adversely affected by the loss in universal service rural health care funding if the new definition of rural were applied to their rural health care funding applications," the FCC noted in the rule. "This, in turn, would serve only to endanger the continued availability of telemedicine and telehealth services that these health care facilities provide."
Consequently, the FCC believes more time is needed to evaluate the effect of the new definition before any providers lose eligibility. Further, the FCC is in the midst of a major, heavily funded telehealth pilot program with 69 rural health organizations. The program is designed to help facilitate creation of a nationwide broadband telehealth network linking rural and urban providers.
(Source: Health Data Management, April 10, 2008)
3/22/2008
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ATSP Urges Support for OAT Funding
The Association of Telehealth Service Providers is
supporting the effort to increase funding for the
Office for the Advancement of Telehealth (OAT) from $6.8 million to $13.8 million in Fiscal Year 2009. OAT works to increase and improve the use of telehealth to meet the needs of underserved people, including those living in rural and remote areas, those who are low-income and uninsured or enrolled in Medicaid.
OAT promotes the use of telehealth technologies by:
- Fostering partnerships within HRSA, and with other Federal agencies, states and private sector groups to create telehealth projects.
- Administering telehealth grant programs.
- Providing technical assistance.
- Evaluating the use of telehealth technologies and programs.
- Developing telehealth policy initiatives to improve access to quality health services.
- Promoting knowledge exchange about "best telehealth practices."
Increasing OAT funding will allow the Department of Health and Human Services to expand support for telehealth grant opportunities for demonstrations and model projects. In addition, it will provide continued support for telehealth resource centers, telehealth and home telehealth pilot projects, and grants to state health licensing boards.
3/22/2008
Congress is currently in the process of drafting appropriations legislation to provide federal spending for fiscal year (FY) 2009, which will begin on October 1st of this year. Last year, the telehealth community galvanized a strong grassroots advocacy campaign in support of increasing funding for the Office for the Advancement of Telehealth (OAT). Hundreds of individuals and institutions contacted Congress urging that OAT funding be increased. These grassroots efforts resulted in the Senate voting to approve an amendment boosting OAT funding from $6.8 million to $13.8 million. While this increase was unfortunately not retained in compromise negotiations with the House of Representatives, the Senate vote was proof that Congress will act to support telehealth when they hear from constituents in their states and districts.
Members of the telehealth community are urged to reach out to Congress and urge that telehealth receive the support it deserves. A $13.8 million budget for OAT will significantly advance telehealth in the United States.
If you are willing to have your name added to the list of those supporting an increase in telehealth funding, please send an email to info@telehealthleadership.org including your name, title, organization, and address. This information will be used to add your name to the letter. Please also contact your two senators and urge them to add their names to a joint letter being circulated by Sen. Debbie Stabenow of Michigan and Sen. John Thune of South Dakota urging that telehealth funding in the FY 2009 Labor-HHS bill be raised to $13.8 million.
With the telehealth communities grassroots efforts, funding for this critical telehealth agency can be increased.
(Source: Bob Waters, Partner and Chair, Telehealth, E-Health Law & Government Relations Groups
Drinker, Biddle & Reath, March 21, 2008)
3/1/2008
An
Oregon bill that would allow mental health patients in 18 rural counties to receive treatment via teleconferencing has been approved by a Oregon Senate committee, but must clear the budget-writing Ways and Means Committee. The "telemedical access bill" would link patients with licensed mental health specialists via a video link-up from a secure facility.
Local doctors could in turn confer with Oregon Health and Sciences University (OHSU) psychiatrists in Portland for treatment options. OHSU operates a telehealth program that has served, among others, victims of Hurricane Katrina.
The chief sponsor is Sen. Jason Atkinson, R-Central Point, who was elated when the Senate Health Policy Committee sent the measure, SB1100, out Monday evening.
"They (OHSU) found that it's worked fantastically well when the privacy was there, and the physician was in a clinical environment," Atkinson said. "I've got to put that same option in the hands of local providers in outlying areas of Oregon."
He said his bill could provide world-class clinical medical care to rural people.
As originally introduced, the bill included all health services, with an estimated price tag pegged at $900,000 by the Legislative Fiscal Office. As a result, Atkinson scaled it back.
(Source: Medford Mail Tribune, February 13, 2008)
Blue Shield of California Foundation (BSCF) recently announced the award of $13.1 million in grants to nonprofit organizations and programs to improve the quality of patient care through health technology.
The telemedicine related grants include $350,000 to the California Health Foundation and Trust to expand its telemedicine program by increasing the number of telemedicine providers and offering technical assistance to those in the field. Telemedicine is vital in rural, underserved areas.
(Source: BSCF Press Release, February 26, 2008)
The New England Telehealth Consortium has won a $24.7 million grant – the largest single grant awarded – as part of a national Federal Communications Commission program aimed at beefing up rural telecom health efforts. The telehealth consortium consists of 31 members, representing 555 health-care sites in Maine, New Hampshire and Vermont.
The New England consortium award will be used to build an information health-care network throughout New Hampshire, Maine and Vermont. All told, the FCC has dedicated $417 million over three years for rural health efforts at 69 regional or statewide sites across the country.
The New England award will give all qualified rural and urban nonprofit health-care providers in the consortium an 85 percent cost reimbursement for consortium-covered project costs. Projects may include network design, services and equipment to build a broadband telehealth network in northern New England.
The funding will be used to connect providers with high-speed Internet service to allow for such things as faster uploading of patients’ records and better access to health care resources across the state and the nation.
“The goal of the New Hampshire Telehealth Program is to maximize the use of cost-effective telehealth technologies in the Granite State,” said Dr. Louis Kazal, director of the telehealth program. “The FCC award is a major step toward fulfilling that mission.”
According to Jim Rogers, CEO of ProInfoNet and founder of the consortium, the grant is “a huge step forward toward advanced health-care technology in rural New England.”
He said the consortium “will be the least expensive way to bring telemedicine services to Northern New England, since we now have both funding and buying power due to our large numbers and our ability to coordinate services through the New England Telehealth Consortium.”
He said initial sites are expected to be up and running by the summer.
(Source: New Hampshire Business Review, February 15, 2008)
The
University of Virginia's telemedicine program is growing. The latest addition allows physicians to examine patients remotely at a Grayson County clinic The University of Virginia started a telemedicine service in 1996 at Lee County Regional Hospital and is now connected to 60 sites. Most of them are in southwest Virginia, which has fewer medical services than the rest of the state.
Officials say physicians have used telemedicine to examine more than 11,300 patients so far. Setting up a telemedicine site can cost up to $25,000 but the patient's bill for an examination is the same as if it were face to face. Special funds are available to pay for patients without insurance.
(Source: Associated Press, February 24, 2008)
Without ever leaving the nursery, babies born at Adena Regional Medical Center in Chillicothe,
Ohio, are receiving clinical assessments from specialists an hour away at Columbus' Nationwide Children's Hospital. High-definition videoconferencing capabilities are making the assessments possible via the Ohio Supercomputer Center.
The project enables specialists in Columbus to view distressed newborns with exceptional clarity, examine detailed X-rays, view lab results and consult with attending physicians in Chillicothe in real time.
"Telemedicine dramatically increases the care of our youngest patients," said Dr. John Fortney, medical director for Adena Health System. "If we're looking for help with a diagnosis, someone from Children's -- whether it's a neonatologist or a sub-specialist, such as a pediatric cardiologist -- will see the patient and speak to the attending physician in real time.
"Currently, information is relayed by telephone, which means it's subject to interpretation," Dr. Fortney explained. "With high-definition videoconferencing, specialists can make a more thorough evaluation."
Adena Regional Medical Center was selected for the pilot because the hospital sends more pediatric patients to Nationwide Children's than any other outside of the Columbus metropolitan area. In the center's first year of operation with telemedicine, physicians were able to make quicker and more accurate clinical assessments via videoconferencing, especially regarding the need to transfer these critical care newborns.
"If a baby needs to be moved to our facility, doctors have seen the child, reviewed their diagnostic images and can prepare for the infant's care as soon as he or she arrives," said Stephen Welty, MD, chief of neonatology, Nationwide Childrens Hospital. "Just as importantly, we also use this as a tool to determine if a baby doesn't need to be transferred. Then, the child can stay with family and avoid unnecessary stress."
Recently, the Federal Communications Commission's Rural Health Care Pilot Program awarded $417 million to 69 projects around the nation to "significantly increase access to acute, primary and preventative health care in rural America." Three of those projects serve Ohioans by providing high-speed connections to health care facilities in nearly half of Ohio's 88 counties.
Those three regional telehealth networks will connect to Broadband Ohio's backbone to transport data traffic between regions in Ohio, as well as to use OSCnet to access Internet2, the primary national research and education network in the country. This fulfills a key requirement of the grant -- that the health care traffic be able to flow across the country from Ohio.
"Just as OSCnet provides the higher education community with a backbone that allows it to share critical education material around the state of Ohio, it will provide a network infrastructure to help make the Broadband Ohio initiative a reality for state-supported hospitals to access advanced telemedicine applications," said Stan Ahalt, executive director of the Ohio Supercomputer Center.
(Source: ADVANCE for Health Information Executives, March 1, 2008)3/1/2008
The U.S. Department of Health and Human Services (HHS) recently released a fact sheet on their new broadband initiative. In November 2007, HHS Secretary Mike Leavitt and Federal Communications Commission (FCC) Chairman Kevin J. Martin
announced a coordinated effort to deploy broadband access to rural and underserved communities with a particular focus on reaching health care providers. The FCC has awarded over $417 million for the construction of 69 statewide or regional broadband telehealth networks in 42 states and three U.S. territories. This Rural Health Care Pilot Program will support the connection of more than 6,000 public and non-profit health care providers nationwide to telehealth networks to improve patient care.
HHS programs and priorities benefiting from broadband / health IT include:
Indian Health Service (IHS)
Health care is being improved in all 12 areas of the Indian Health Service (IHS). Leading clinical telehealth applications include: teleradiology, telecardiology, telebehavioral health, teledermatology, and teleophthalmology.
The IHS-JVN (Joslin Vision Network) Teleophthalmology Program demonstrates how broadband can be used to deliver innovative services.
- Patients in 57 Indian health facilities spanning 15 states currently receive comprehensive diabetic eye care services through the program.
- To date, the program has performed more than 21,000 remote interpretations from a distributed tele-ophthalomology reading center in Arizona.
- The IHS-JVN program demonstrates how telehealth-based services can help identify, manage, and prevent diabetic retinopathy - a leading cause of blindness for American Indian and Alaska Native people.
Broadband also enables critical capacity for health IT systems that support daily health service delivery across the Indian health system through the IHS Resource and Patient Management System, the IHS Electronic Health Record, the VA VistA Imaging program, and the Alaska Federal Health Care Access Network.
The Health Research and Services Administration (HRSA)
HRSA works to increase and improve the use of health IT to meet the needs of underserved people, including those who are uninsured, isolated or medically vulnerable. Over the past 10 years, HRSA has invested more than $100 million in health IT improvements in Community Health Centers to help improve patient care as well as the centers' financial and business operations.
In Fiscal Year 2007, HRSA awarded 63 new grants, valued at more than $56 million, to advance health IT and telemedicine in health centers and Critical Access Hospitals in 35 states and the District of Columbia. These funds will support EHRs in more than 170 health centers representing over 900 sites and serving more than two million patients. The grants will also support the establishment of 16 regional health information exchange pilots that link primary, post-acute, acute, and tertiary care providers to improve coordination of care in these rural communities.
In addition, in FY 2007, HRSA provided over $6.8 million dollars for specific grants and contracts to advance the use of telehealth services around the nation.
- Sixteen grants were awarded to assist communities in developing advanced telehealth networks in rural communities and to evaluate the use of home-telehealth services in rural communities;
- Two grants were awarded to overcome licensure barriers to the effective use of telehealth services; and
- Six grants funded centers of excellence to provide technical assistance to communities in developing telehealth services across the nation.
The Agency for Healthcare Research and Quality (AHRQ)
AHRQ, along with HRSA, launched a health IT Community Web portal for safety-net providers. The portal provides a virtual meeting place for users who share documents and exchange tools and resources on designing, implementing, and using health IT. To date, about 2,000 health centers, primary care associations, and maternal and child health grantees are using the site.
AHRQ's mission is to improve the quality, safety, efficiency and effectiveness of health care for all Americans. Since 2004, AHRQ has funded over 175 projects and demonstrations in the form of grants, contracts and cooperative agreements to advance health IT and telemedicine. These projects focus on the impact of health IT and telemedicine on the quality, safety, effectiveness and efficiency of health care and best practices that can improve quality of care. Funding for these projects totals $216 million with projects in over 40 states and territories.
Outcomes from AHRQ-funded projects indicate improvements in patients' health status and experiences with the health care system.
A project in Minnesota demonstrated that remote pharmacy services provided to rural hospitals during irregular hours can more effectively detect and prevent dangerous medication errors than traditional methods whereby pharmacists manually review "night and weekend" orders first thing in the morning before turning to day shift activities.
A project in New York demonstrated that remote pediatric care can treat common childhood illnesses from schools and child care centers. This helped parents avoid missing work, and reduced unnecessary trips to the emergency room.
A project in New Mexico demonstrated that telemedicine can effectively support rural primary-care clinicians in caring for patients with chronic, common, and complex diseases by delivering case-based information and support.
A project in Oklahoma has helped patients in rural parts of the state receive better quality of care -- including treatment for previously undetected diabetes and faster healing of wounds - when home health care workers were connected remotely with specialists, including certified wound care nurses and endocrinologists. A combination of images from digital cameras, video phone encounters, and access to electronic health records was used to improve care for home-bound and nursing home patients with wounds that are difficult to diagnose and treat.
AHRQ's telemedicine projects depend on quick and efficient access to critical health information for clinicians. This access to images, EHRs, and decision support is best facilitated by broadband connection to hospitals, physician offices, and public health departments. This access can also reduce health care disparities by providing high-quality and safe health care services for patients who cannot always travel the great distances sometimes required to receive appropriate care.
The entire HHS Broadband Fact Sheet is available online on the
HHS website.
(Source: HHS, February 21, 2008)
2/11/2008
So far in 2008, a number of bills and acts are under consideration in some of the state legislatures concerning a variety of topics that relate to telemedicine, electronic medical record systems, research, prescriptions, task forces, commissions, and broadband adoption.
The bill (HB 16) was introduced in the Utah House to allow telemedicine to be used for certified services to be reimbursed under the State Medicaid plan. The Colorado legislature is also considering legislation to allow for telemedicine mental healthcare services under the Medicaid program.
The state of Tennessee is considering (SB 3122) to allow health centers with registered nurses or certified pharmacy technicians to dispense prescription drugs without the direct on premises supervision of a pharmacist. This bill would allow a pharmacist to provide the needed supervision by being available via telemedicine. When providing this distance supervision, the pharmacist would have to be on duty at an appropriate pharmacy facility.
The state of Oklahoma is considering (HB 3368) to create the Oklahoma Rural Health Policy and Research Center at the Oklahoma State University College of Osteopathic Medicine. This bill would improve rural healthcare delivery in the state by coordinating rural medical education, telemedicine, research, and healthcare policy.
The state of Oklahoma is also considering (HB 2788) to create the KidSafe Child Abuse Task Force. The Task Force would have nine members and one member would be the Provost of the University of Oklahoma Health Science Center or a designee from the telemedicine department.
The bill (AB 1391) introduced in New Jersey’s legislature would establish the New Jersey Health Information Technology Commission in the Department of Health and Senior Services. The Commission would collaborate with the Office for e-HIT in the Department of Banking and Insurance to educate the public. Information would be distributed on the value of health IT, how to improve patient care, the process on developing healthcare policymaking, and data would be provided on clinical research, healthcare financing, and quality improvements. The Commission would also study the need to promote national standards for an interoperable system.
In Florida, the bill (HB 637) would expand access to a patient’s medical records to facilitate the electronic exchange of data between certain healthcare facilities, practitioners, and providers, and attending physicians. The proposed legislation would create the “Florida eHealth Initiative Act” and establish the Electronic Medical Records System Adoption Loan Program.
Several pieces of legislation are under discussion in the New York that would authorize an electronic medical records system when dispensing certain controlled substances and would authorize physicians with patients receiving Medicaid to dispense prescriptions through such systems.
The Kansas legislature is considering several bills (HB 2645) to establish a Broadband Technology and Application Advisory Council. The Council members would be both technology providers and users with knowledge of emerging technologies and innovative applications.
(Source: Federal Telemedicine News, January 26, 2008)
2/11/2008
The University of Virginia School of Law recently hosted a talk by Gil Siegal, a visiting law professor and director of the Center for Health Law and Bioethics at Ono Academic College in Israel. Siegal, who has both an M.D. and an LL.B. from Tel Aviv University, spoke about the promise of telemedicine and the legal issues it entails.
“The law,” said Siegal, “is the single biggest thing standing in the way of the promise of telemedicine.”
Indeed, legal issues seem to plague the nascent field at every turn. How do you establish a worldwide standard of care for practitioners? Can you sue the Internet company if the connection drops in the middle of your carotid endarterectomy? What are the proper jurisdiction and choice of law rules when the doctor is in Ohio, the patient is in Cambodia, the computers are in the Cayman Islands, and the medical corporation that organized it all is in New York?
The law is actually starting to answer some of these questions, if slowly. The well-developed areas, such as jurisdiction, are easier. The contacts test in International Shoe can be applied to any party that may face liability. Courts seem to have little issue with the use of forum selection clauses in agreements for treatment. Informed consent, though obviously more complicated, retains its familiar outlines. But areas where there is still little consensus in traditional medicine present larger problems. The two most contentious are licensure and reimbursement.
Typically, explained Siegal, physicians must be licensed in each state in which they practice. There are no national standards, and practicing without a license is a criminal offense. There are some exceptions, made for consultations or limited work performed by famously skilled practitioners, and a small number of states do recognize each other’s licensing credentials. Nonetheless, systems of reciprocity and endorsement are patchwork at best and are almost nonexistent on the international level. For a tele-doc to obtain the proper certification in all 50 states, let alone the rest of the world, it would be immensely time-consuming and costly, and even a single jurisdiction normally takes too long for the process to work on an ad hoc basis.
Siegal pointed out that there have been some attempts to simplify things by establishing a special license for telemedicine as opposed to medicine generally, or to exempt doctors working in such a capacity from laws prohibiting the unauthorized practice of medicine. Authorities are understandably wary of both. The most promising prospect is for the federal government to establish nationwide standards, but doing so will take time.
Even if doctors are licensed, however, they still have to get paid. Insurance companies like things simple, and because of the legal uncertainties discussed above, few are willing to shell out for the services of a far distant dermatologist, even when they agree that you should really have that rash looked at. Things are even worse when the government is asked to foot the bill.
“Medicare and Medicaid don’t want to pay for any of this stuff,” Siegal complains, “even when it will save them money. Medicaid spends $51 million a year transporting patients to see doctors, but they won’t pay for a $100 teleconsultation.”
Most schemes, public and private, will only reimburse patients who live in rural areas, but the definition of “rural” is shockingly narrow and changes from agency to agency and from company to company.
Despite all these hurdles, Siegal remains optimistic. The gains for society are obvious, and as awareness of the possibilities grows, demand will provide a strong impetus for progress in the legal and regulatory spheres. Telemedicine will become commonplace; it’s just a matter of when.
“When you guys become legislators,” he quipped to the law school audience, “fix some of this stuff.”
(Source: Virginia Law Weekly, February 1, 2008)2/11/2008
In recent weeks, Aetna Inc., the nation's largest insurer, and Cigna Corp. have agreed to reimburse doctors for online visits. Other large insurers are expected to follow, experts say. These new online services, which typically cost the same as a regular office visit, are aimed primarily at those who already have a doctor.
The virtual visits are considered best for follow-up consultations and treatment for minor ailments such as colds and sore throats. But some specialists, including cardiologists and gynecologists, also see these e-mail tete-a-tetes as ideal for periodic checkups that don't require in-person visits.
"People can wait a long time to get in to see their primary-care doctor and longer for a specialist. . . . To have immediate access is huge," said Dr. Melissa Welch, Aetna's Northern California medical director.
As more doctors move online, others are looking further ahead and adding webcams to their online arsenal, even if the video quality remains spotty.
Dr. Christy Calderon, a family physician at Kaiser Permanente's Whittier office, conducts as many as half her appointments over the phone or online with a 3-inch camera affixed to her desktop. "It adds a more personal touch," she said.
Although actual doctor visits aren't likely to disappear, the recent moves are evidence that long-delayed efforts to bring American medicine into the digital age may be gaining momentum, experts say.
"Paying doctors to do more patient care over the Internet is a small but important step in a good direction," said David Cutler, a Harvard University healthcare economist. "It increases patient access and could significantly improve their satisfaction."
If so, it comes at an auspicious time.
Doctor visits in the United States have surged 20% in the last five years to more than 1.2 billion visits annually, according to the Centers for Disease Control and Prevention. Even as the population ages, the number of doctors is falling across the country, and experts predict that office wait times will increase in the coming years.
Meanwhile, at-home devices that remotely check patients' blood pressure and diabetics' sugar levels are becoming cheaper, and tech leaders Google Inc. and Microsoft Corp. are expected to introduce products this year to simplify patient care and put medical records online, although neither company plans to assist in online physician appointments.
Critics, including many doctors, contend that online medical care carries risks. Some worry that mistakes are bound to happen and that the practice raises several hard-to-answer ethical questions.
"It's perfectly appropriate that we use 21st century technology in the 21st century," said California Medical Assn. President Dr. Richard S. Frankenstein, an Orange County pulmonologist. "The concern I have is that [online visits] are simply not a substitute for an actual doctor."
And experts caution that this may not be a money saver. Healthcare costs could increase if the new technology leads more patients to seek care more often.
By the time San Francisco consultant Meg Young got to Boston on a chilly night last winter, she was running a 102-degree fever. She considered going to the emergency room. Instead, she went online in her hotel room.
The 40-year-old technology expert booked a visit with her primary-care doctor at Stanford University Hospital. After Young filled out a form and described her symptoms, he diagnosed a bacterial infection, prescribed an antibiotic from a drugstore near the hotel and suggested she get some rest.
"I couldn't have been happier to not sit in some hospital for half the night," Young said.
Doctors and patients have many ways to communicate over the Internet. Some doctors and their office staffers already e-mail patients free of charge, especially when it involves minor questions or prescription refills.
Most of the new online consultations are far more structured than a simple e-mail. If insurance companies are expected to pay the bill, physicians need documentation of the event, including diagnosis and time spent.
As a result, companies have emerged to help doctors handle this. They typically arrange the online visits, maintain records and handle insurance reimbursements, patient co-payments and other payments.
To begin using these online services, patients visit a doctor's website or go directly to one of the Internet companies that handle such services -- for example, RelayHealth Inc. or Medem Inc.
Doctors are typically encouraged to respond to patients within a day; they receive an e-mail reminder if they haven't, with a phone call on the second day. Prices can vary from $25 to $125, which patients pay with a credit card at the end of the session.
Allison Holt, 47, of Santa Ana said she was "completely sold" on online healthcare and didn't plan to visit her doctor in person anymore if she could help it.
The former human resources manager began using online appointments in May, after a long-simmering back problem flared up.
Holt has had two full check-ups since then and occasionally e-mails her doctor with minor questions or to request a prescription refill.
The visits cost $25 and are not covered by her insurance.
"When I used to call his office, the staff would take a message, wait for a reply and then call me back when they had time," she said. "Now I get an e-mail by the end of the day."
Even with major insurers signing on, it remains to be seen whether a large share of the public will embrace Internet medicine. Surveys show that many patients and doctors remain uncertain whether the technology is right for them. Also still on the sidelines is the federal Medicare agency, which pays about half the nation's doctor bills.
Recently, some smaller insurers that began reimbursing for online consultations stopped doing so because few members used the service.
(Source: Los Angeles Times, February 4th, 2007)1/9/2008
The Centers for Medicare & Medicare Services (CMS) recently announced in that the neurobehavioral status exam (Healthcare Common Procedure Coding System (HCPCS) code 96116) has been added to the list of Medicare telehealth services. Previously, CMS determined that, if the eligibility criteria, and conditions of payment are satisfied, the use of a telecommunications system may substitute for a face-to-face, "hands on" encounter for consultation, office visits, individual psychotherapy, pharmacologic management, psychiatric diagnostic interview examination, end stage renal disease related services, and individual medical nutrition therapy.
When billing this code as a Medicare telehealth service, you must append modifier GT (“telehealth service via interactive audio-video telecommunication system”), and all other criteria for telehealth reimbursement under Medicare must be met as set forth in the Medicare Benefit Policy Manual (Publication 100-02, Chapter 15, Section 270) and the Medicare Claims Processing Manual (Publication 100-04, Chapter 12, Section 190).
HCPCS code 96116, neurobehavioral status exam, involves clinical assessment of thinking, reasoning and judgment per hour of a psychologist's or physician's time.
More information is available in this
Medicare Learning Network article number MM5628 [pdf].
(Source: California eHealth and Telemedicine Center News, January 3, 2008)
