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U.S. Congressman Mike Thompson (D-CA05) is preparing to re-introduce the remaining provisions from the Telehealth Promotion Act (H.R. 6719) from the previous Congress.  He would like to know any comments you have by Monday May 5.

His letter inviting comments (with info about how to submit) is at http://www.americantelemed.org/docs/default-source/policy/telehealth-advocates and his draft bill is at http://www.americantelemed.org/docs/default-source/policy/thomca_044_xml-discussion-draft.
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The Tennessee Board of Medical Examiners has issued a notice of rulemaking hearing (0880-02) regarding telemedicine practice guidelines.  The hearing is scheduled on May 19th at 2pm CDT, and the deadline for public comments is May 2nd.

The Board's proposal is timely, considering that the TN General Assembly recently passed and subsequently sent to the Governor a telehealth parity bill for private insurance, Medicaid and state employee plans.  Despite the forward thinking action by the legislature, the Board's proposal would create additional barriers and more stringent standards for all physicians practicing telemedicine in Tennessee.

The Board's proposal outlines the following changes:
  • Requires a face-to-face examination before a telemedicine encounter if there is no existing relationship;
  • Requires a health care provider to be present with the patient during a telemedicine encounter;
  • Creates the exemptions for the following providers:
  1. Physicians with established relationships with their patients are exempt from these requirements, but must meet with their patients in-person annually or every 4th encounter; 
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The Federation of State Medical Boards (FSMB) has issued proposed regulations for telemedicine.  The 8-page FSMB proposal is available at www.assets.fiercemarkets.com/public/newsletter/fiercehealthit/fsmbreg.pdf.   

The next procedural step for the draft is an April 25 meeting of the FSMB Reference Committee that will hear in-person comments.  The proposal will be considered for a vote at the Federation’s April 24-26 Convention in Denver. 

It is important that ATA members know about the proposal as it has important implications for providers of remote health services in every state.  ATA’s Board of Directors is reviewing the proposal and may issue a comment as well as participate in the FSMB hearing.  If you have comments you would like to share with ATA, please email them to me at gcapistrant@americantelemed.orgAlso, members
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The Department of Health and Human Services just released a draft report that includes a proposed strategy and recommendations for a health information technology (health IT) framework, which promotes product innovation while maintaining appropriate patient protections and avoiding regulatory duplication.

The congressionally mandated report was developed in consultation with health IT experts and consumer representatives and proposes to clarify oversight of health IT products based on a product’s function and the potential risk to patients who use it.  The report was developed by the U.S. Food and Drug Administration (FDA) in consultation with 2 other federal agencies that oversee health IT: HHS’ Office of the National Coordinator for Health IT (ONC) and the Federal Communications Commission (FCC). The FDA seeks public comment on the draft document.

Press release is at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/UCM390988.htm
Report

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If anyone has any recommendations for a telehealth consulting firm for a start-up company please send me their names and contact information. I'm looking for a whole package or a la cart services to get a telemedicine service up and going from the ground.

Thanks

Shawn Akhavan, MD
shawnakhavan@gmail.com
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The U.S. Food and Drug Administration is proposing to amend regulations for classification of medical devices to conform to provisions in the FDA Safety and Innovation Act of 2012. They also propose changes to codify the procedures and criteria that apply to classification of devices and to provide for classification in the lowest regulatory class consistent with the public health and the statutory scheme for device regulation.

The deadline for public comments is June 23.

The proposed rulemaking is at
http://www.gpo.gov/fdsys/pkg/FR-2014-03-25/pdf/2014-06364.pdf.
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All,

Rick, here are some references and one grant we have done on e-consults; may not be exactly what you do but some good papers to document your work and a small literature on 'curbside' consults.  Maybe you, I and a few others should submit a presentation or workshop/symposium next year?

We did the following:
1. E-consult multiple specialty,
2. Psych e-consult, and 
3. Incorp the idea into other grants as 'stepped care' approach.

Considerations:
1. Getting folks to use it is usually the problem, as they 'add' to time of busy day.  Your program has too many consults --> warm line with 7d turn around?  
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Colleagues, 
We are organizing a Special Interest Meeting at the upcoming ATA meeting in Baltimore.  
The goal of this meeting is to organize our thoughts on an operational standard for inpatient telemedicine model of care for general neurology.   

Please feel free to comment if you have had success in implementing a general neurology model of telemedicine. 

We feel that our collective thoughts would be helpful in creating standard of care for a comprehensive model of care for tele-neurology.   
Please let me know if you are interested in attending this SIG meeting and I will arrange and post exact times and dates. 

Thank you
Nima Mowzoon, MD
Telespecialists, LLC
ceo@tele-specialists.com
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Colleagues, 
We are organizing a Special Interest Meeting at the upcoming ATA meeting in Baltimore.  
The goal of this meeting is to organize our thoughts on an operational standard for inpatient telemedicine model of care for general neurology.   

Please feel free to comment if you have had success in implementing a general neurology model of telemedicine. 

We feel that our collective thoughts would be helpful in creating standard of care for a comprehensive model of care for tele-neurology.   
Please let me know if you are interested in attending this SIG meeting and I will arrange and post exact times and dates. 

Thank you
Nima Mowzoon, MD
Telespecialists, LLC
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Link to more information -- http://www.dcregs.dc.gov/Gateway/NoticeHome.aspx?noticeid=4741862

The Government of the District of Columbia, Department of Health (DOH), Community Health Administration (CHA) is soliciting applications from qualified applicants to conduct feasibility assessments and/or demonstration projects to expand access to health care through telehealth or urgent care. The grants to be awarded through this Request for Applications (RFA) will serve as seed funding for eligible organizations to implement new and/or to enhance existing healthcare services via telehealth or urgent care.

Approximately $400,000 in local appropriated funds will become available for up to five (5) awards.  Award sizes will range from a minimum of $50,000 up to a maximum of $200,000. Funds are available for a program period of six (6) months (April through September 2014).  

This funding is made available using local appropriations in the Fiscal Year 2014 Budget Support Act of 2013 through the Department of Health Function Clarification Amendment Act of 2013 (D.C. Law 18-111; DC Official Code 7-736.01) whereby for Fiscal year 2014, the Director of the Department of Health shall have the authority to issue grants to qualified community organizations for the purposes of providing ambulatory health services.
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Dear ATA Members,

Just a friendly reminder of ATA's scheduled webinar on state policy -- January 30th at 2pm.  ATA staff will provide an overview of promising telemedicine bills in CA, FL, HI, IL, MS, NE, OH, OR, SC and WA.  There will also be an opportunity for ATA members to engage in a limited discussion about each state.

Telemedicine in 2014 State Legislatures

Thursday, January 30, 2014, 2:00 PM - 3:00 PM (Eastern Time (US & Canada))
Most state legislatures are back and 2014 is expected to be the best ever for state telehealth progress – private insurance coverage, Medicaid coverage, licensure, state projects, etc. So far, 18 states have telemedicine bills.  Rule-making is going forward in states that enacted telemedicine laws last year.  The ATA’s Policy team will highlight state trends for telemedicine policy and winning tactics.  More importantly, this will be a forum to share your insights and updates about state prospects and coordinate and collaborate with allies.
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Beginning in 2014, Medicare eligibility for telehealth coverage is expanded from just rural counties to include health professional shortage areas in the "fringes" of metropolitan counties.

To see if your health care site is eligible for Medicare telehealth use http://datawarehouse.hrsa.gov/telehealthAdvisor/telehealthEligibility.aspx.

Authorized originating sites include--
  • Offices of a Physician or Practitioner
  • Hospitals
  • Community Mental Health Centers
  • Skilled Nursing Facilities
  • Rural Health Clinics
  • Federally Qualified Health Centers
  • Hospital-Based Renal Dialysis Centers (including satellites)
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At Virtual Neurology, we have developed a new model of healthcare delivery for a comprehensive neurologic service line. While protocols for acute neurologic consultations have been well established, little has been done to promote provision of neurologic service line that provides comprehensive neurology tele-neurohospitalist physician services.

We have developed a business model that :

·Increased patient retention and increased volume of patients : this helps to increase Case Mix Index and allows the hospitals to attract volumes of patients with high paying DRGs, and allows financial ROI by benefitting from ancillaries and/ or DRG payments

·Cerebrovascular disease- related diagnoses often require neuroimaging which adds to the bottom line for per diem contracts.

·Reduce number of costly transfers

·Increased patient satisfaction

The process of implementation of this service includes application of the Lean Six Sigma model in process improvement of the acute stroke protocols.

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Serialization of Rx pharma is included in the provisions of the DQSA http://www.rxtrace.com/2013/11/its-official-president-obama-signs-h-r-3204-dqsa-into-law.html/ . Serialization is an enabler for populating EMRs and for both institutional and  mobile medication management. 

As we’ve discussed, the point of care for pharma is wherever the patient doses.  Specialty pharma and FDA requirements for REMS are growing. Dosing is moving out of institutions to save cost.  ACOs are demanding real world data on pharma outcomes.   DQSA enables data capture.

Please see  the guest editorial http://www.pharmalive.com/track-and-trace-can-improve-patient-adherence-monroe-explains/?cid=nl_pharma_pharmalot . Now that the legislation including the track and trace has been signed,  is this a topic of interest to ATA? I’ll be at mHIMSS net week. Hope to see you there. 

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There are 72 Members of Congress on one of the 2 pending bipartisan bills to expand the "one state license" to other Federal interstate telehealth.  With these bills a health care professional would need only one state license to serve patients anywhere who are covered a specific federal health program.

Please urge your Representative to join the list of sponsors below.


The bills are--
  • H.R. 2001 for the Department of Veterans Affairs with the VETS Act (Veterans E-Health & Telemedicine Support Act) introduced by Charles Rangel (D) and Glenn Thompson (R) with a total of 49 sponsors
  • H.R. 3077 for Medicare with the TELE-MED Act (TELEmedicine for MEDicare Act) introduced by Devin Nunes (R) and Frank Pallone (D) with a total 30 sponsors

There are no Senate companion bills at this time -- so there is an opening for your Senators.



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The American Telemedicine Association (ATA) voices its support of the 21st Century Care for Military & Veterans Act, H.R. 3507. This bipartisan bill would improve healthcare accessibility using telehealth technology for active-duty service members, veterans, retirees and dependents under TRICARE, the Department of Veterans Affairs and the CHAMPVA healthcare programs.

This important Congressional plan would create parity in coverage between telehealth and in-person health services for these patient populations. It would also allow healthcare providers to provide services across state lines with one state license.

“Parity for telehealth and interstate access are two important concepts to extend to all federal healthcare programs,” said Jonathan Linkous, chief executive officer for the American Telemedicine Association. “We applaud this effort to remove artificial barriers to care in the federal government.”

H.R. 3507 was introduced by Reps. Scott Peters (D-CA 52), a member of the Armed Services Committee, Mike Thompson (D-CA 5), co-chair of the Military Veterans Caucus in the House of Representatives, and Gregg Harper (R-MS 3), also a member of the Military Veterans Caucus.

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The Affordable Care Act includes a “stick” for general acute hospitals to reduce readmissions.  ATA supports adding a “carrot” – benefiting hospitals and Medicare.

The “stick” is a Medicare payment penalty for a hospital that falls short of reduction benchmarks.  However, there is no incentive for a hospital to do more nor a way to recognize a hospital’s additional costs for better performance, such as using remote patient monitoring and home telehealth.  A “carrot” of shared savings for hospitals would address these 2 deficiencies.  This is the first provision of the Telehealth Enhancement Act, H.R. 3306 (http://www.gpo.gov/fdsys/pkg/BILLS-113hr3306ih/pdf/BILLS-113hr3306ih.pdf).

Also, we expect that the Congressional Budget Office will be able to estimate “scorable” savings for the Medicare program from this change since only “new” savings would be shared with a hospital.

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ATA, with other association allies, submitted input to the House Ways & Means and Senate Finance Committees in response to a proposed their discussion draft about repealing the sustainable growth rate (SGR) formula and reform the Medicare physician payment system.

We stressed--
1) the importance of incentivizing the adoption of patient-generated health data in these reform efforts
2) that the use of open and voluntary standards for interoperability between remote patient monitoring devices and electronic health records will leverage the broader information and communications technology industry
3) that focusing on high priority conditions will result in SGR-related cost savings as well as be consistent with the Center for Medicare and Medicaid Services priority to reduce long-term health care costs.

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Tags/Keywords:
Tags : mHealth, monitoring

Responding to the discussion draft on repeal of the sustainable growth rate limitation and Medicare physician payment reform from the Senate Finance and House Ways and Means Committees, ATA urged that the Social Security Act section 1834(m) [the “fee-for-service” telehealth restrictions] not apply to the proposed “alternative payment methods.”

Similarly, we urge that recent alternative payment methods for accountable care organizations under section 1899 and bundled payments under section 1866D, be amended for 1834(m) to not apply.  Legislative language for these improvements are included in the bipartisan H.R. 3306 as sections 103 and 104, respectively, and could yield scorable savings estimates from the Congressional Budget Office.

To advance and enhance two specific forms of alternate payment, we urge authorization, without regard to 1834(m) and as proposed in H.R. 3306 section 102, for--

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Tags/Keywords:
Tags : Medicare

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