Telemedicine stalled by payment debate


WASHINGTON, June 19 (UPI) -- Federal lawmakers should lead the way in persuading insurers that telemedicine -- healthcare delivered via videoconferencing or over the Internet -- can equal the quality of care in a doctor's office, a panel of experts said Wednesday.

Speaking to reporters after a roundtable discussion at the Commerce Department, Undersecretary for Technology Phil Bond said telemedicine is poised to make real contributions to society, through more efficient and accessible health care.


"There are steps we learned today that government needs to be taking to remove some hurdles and enable (telemedicine) to surge forward," Bond said.

Chief among those steps is redefining how a healthcare provider can interact with a patient, said Steve Brown, president of the Health Hero Network. This does not mean cramming more clients into a doctor's day, he said.


"We need to modernize the rules, change some of the paradigms -- you have to pay doctors for monitoring patients remotely, before they're in the hospital and after they leave," Brown told reporters. "One of the barriers to doing that is convincing the payers, the government in particular, that these things are effective. They're looked at very narrowly now, 'What does this new thing cost,' not looking at what it saves as well."

The ability to transmit medical data reliably means an examination room can be anywhere, providing great boosts to preventative healthcare, so payment schemes should take that into account, said Dr. Jay Sanders, president of the Global Telemedicine Group.

"In the same way your bank follows you through (automatic teller machines), this technology is the enabling ATM in health care," Sanders said. "It allows the health care system to be with patients wherever they are."

An example of telemedicine's promise lies in an upcoming partnership between Medical Missions for Children, a non-profit organization that enables children's hospitals outside the United States to consult with U.S. specialists, and the Department of Defense, which will offer capacity on its leased commercial satellites for communication within each targeted country. The organization hopes such telemedicine can help 10,000 seriously ill children directly, and 50,000 to 100,000 children indirectly, each year.


One "baby step" towards the payment shift that could make telemedicine widely accepted is the Medicare Remote Monitoring Services Coverage Act, Brown said. The bill -- which currently is under consideration at the committee level in both the House and Senate -- would equate data gathered remotely with that obtained by a doctor in an office, with equivalent payment, he said.

Another key role the government could play is setting standards for telemedicine technology, said Army Col. Ron Poropatich, chief of telemedicine at Walter Reed Army Medical Center and president of the American Telemedicine Association.

Such standards are always critical in ensuring proper care, Sanders said, pointing out how fax machines only became accepted tools in doctors' offices after compatibility among different brands was assured.

National laboratories could fill an education position, Poropatich said, helping health care workers adapt to the quirks of telemedicine, such as how to conduct mass screenings in the case of a disease outbreak.

Sanders said the possible utility of widespread telemedicine in a bioterrorism situation cannot be underestimated. For example, specialists at the Centers for Disease Control in Atlanta, or at the Army's infectious-diseases team at Fort Dietrick, Md., could treat patients directly from their offices, keeping the doctors safe from infection and reducing the overall population's exposure from transporting victims, he said.


"Given a good digital photo in an e-mail and a patient's history, I can diagnose anthrax or smallpox (remotely)," Sanders said.

Malpractice worries might be a roadblock to accepting telemedicine in the short run, he noted, but government action in this area is probably unnecessary. Existing telemedicine efforts have shown no penalty in malpractice insurance premiums, he said.

Some lawyers have suggested the ability to obtain an informed second opinion quickly via telemedicine might drive down the cost of such insurance, Sanders said. Access to such expertise could benefit insurers by reducing the likelihood of frivolous lawsuits, Brown added.

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