Sunday, May 25, 2008

Health Technologies Hill Topic

Representative Allyson Y. Schwartz (D-PA), Honorary Co-Chair of the Committee, a member of the Ways and Means Committee, and a member of the New Democrat Coalition, opened the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics session held on May 21, 2008. She is championing E-prescribing because it can reduce medical errors in filling prescriptions and is not expensive.

In December 2007, Representative Schwartz introduced the E-MEDS Act of 2007 (H.R. 4296) that would require physicians to use the Medicare electronic prescription drug program and provide incentive payments for physicians.

The author of the study “The Telehealth Promise: Better Health Care and Cost Savings for the 21st Century” Dr. Alexander Vo, AT&T Center for Telehealth Research and Policy at the University of Texas Medical Branch (UTMB), spoke at the session. He reported that the UTMB telemedicine program providing healthcare to correctional facilities, is now serving over two thirds of the state’s prison population with all types of services.

UTMB has built 8 virtual physician suites with numerous telemedicine stations and conducts over 200 remote medical exams each day to enable physicians to treat inmates at correctional facilities without transporting them to a healthcare facility. Since 1994, the UTMB program has provided inmates with over 250,000 consultations at a net savings to taxpayers of about $780 million.

UTMB wanted to test its belief that their success with using telemedicine has a broader implication for national healthcare. Working with the Center for Information Technology Leadership on the study, they wanted to find out the extent of cost savings possible by embracing telemedicine nationally.

Dr Vo said that the study indicates that the benefits of nationally implementing telehealth technologies can far outweigh the costs. However, using telehealth nationally would require substantial infrastructure investment and therefore benefits would not exceed costs until the fourth year of implementation. By year six, the cost-benefit ratio would reach steady state and achieve a peak level of net savings that would continue year after year.

According to the study, telemedicine can be very effectively used in emergency departments since it reduces the frequency of transportation from one emergency department to another emergency department. UTMB found that telehealth avoided at least one trip in caring for 95% of the prisoners examined. Just reducing transfers from correctional facilities to physicians’ offices and emergency rooms would reduce costs by $270.3 million annually.

As for nursing facilities, the savings would be $327 million a year by just avoiding the emergency department all together and another $479 million by cutting transfers from nursing homes to physicians’ offices.

In the outpatient setting, provider to provider consultations via telehealth would enable patients to have medical care sooner with a specialist and $3.61 billion would result in cost savings since there would be less redundant testing and fewer face-to-face visits.

Dr. Vo pointed out that the study looked specifically at what needed to be addressed to fully integrate telehealth into the healthcare system. The study concluded that there needs to be standardized Medicare and Medicaid reimbursement models, cases involving telehealth interventions needs to be addressed. Other issues that need to be addressed include studying the licensure rules that prevent telehealth consultations across state lines, finding the best ways to develop HIT infrastructure, and examine state and local initiatives to find ways to provide cost sharing measures along with pooling resources.

Walter Grant, Director, Government Affairs and IT Integration, INRange Systems, described the current eRX picture. One of the biggest influences increasing the use of eRX has been the regional based adoption programs sponsored by payers, health systems, large clinics, and state departments of health. In addition, Executive Orders have been issued from a number of state and federal officials to eliminate paper prescriptions. Lastly, physician technology vendors have made efforts to convert existing user base from faxing to e-prescribing.

Grant suggested that there are some actions that could have an impact on e-prescribing adoption. For example, DEA needs to allow e-prescribing for controlled substances. Secondly, authority should be granted to CMS to mandate e-prescribing, and lastly, health plans should base adoption programs incentives for prescribers.

According to Grant, the “Hospital at Home” concept is going to become very important with the rising number of patients with chronic diseases and the growing aging population. In order to enable more services at home, more medical devices and equipment will be essential and bi-directional communications will play an important role.

One of the most critical factors in delivering care at home is the need to practice good medicine management. Good medicine management systems improve patient outcomes by delivering the right pill at the right time, documenting compliance and adherence, documenting interventions, and a good medical management system enables physicians to coordinate treatments. INRange’s medical management system “EMMA” is successful at managing outpatient medical delivery because the system can select and deliver individual doses of medicine for the patient according to instructions.

One of the major issues holding up the passage of HIT legislation so far has been the ability to provide patient guarantees to privacy and security, according to David Roberts, MPA, FHIMSS, Vice President Government Relations, HIMSS.

Robert reported that the “Wired for Health Care Quality Act” (S.1693) has passed the Senate HELP Committee and is now awaiting full Senate action. So far, there is no House action on the companion bill (H.R. 3800). In addition, e-prescribing legislation (S.2408 and H.R 4296) have been introduced on both sides of the aisle. Roberts suggests that e-prescribing legislation will probably be attached to the Medicare Physician Reimbursement Reform.

He continued to say that the Senate Finance Committee leaders continue to hash out the Medicare package to delay the 10% physician pay cut set to take effect July 1. Some health groups are trying to attach their issues to the must pass bill, while others are hoping lawmakers won’t seek offsets for the bill’s possibly $18 billion price tag from their specialties. The bill would require pharmacy benefit managers to reimburse for Medicare prescription drug claims in 14 days and would delay a cut in Medicaid reimbursement for generic drugs for one year.

Also, a new rule to provide for tamper proof Rx pad law implementation was attached to the May 25, 2007 appropriations bill. The goal is to reduce expenditures for fraudulent Medicaid prescriptions by requiring non-electronic Rx use tamper resistant pads to be used.

According to Roberts, a number of pieces of legislation have been introduced in 45 states legislatures to address HIT. In 2007, 250 plus bills were introduced in 38 state legislatures and the District of Columbia, with 74 bills passing and becoming law.

Christine Bechtel, Vice President, Government Relations eHealth Initiative, gave her analysis of state legislative activities. She reported that HIT state activity is on the rise and in 2008, 92 bills were introduced in 27 states. Also, 9 executive orders were issued by governors calling for HIT and HIE in 2007, and 4 so far in 2008. Fifty seven bills in the states were proposed in 2007 calling for establishing committees, taskforces, commissions, or working groups within the states. States have begun to dictate certain interoperability levels in the proposed state legislation as it concerns state agencies.

According to Bechtel, key issues need to be addressed in legislation that relate to privacy, funding, ICD 9/ICD10, and the Stark and Anti-Kickback statues. Currently, the House Energy and Commerce Committee is developing a “Chairman’s Package HIT bill. The bill will be a compilation of past, existing, and new legislative provisions.

Jon Linkous, Executive Director, American Telemedicine Association enthusiastically supports the Medicare Telehealth Improvement Act of 2008 (S. 2812) and wants to see the telemedicine community rally behind this important legislation introduced by Senators Kent Conrad (D-ND), Debbie Stabenow (D-MI), and John Thune (R-SD).

The legislation would add skilled nursing facilities, dialysis centers, and community mental health centers to the list of originating sites and would allow patients to receive the benefits of telemedicine. The legislation would also make additional healthcare providers eligible to provide telemedicine care under Medicare, and very importantly create an advisory committee to aid CMS in assessing what telemedicine services should be eligible for Medicare reimbursement.

In general, Linkous thinks that telemedicine is moving in the right direction but there still are regulatory issues that need to be addressed. As he sees it, most of the progress right now is happening within the states and although the state activities are very important, he would also like to see the federal government catch up and expand their efforts.

He also reports that there have been a number of advances internationally with medical services being provided to other countries with telecommunications capabilities. Hospitals are linking all the time to hospitals in other countries but not always using the term telemedicine or telehealth. There has been a huge outpouring from NGOs concerning healthcare and everyday new developments and new projects are taking place internationally.

Neal Neuberger, President, Health Tech Strategies and Chair, ATA Public Policy Committee, recommends that everyone take part in the 3rd Annual National Health IT Week to be held on June 9-13, 2008 and attend the Health Information Technology all Day Showcase and e-Health Panel Discussion to be held on Capitol Hill in Room 902 Hart Senate Office Building on June 12th from 10am to 3pm.

Continuing Honorary Steering Committee Co-Chairs are Senators Kent Conrad (D-ND), Mike Crapo (R-ID), Sheldon Whitehouse (D-RI) and Representatives Eric Cantor (R- VA), Rick Boucher (D-VA), Bart Gordon (D-TN), Allyson Y. Schwartz (D-PA), David Wu (D-OR) and Phil English R-PA). The Steering Committee coordinates many activities with the House 21st Century Health Care Caucus, co-chaired by Representatives Patrick Kennedy (D-RI) and Tim Murphy (R-PA).

For more information on the Capitol Hill sessions and the HIT all day Showcase, contact Neal Neuberger, President, Health Tech Strategies LLC, at (703) 790-4933 or email