The American Telemedicine Association (ATA) provided specific comments and recommendations on May 15th to Chairman Max Baucus, Ranking Member Chuck Grassley, and other members of the Senate Finance Committee concerning the Committee’s Policy Options paper of April 29th. The paper is titled “Transforming the Health Care Delivery System: Proposals to Improve Patient Care and Reduce health Care Costs.”
ATA is very interested in addressing Medicare coverage for telemedicine. According to the data, Medicare payments for interactive telehealth services were only $6 million in 2007. One of Medicare’s worst restrictions is that it essentially excludes beneficiaries in metropolitan areas and as a result, 83 percent of the U.S. population is left out.
Surprisingly, this affects even some of the most rural states in the country. For example, 47 percent of North Dakota’s population resides in a metropolitan area and the figure for Montana residents is 35 percent. New Jersey and Rhode Island beneficiaries essentially do not have telehealth coverage because all of their counties are within a metropolitan area. Also Medicare’s restrictions block telehealth services in HHS identified health professional shortage areas, medically underserved areas, or medically underserved populations within metropolitan areas.
ATA estimates that extending covered telehealth services for all Medicare beneficiaries would result in less than $40 million in total expenditures per year, even without factoring in any resulting cost savings for remote services.
According to ATA, home telehealth and patient monitoring services have proven to yield substantial cost savings and improve care in homebound and chronic disease patient groups. Telehealth has been singled out as a valued service by patients but Medicare pays for almost no remote health monitoring.
Telemedicine is set to have a widespread and significant impact on the delivery of healthcare. Physicians and other providers have been learning and adapting. For example, the application of advanced life-saving therapies for people suffering a stroke requires access to specialized stroke and brain imaging expertise. The American Heart Association and the American Stroke Association recommends the use of telemedicine to overcome significant disparities in access to care in the U.S.
Telemedicine encompasses a wide variety of applications from remote reads of medical images, to live video consultations, to distant monitoring of vital signs. Key technologies such as wireless, video resolution, sensors, and mobile devices have been rapidly advancing and allowing telemedicine to be better, faster, and cheaper.
ATA strongly urges the Senate Committee to include Medicare reimbursement for telehealth services throughout the country. It makes no sense to invest billions of taxpayer dollars to purchase health information technology, deploy broadband telecommunications, but not allow providers to use the technology and for patients not to receive the benefits.
Some of ATA’s recommendations and clarifications sent to the Senate Committee want telemedicine and telehealth technologies included in coverage to Medicare beneficiaries regardless of their location, Medicare facilities to be originating sites for interactive video, store-and-forward applications use needs to be expanded, advanced software systems need to be used in hospital intensive care units, and remote monitoring should be used when treating chronic conditions in the home.
For more information, contact Gary Capistrant at gcapistrant@americantelemed.org.
Sunday, May 31, 2009
New Legislation Introduced
Representative Harry Teague from New Mexico introduced legislation on May 19th to direct the VA to establish three pilot projects that would use telehealth platforms to help treat veterans living in rural areas who suffer from PTSD or TBI. The goals for the “Reaching Rural Veterans through Telehealth Act (HR 2505)” would provide education to help primary care providers diagnose and better manage their clients on a 24/7 basis. The bill has been referred to the House Committee on Veterans Affairs.
Participants could include medical clinicians, trainers, educators, researchers, community members and others. Grants provided in the bill would be awarded based on geographical diversity, ability to reach the most veterans that are not currently receiving treatment, and would create programs for rural Veterans Integrated Service Networks. Funds may be used for training, research, to purchase equipment, and for partnering and contracting with local community groups already providing services in a rural area.
On May 20th, Representative Peter Welch from Vermont introduced the “Blueprint for Health Act of 2009 (HR 2535)” to establish a blueprint to help create a comprehensive system of care. The plan would integrate coordinated chronic care management to include medical practices acting as medical homes with community care teams to provide the care and coordination needed.
Chronic care management programs would identify and enroll chronically ill patients and also encourage primary care physicians, specialists, hospitals, and others to participate in the program. In addition, the legislation calls for methods to increase communication among healthcare professionals and patients.
Financial incentives included in the legislation would include increased payments to medical practices based on a per member per month fee, payment for care support services to include community care teams, and the support of community-based savings sharing and reinvestment models referred to as an accountable care organizations. The plan could include grant opportunities and Federal tax credits for localities to use to conduct community assessments, interventions, and to develop activation plans.
Participants could include medical clinicians, trainers, educators, researchers, community members and others. Grants provided in the bill would be awarded based on geographical diversity, ability to reach the most veterans that are not currently receiving treatment, and would create programs for rural Veterans Integrated Service Networks. Funds may be used for training, research, to purchase equipment, and for partnering and contracting with local community groups already providing services in a rural area.
On May 20th, Representative Peter Welch from Vermont introduced the “Blueprint for Health Act of 2009 (HR 2535)” to establish a blueprint to help create a comprehensive system of care. The plan would integrate coordinated chronic care management to include medical practices acting as medical homes with community care teams to provide the care and coordination needed.
Chronic care management programs would identify and enroll chronically ill patients and also encourage primary care physicians, specialists, hospitals, and others to participate in the program. In addition, the legislation calls for methods to increase communication among healthcare professionals and patients.
Financial incentives included in the legislation would include increased payments to medical practices based on a per member per month fee, payment for care support services to include community care teams, and the support of community-based savings sharing and reinvestment models referred to as an accountable care organizations. The plan could include grant opportunities and Federal tax credits for localities to use to conduct community assessments, interventions, and to develop activation plans.
Maryland Issues RFA
The Maryland Health Care Commission (MHCC) and the Health Services Cost Review Commission (HSCRC) issued a Request for Application due on June 12, 2009 to build a statewide health information exchange. The HSCRC will provide the initial funding of up to $10 million through hospital reimbursement rate adjustments.
Applications need to provide sound solutions on issues such as governance, privacy and security, and the strategies to use to help consumers have appropriate control over their health information. The system must also serve public health, provide for post marketing drug surveillance, and for health services research.
The requirements for a statewide HIE will take into account the ideas submitted by several multi-stakeholders groups. These groups included the Chesapeake Regional Information System for our Patients (CRISP) and the Montgomery County Health Information Exchange Collaborative (MCHIE). These teams focused on not only governance, privacy and security and standards but also on the architecture of the exchange, on hardware and software solutions, and cost for implementation. Go to http://mhcc.maryland.gov/electronichealth/statehie.html for the final report.
The financial model must provide a feasible strategy on how to provide long term funding and sustainability. Responders must detail the revenue sources for both the start-up and ongoing operations of the HIE. In discussing fees, the responder must define who the fee is for, the amount, how the fee is calculated, service offerings, and funding available from other sources. The responder must also outline a strategy to secure additional funding, the amount of proposed funding, and the anticipated time frame for the funding.
For more information, on the RFA “A Consumer-Centric Health Information Exchange for Maryland”, email Kathy Francis, Chief of the Center for Health Information Technology, at kfrancis@mhcc.state.md.us or call (410) 764-5590.
Applications need to provide sound solutions on issues such as governance, privacy and security, and the strategies to use to help consumers have appropriate control over their health information. The system must also serve public health, provide for post marketing drug surveillance, and for health services research.
The requirements for a statewide HIE will take into account the ideas submitted by several multi-stakeholders groups. These groups included the Chesapeake Regional Information System for our Patients (CRISP) and the Montgomery County Health Information Exchange Collaborative (MCHIE). These teams focused on not only governance, privacy and security and standards but also on the architecture of the exchange, on hardware and software solutions, and cost for implementation. Go to http://mhcc.maryland.gov/electronichealth/statehie.html for the final report.
The financial model must provide a feasible strategy on how to provide long term funding and sustainability. Responders must detail the revenue sources for both the start-up and ongoing operations of the HIE. In discussing fees, the responder must define who the fee is for, the amount, how the fee is calculated, service offerings, and funding available from other sources. The responder must also outline a strategy to secure additional funding, the amount of proposed funding, and the anticipated time frame for the funding.
For more information, on the RFA “A Consumer-Centric Health Information Exchange for Maryland”, email Kathy Francis, Chief of the Center for Health Information Technology, at kfrancis@mhcc.state.md.us or call (410) 764-5590.
Draft Published on Centers
HHS published their draft description of the proposed regional extension centers program in the “Federal Register “on May 28th. The notice seeks feedback and comments on setting up the centers so that clinicians and hospitals will have an easier time in adopting health IT as required by the HITECH Act.
The notice is not a solicitation for proposals but only seeks comments on the draft description. However, after the comments are reviewed, a solicitation will be published to provide further details on the requirements and the application process that applicants need to go through to receive an award.
HHS anticipates that the average award will be approximately $1 million to $2 million per center with the maximum award for any one regional center to be $10 million. HHS proposes to make initial awards for the regional centers as early as the first quarter of FY 2010 and to continue making awards through the fourth quarter of FY 2010.
HHS anticipates not requiring matching funds for awards made in FY 2010 due to the current economic situation, however, using matching funds will be encouraged but not required.
All comments on the draft plan are due on June 11, 2009. For information, send an email to onc.request@hhs.gov, or call (202) -690-7151.
The notice is not a solicitation for proposals but only seeks comments on the draft description. However, after the comments are reviewed, a solicitation will be published to provide further details on the requirements and the application process that applicants need to go through to receive an award.
HHS anticipates that the average award will be approximately $1 million to $2 million per center with the maximum award for any one regional center to be $10 million. HHS proposes to make initial awards for the regional centers as early as the first quarter of FY 2010 and to continue making awards through the fourth quarter of FY 2010.
HHS anticipates not requiring matching funds for awards made in FY 2010 due to the current economic situation, however, using matching funds will be encouraged but not required.
All comments on the draft plan are due on June 11, 2009. For information, send an email to onc.request@hhs.gov, or call (202) -690-7151.
Tuesday, May 26, 2009
EMRs & PHRs Discussed
Leading experts came to the May 21st Steering Committee on Telehealth and Healthcare Informatics lunch briefing held on Capitol Hill to discuss how EMRs, PHRs, and hybrid systems are going to operate and change in the coming years.
Congressman Patrick Kennedy (D-RI) lending his support to the Steering Committee’s work, was introduced by Neal Neuberger, Executive Director of the Institute for e-Health Policy. Congressman Kennedy told the attendees that we are so fortunate that $19 billion is out there to support health IT, but he emphasized that legislation needs to be crafted to fit and work with those dollars so that the money will be spent wisely.
Jeff Margolis Chairman and CEO, TriZetto, defined Integrated Healthcare Management as the system application of processes and shared information to optimize the coordination of benefits and care for the healthcare consumer. The reality is that our healthcare system is in crisis which is going to require that any technology used in healthcare will need to be integrated. Every time that you combine good information with technology, the healthcare system can only win.
He explained that the core elements for an integrated healthcare management system depend on value-based benefits, value-based reimbursement designs, systematic health management, and the active engagement of all constituents in a culture of health. All of these elements need to be based upon a growing body of evidence-based medicine.
Additionally, breaking down information silos by taking the best of benefits information and adding this information to the best of care information helps the consumer at the right time and provides effective information management.
Alfred Spector, PhD., Vice President, Research and Special Initiatives, Google Health, stressed that it is important for PHRs to put order to disorganized information so that the information can be shared. Google’s PHR system is able to store large amounts of data, manage the data, and then make the information accessible.
Google’s vision is to provide a non-tethered PHR where the user controls and owns the data, and where Google is able to add on services and tools personalized to suit the users’ needs. The business model enables the product to be offered free, no advertising is permitted on the site, and the data is not sold. The only time the data is shared is if the user gives permission.
As Dr. Spector told the group, there are still challenges to using the technology since there are still interoperability issues, problems at times getting accurate and complete data, incorporating the PHR data into the physicians’ electronic medical record, and finding ways to increase the consumer’s use of the site.
Deven McGraw, Esq., Director of the Health Privacy Project, Center for Democracy and Technology, pointed out that it is not yet clear how regulators and courts will interpret ARRA’s health privacy provisions. ARRA charges the FTC to work with HHS to report to Congress on privacy and security recommendation for PHR vendors. PHRs are covered by HIPAA if offered by a covered entity or business associates but is not covered by HIPAA if offered by an independent vendor.
McGraw explained that HIPAA permits broad information sharing for treatment payment and healthcare operations. This is the right approach for the health system but the wrong approach for a tool intended to be used by consumers. Today and in the future, health privacy needs to build on HIPAA, establish new protections to address concerns, and develop specific rules to make electronic medical records and PHRs sustainable over the long term.
John Hummel, CTO, Perot Healthcare Services, said the company provides innovative technology to improve the safety and quality of care. Services are provided to over 1000 hospitals, to over 65 million health plan members, and to more than 70 health insurers.
In his own experience he has seen his wife receive duplicate tests and duplicate drugs simply because the hospital couldn’t communicate the information to the right place at the right time. Obviously, our healthcare system has to be able to provide data that is accurate, timely, secure and private.
Hummel joined Perot Systems coming from the California Prison Healthcare Receivership. The receivership was a federal court takeover of California’s failing prison healthcare system which was declared unconstitutional due to the deaths of inmates. In California, there is a death every five days since prisoners receive below third-world country care levels of medical quality and safety. Hummel worked to ensure that the most clinically, technically, and cost-effective tools were designed and deployed to help repair the problem.
HIMSS launched the Washington-based Institute for e-Health Policy last year and manages the Capitol Hill HIT briefing series. For more information, go to www.e-healthpolicy.org.
Congressman Patrick Kennedy (D-RI) lending his support to the Steering Committee’s work, was introduced by Neal Neuberger, Executive Director of the Institute for e-Health Policy. Congressman Kennedy told the attendees that we are so fortunate that $19 billion is out there to support health IT, but he emphasized that legislation needs to be crafted to fit and work with those dollars so that the money will be spent wisely.
Jeff Margolis Chairman and CEO, TriZetto, defined Integrated Healthcare Management as the system application of processes and shared information to optimize the coordination of benefits and care for the healthcare consumer. The reality is that our healthcare system is in crisis which is going to require that any technology used in healthcare will need to be integrated. Every time that you combine good information with technology, the healthcare system can only win.
He explained that the core elements for an integrated healthcare management system depend on value-based benefits, value-based reimbursement designs, systematic health management, and the active engagement of all constituents in a culture of health. All of these elements need to be based upon a growing body of evidence-based medicine.
Additionally, breaking down information silos by taking the best of benefits information and adding this information to the best of care information helps the consumer at the right time and provides effective information management.
Alfred Spector, PhD., Vice President, Research and Special Initiatives, Google Health, stressed that it is important for PHRs to put order to disorganized information so that the information can be shared. Google’s PHR system is able to store large amounts of data, manage the data, and then make the information accessible.
Google’s vision is to provide a non-tethered PHR where the user controls and owns the data, and where Google is able to add on services and tools personalized to suit the users’ needs. The business model enables the product to be offered free, no advertising is permitted on the site, and the data is not sold. The only time the data is shared is if the user gives permission.
As Dr. Spector told the group, there are still challenges to using the technology since there are still interoperability issues, problems at times getting accurate and complete data, incorporating the PHR data into the physicians’ electronic medical record, and finding ways to increase the consumer’s use of the site.
Deven McGraw, Esq., Director of the Health Privacy Project, Center for Democracy and Technology, pointed out that it is not yet clear how regulators and courts will interpret ARRA’s health privacy provisions. ARRA charges the FTC to work with HHS to report to Congress on privacy and security recommendation for PHR vendors. PHRs are covered by HIPAA if offered by a covered entity or business associates but is not covered by HIPAA if offered by an independent vendor.
McGraw explained that HIPAA permits broad information sharing for treatment payment and healthcare operations. This is the right approach for the health system but the wrong approach for a tool intended to be used by consumers. Today and in the future, health privacy needs to build on HIPAA, establish new protections to address concerns, and develop specific rules to make electronic medical records and PHRs sustainable over the long term.
John Hummel, CTO, Perot Healthcare Services, said the company provides innovative technology to improve the safety and quality of care. Services are provided to over 1000 hospitals, to over 65 million health plan members, and to more than 70 health insurers.
In his own experience he has seen his wife receive duplicate tests and duplicate drugs simply because the hospital couldn’t communicate the information to the right place at the right time. Obviously, our healthcare system has to be able to provide data that is accurate, timely, secure and private.
Hummel joined Perot Systems coming from the California Prison Healthcare Receivership. The receivership was a federal court takeover of California’s failing prison healthcare system which was declared unconstitutional due to the deaths of inmates. In California, there is a death every five days since prisoners receive below third-world country care levels of medical quality and safety. Hummel worked to ensure that the most clinically, technically, and cost-effective tools were designed and deployed to help repair the problem.
HIMSS launched the Washington-based Institute for e-Health Policy last year and manages the Capitol Hill HIT briefing series. For more information, go to www.e-healthpolicy.org.
$215 Million to Help Rural Vets
The Department of Veterans Affairs has provided $215 million to improve access and quality of healthcare for veterans in rural areas. The funding will be used to support the latest technologies, to recruit and retain a well educated and trained healthcare workforce, and to collaborate with non-VA rural health community partners.
According to Secretary of Veterans Affairs Eric Shinseki, the funds will enable the VA to establish new outpatient clinics, expand collaborations with federal and community partners, accelerate the use of telemedicine deployment, explore innovative uses of technology, and fund pilot programs.
The VISNs, VA regional healthcare networks, and VHA program offices were allowed to submit up to eight proposed projects each for funding. The proposals were prioritized and then sent to the Office of Rural Health where they were evaluated based on methodology, feasibility, and the intended impact on rural veterans. ORH then selected 74 programs where many of the programs were either national in scope or affected multiple states.
To address the issues facing rural veterans, the VA created the Office of Rural Health in 2007. In the past two years, the VA formed a 16 member national committee to advise on issues affecting rural veterans, opened three Veterans Rural Health Resource Centers to study rural veteran issues, rolled out four new mobile health clinics to serve 24 predominately rural counties, and announced that 10 new rural outreach clinics are scheduled to be opened in 2009.
According to Secretary of Veterans Affairs Eric Shinseki, the funds will enable the VA to establish new outpatient clinics, expand collaborations with federal and community partners, accelerate the use of telemedicine deployment, explore innovative uses of technology, and fund pilot programs.
The VISNs, VA regional healthcare networks, and VHA program offices were allowed to submit up to eight proposed projects each for funding. The proposals were prioritized and then sent to the Office of Rural Health where they were evaluated based on methodology, feasibility, and the intended impact on rural veterans. ORH then selected 74 programs where many of the programs were either national in scope or affected multiple states.
To address the issues facing rural veterans, the VA created the Office of Rural Health in 2007. In the past two years, the VA formed a 16 member national committee to advise on issues affecting rural veterans, opened three Veterans Rural Health Resource Centers to study rural veteran issues, rolled out four new mobile health clinics to serve 24 predominately rural counties, and announced that 10 new rural outreach clinics are scheduled to be opened in 2009.
Telehealth Funding Opportunity
HRSA posted the notice (HRSA-09-239) on May 22nd for $500,000.00 in grant funding to be used to demonstrate how existing telehealth programs, networks, and sites can improve access to quality healthcare services. The project is specifically geared to children and youth with epilepsy and their families dealing with the issues living in medically underserved areas and rural areas.
The grant funding will support telehealth networks that provide services in different settings such as long term care facilities, community health centers or clinics, medical homes, hospitals, and schools. The goal is to demonstrate how telehealth networks can be used to expand access to care, coordinate, and improve the quality of healthcare services, improve the training of healthcare providers, and also improve the quality of health information.
The grantees will need to:
- Increase the dialogue and collaboration between families and their healthcare providers
- Improve community-wide interventions and models to improve access and also reduce the wait time associated when referrals are made to specialists
- Improve the integration with community support services including partnerships with media and other community-based resources
- Deliver the medical home model of care for children and families that is culturally and linguistically competent, family centered, comprehensive, and coordinated
- Improve communications by developing tools such as individualized written care plans, home medication lists, individualized school support plans, and written plans to support the youth transition to adult care
HRSA is looking for projects that will integrate administrative and clinical information systems with the proposed telehealth system and then integrate the proposed system into the normal provider practice. Projects will also need to address the privacy of patients and clinicians using the system. In addition, each grant applicant is required to submit a sustainability plan that outlines how the services will be sustained after the federal funding has ended.
Any public or private entity including an Indian tribe or tribal organization, faith based, and community-based organizations are eligible to apply for the funding. The application deadline is June 29, 2009 and a letter of intent is not required. The estimate average size of the awards will be up to $250,000 with two awards estimated.
For more information, go to www.grants.gov or contact Deanna McPherson at DMcPherson@hrsa.gov.
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