THE GOVERNING OF TELEMEDICINE AND OTHER IT MEDICAL ISSUES FOR

CITIZENRY IN WEST VIRGINIA- - -

DELEGATE DON PERDUE, CHAIRHOUSE COMMITTEE ON HEALTH & HUMAN

RESOURCES

Telehealth State of Affairs“The Doctor is Ready to See

you”

TELEMEDICINE

Is the practice of medicine using tools such as electronic communication, information technology or other means of interaction between a licensed health care professional in on location and a patient in another location, with or without an intervening healthcare provider. The utilization of electronic communication in on-call, cross-coverage and emergency services situations shall not constitute telemedicine.

How Telemedicine Has Already Surpassed Our Earliest Predictions

Telehealth Foretold

Telemedicine is the wave of the future, but you might be surprised to learn that it has been for nearly a century.

In 1924 the writers of Science and Invention magazine thought they’d found an answer for delivering useful information to people with the expertise to analyze data.

The headline proclaimed, “Specialist Brought to Every Town,” and promised that experts in every field of medicine would be able to diagnose disease from a control room far removed from their patients.

“Science and Invention” -1924

“With the aid of electrical indicating devices, it is easily possible to transmit the findings of any disease over wires from one place to another with almost absolute accuracy. The ideas necessary are shown in the illustration herewith. A cardiograph is attached to the patient’s two wrists and variations in the current can be made to register in the distant specialist’s office. Respiration pressure is transmitted through a carbon rheostat, the same as is the case with the blood pressure. The heart tone is transmitted by a radio microphone, temperature through a thermocouple. An X-ray of the infected member is transmitted by television.”

Telehealth has been actively used in West Virginia for the past 20 years

First used in radiology then pathology and more recently psychiatry.

One of the basic tenants of telemedicine is that the practice of medicine occurs where the patient is located.

Telehealth is rapidly developing

In the past four years telemedicine has made huge strides in gaining acceptance in the developing across the nation.

West Virginia has made strides in their approach to telehealth but there is more to do…

WV Code Sec. 30-3-13

West Virginia’s current language was written in the mid 1990’s and consisted of two sentences.

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30-3-13 The practice of telemedicine means the use of electronic information and communication technologies to provide health care when distance separates participants. It includes one or both of the following:

1.The diagnosis of a patient within this state by a physician located outside this state, as a result of the transmission of individual patient data, specimens or other material by electronic or other means from within this state to the physician or his or her agent;

2.The rendering of treatment to a

patient within this state by a physician located outside this State as a result of transmission of individual patient data, specimens or other material by electronic or other means from within this State to the physician or his or her agent.”

Reimbursement

States with Coverage for Telehealth Services

Reimbursement Overview

The absence of consistent, comprehensive reimbursement policies is often cited as one of the most serious obstacles to total integration of telehealth into health care practice. The lack of an overall telehealth reimbursement policy reflects the multiplicity of payment sources and policies within the current United States health care system. The vast majority of health care costs are paid by private insurers, Medicare and Medicaid.

West Virginia reimburses Medicaid under two conditions:

The consultation must involve real time consultation as appropriate for the member’s medical needs and as needed to provide information to and at the direction of the consulting physician.

Medicaid coverage of teleconsultation is limited to members in non-metropolitan statistical professional shortage areas as defined by CMS. The referring provider must be located in the non-metropolitan area.

Reimbursement/ Other

West Virginia currently does not reimburse private insurance for Telehealth.

Rural Dilemma.

Workforce shortages

Rural Access & Workforce Shortage

About 51 million Americans live in rural areas, where obtaining medical care often involved long drives and extra expense.

10% of physicians practice in rural America.The rural heath care workforce is stretched to its

limits in most states. Despite programs operated by state, federal and local governments aimed at recruiting and retaining primary care professionals to these areas, the need outpaces the supply in many communities.

Many primary care physicians are nearing retirement and the numbers to replace them are insufficient.

Access, continued

As a result of the fractured nature of the health care delivery system, as well as unique economic factors and cultural and social differences, rural Americans generally have poorer health status and less access to care than their urban counterparts. Today, rural households have higher rates of death, disability and chronic disease. The rural population is older; has lower education and income levels; and is more likely to smoke, be obese and be physically inactive than the urban population. To reduce inefficiencies and improve care for rural residents, state legislatures seek innovative ways to increase access to doctors and to better coordinate care.

Provider-Patient Relationships

Standard of Care

Patient Records

Prescribing Limitations

Standard of Care

Medical services provided via telemedicine technologies, including the establishment of a provider-patient relationship and issuing a prescription via electronic means as a part of a telemedicine encounter, are subject to the same standard of care, professional practice requirements and scope of practice limitations as traditional in-person provider-patient encounters. Treatment, including a prescription, based solely on an online questionnaire does not constitute an acceptable standard of care.

Patient Records

The patient record established during the use of telemedicine technologies must be accessible and documented for both the physician and patient, consistent with all established laws and regulations governing patient healthcare records and shall include a copy of the informed consent to the provision of medical services provided through telemedicine technologies. Physicians solely providing services using telemedicine technologies must make documentation of the encounter easily available to the patient, and subject to the patient’s consent, any identified care provider of the patient immediately after the encounter.

Prescribing Limitations

A physician or podiatrist who provides medical services to a patient solely through the telemedicine technologies any controlled substance listed in Schedule I or II of the Uniform Controlled Substance Act.

Ongoing Concerns

Is audio satisfactoryEmergency SituationsOverprescribing of antibioticsCorporate practice of medicinePatient examination

Other Issues

Prescription Drug Monitoring Database

Nplex

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