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Facilitating the Practice of Telemedicine

Legislature, FMA support legislative action to reimburse telemedicine for same rate as in-clinic visit and other benefits

By the time state lawmakers meet March 3 for the 2015 opening legislative session, legislation bringing Florida to the forefront of telemedicine may very well need only the polishing of a few details. Or will it? Both bills lack one important element: parity for telemedicine reimbursement.

State Sen. Aaron Bean (R-Jacksonville), a staunch supporter of telemedicine, indicated earlier this year that a proposed telemedicine bill will likely pass this session. Bean, chairman of the Senate Health Policy committee, said last year’s 26-page bill was too complex for bipartisan support.

The much shorter 2015 draft of Senate Bill 478 should facilitate the practice of remote medicine, Bean said.

The Florida TeleHealth Workgroup, initiated by the Southeastern TeleHealth Resource Center (SETRC), held a summit in Orlando last December, with improved telemedicine policy at the top of the agenda. Last month, the workgroups met throughout Florida to provide insight and direction regarding the advancement of telehealth and to encourage collaboration among existing telehealth networks and programs.

“Once improved telemedicine legislation is approved and implemented, we’ll have elements in place to help facilitate its growth,” said SETRC director Rena Brewer, RN, MA. “The medical community is committed to the advancement of telehealth because of its great potential to reach more patients.”

Michael P. Smith, MA, MPA, development director of the Telemedicine Program for the Florida State University College of Medicine, and Ken Peach, executive director of the Health Council of East Central Florida, participated in a telemedicine press conference at the Florida Capitol that included Bean, Sen. Arthenia Joyner (D-Tampa), Rep. Travis Cummings (R-Clay County), and Rep. Mia Jones (D-Duval County), and garnered quite a bit of publicity.

“As Rep. Jones mentioned, after four years of effort, this may just be the year to get this legislation passed,” said Smith, noting that Miami Children’s Hospital, an early pioneer of telemedicine since 1973, Lee Memorial Health System, Florida Chamber of Commerce and Baptist Health South, among others, provided compelling demonstrations of telemedicine’s potential for Florida.

The Florida Medical Association released a position statement on telemedicine in its legislative agenda, “The FMA’s Prescription for a Healthy Florida,” supporting the use of new technologies to expand access to areas where too few physicians or a second opinion by a specialist is quickly needed.

“Our goal is to expand the use of telemedicine while ensuring high standards and providing appropriate safeguards to protect patient safety and privacy,” said Jeff Scott, FMA director of legal and governmental affairs, noting four components the statewide association believes must be accomplished:

Definition of Telemedicine: Florida must clearly define the practices of telehealth, telemonitoring and telemedicine. The definition of telemedicine must include language that requires an established patient-physician relationship and also the requirement for patient-informed consent. 

Physician Accountability: Physicians using telemedicine must be licensed in Florida. To ensure the safety of Florida’s patients, these physicians should meet uniform standards of care. The Florida Board of Medicine must have jurisdiction to credential and discipline these physicians practicing medicine on Florida patients via telemedicine. 

Continuing Medical Education (CME): All physicians practicing telemedicine must comply with state laws and rules. The best way to maintain this knowledge in an ever-changing technological landscape is for physicians to complete CME provided by their professional association. 

Reimbursement: Lack of payment for telemedicine services is a significant barrier to widespread adoption of this innovative technology. Parity for face-to-face consults and telemedicine consults must apply in the private insurance market and Medicaid. The physician expends the same amount of time, skill and diagnostic expertise when conducting a consult, whether face-to-face or via telemedicine. 

“As with any new technology, there’s always potential for abuse,” Scott pointed out. “It’s important that insurance companies are prevented from using telemedicine physicians as ‘gatekeepers’ to deny care. In addition, health plans should by prohibited from using telemedicine to get around network adequacy requirements.”

Scott emphasized there are no reimbursement issues in either bill.

Smith suggested the lack of reimbursement “is a strategic move ... that will be addressed in subsequent years.”

The House counterpart (HB 545), introduced by Cummings and Jones, defines telehealth and telehealth provider, provides for practice standards for telehealth providers; authorizes telehealth providers to prescribe controlled substances via telehealth with exception; and provides for the maintenance and confidentiality of medical records.

Senate Bill 478 has an addition: “prohibits the use of telehealth or specified computer-controlled devices to prescribe optical devices.”

The Florida Senate Health Policy Committee unanimously voted in favor of Senate bill 478, which was amended and now more closely conforms to the House version.

“We supported the bill in the Senate Health Policy committee,” said Scott. “We’d like to do some fine tuning, and are working with the sponsors to accomplish this.”

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