Is Telemedicine Missing from Health Reform?
Perhaps in recognition of its benefits to areas affected by shortfalls in specialists and primary care physicians or the need for remote monitoring, telemedicine received significant funding in the ARRA. For instance, the Rural Utilities Service was allocated $2.5 billion to fund “shovel-ready” distance learning, telemedicine, and broadband program; the Indian Health Services received $85 million to fund telemedicine; and a portion of the $2 billion allocated to the Office of the National Coordinator is to be used to support the “infrastructure and tools for the promotion of telemedicine.” However, in contrast to the ARRA, the current reform proposals publicly available are missing language facilitating telemedicine which otherwise could be a key component to one of the goals of health reform, bending the cost curve.
The only attention telemedicine receives in the House Tri-Committee Bill – the America’s Affordable Health Choices Act of 2009 – is in the creation of the Telehealth Advisory Committee. This Committee will advise and make recommendations to the HHS Secretary regarding policies for payment of telemedicine services. However, the Senate HELP’s Bill – the Affordable Choices Act – does not even mention telemedicine.
Should something be done regarding this missing health reform element? A group of experts have eloquently made the argument that the present infatuation with electronic health records (“EHRs”) should be expanded to focus on improving the quality of care and equities of care, while decreasing the cost and fragmentation of such care by encouraging the development of telemedicine (which includes, as a component, EHRs).
Also, Intel CEO Paul Otellini provides a sensible guide for achieving comprehensive health reform – and two of his recommendations are reliant on telemedicine. First, he suggests paying providers for outcomes, not just face-to-face visits. If payment was outcome based – even if the correct outcome was achieved in part by utilizing email, the financial interests of the provider would be more closely aligned with the desired goal of the patient, i.e., better health. The other recommendation that involves telemedicine is the development of a nationally-licensed cadre of “virtual care clinicians” to provide care to patients in their home. In the case of an elderly individual with a chronic disease, this could be the difference between staying in their home and moving into a skilled nursing facility and, obviously, the cost between the two options is significant.
