ATA To Medicare: Broaden Hospital Telemedicine Participation Rules
The American Telemedicine Association wants Medicare to approve telemedicine services for stroke and intensive care.
In a letter to acting CMS administrator Marilyn Tavenner, ATA president Jonathan Linkous asked the agency to revise its conditions-of-participation rules to encompass hospitals' use of telemedicine in the areas of emergency medicine, stroke care, and intensive and critical care services.
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In addition, the letter suggested that CMS change its requirements for discharge planning to include planning that might help avoid unnecessary readmissions. Although this section doesn't mention telemedicine, Linkous told InformationWeek Healthcare that it's aimed at motivating hospitals to include remote patient monitoring in discharge planning for certain kinds of patients. Some hospitals are already doing this so that the CMS won't penalize them for excessive readmissions, he said.
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The most common use of telemedicine in hospitals today is in intensive care units. An increasing number of facilities have "eICUs" that allow intensivists to monitor ICU patients remotely. The ATA letter notes that this approach could help hospitals that are unable to hire intensivists or that don't have enough of these specialists to provide around-the-clock coverage in the ICU.
The CMS currently does not bar the use of eICUs for Medicare patients but the program pays only onsite critical-care specialists, not those who do remote monitoring. Last summer, the CMS proposed a redefinition of telehealth services, including eICUs, that might lead to expanded coverage of those services.
The ATA missive pointed out that stroke victims could have better outcomes if they received recommended therapy soon after their strokes. But according to a recent study, the letter said, only 50 percent of the U.S. population has timely access to a stroke center, and rural hospitals tend to lack knowledge of thrombolytic therapy. Hence, the ATA concluded, the use of telemedicine could help improve stroke care and lower the cost of caring for stroke patients.
Some hospitals already have come to the same conclusion. These facilities are beginning to use "stroke networks"--either state-sponsored networks or private entities that contract with facilities--to supplement their staff neurologists and stroke specialists via telemedicine, Linkous said.
Overall, the letter said, increasing the use of telemedicine in hospitals would:
-- Enable hospitals to provide services in off hours through sharing arrangements with other facilities, which will reduce the cost of duplicative staffing.
Although the ATA focused on emergency, stroke, and critical care services, many hospitals have trouble getting a broad range of specialists to come in when they're needed. Most of these facilities have resorted to paying the physicians extra to do so. Linkous believes that extending the use of telemedicine to additional specialties could ameliorate this situation.
Already, he pointed out, "almost every hospital in the country is using tele-radiology at least in part--and not just in emergencies, but after hours or any other time when radiologists can view images from home." In some cases, he noted, this work is outsourced to firms that specialize in this work, both here and abroad. Dermatology and "hospital specialist" companies are arising to meet the same need, he said.
"Our point with CMS is that as you go forward with conditions of participation, let's make it very clear that telemedicine is a good option for hospitals to help meet these requirements," he concluded.
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