Colorado Medical Society

http://dev.cms.org/articles/presidents-letter-september-october-2014/

President’s letter: Telehealth – facilitating the next big thing

Monday, September 01, 2014 12:05 PM

John Lumir Bender, MD, FAAFP
President, Colorado Medical Society

Perhaps like me, you have not really seen telehealth live up to its promise here in Colorado. Although we have some telemedicine occurring in niche markets, like satellite hospital consultations, there is hardly a mainstream movement of consumer access to physician services online or by smart phone. Yet the trends are unmistakable:

• The advent of accountable care organizations and other bundled payment reform systems will allow codes that were largely not paid for under fee for service, like telemedicine, to have a source of funding.
• Regulators at the state and national level are continuing to modernize the law books around telehealth and telemedicine to encourage physicians to engage patients remotely within clear boundaries that are safe and have utility to consumers.
• Patients will be empowered to decide when and with whom they will share critical information thanks to remote monitoring technologies such as Bluetooth-enabled biosensors that can communicate with smartphones and sync data to cloud-based health information exchanges.

So what does Colorado need to do to participate more in the future? Well it turns out, according to the American Telemedicine Association (a reputable national leader in model language for state policy development for telemedicine rules and regulations) that Colorado is a little behind the rest of the nation. One important potential roadblock here at a mile high is that our state code only requires insurers to pay for telehealth if the patient lives in a county with a population of under 150,000 people (C.R.S. 10-16-123). The law itself seems to suggest that health care disparities and access problems only occur in rural and frontier Colorado. The reality is that telehealth could be used to meet the demands of many important access problems across suburban and urban Colorado as well. I am always amazed at how many patients may not have an automobile in this economy, but they will have a computer tablet and Internet access (and they use it right in the exam room!). Note that the Colorado law itself was written in 2001, long before Facebook, smart phones, and the widespread use of computer tablets by consumers.

Estimates vary, but perhaps 20% of what physicians do on average in the office could be accomplished remotely. I would even go so far to say that much of what happens in a retail clinic could be performed as a telehealth visit.

Now may be the right time to actively engage with other stakeholders to modernize Colorado’s approach to telemedicine/telehealth in order to enhance access and improve the quality and cost-effectiveness of our care. At the upcoming annual meeting the House of Delegates will take action on a new policy for CMS on telemedicine. Taking that one step further, now may be the time to consider other potential roadblocks to expanded use of telehealth technologies, like requirements for physicians to document a barrier to an in-person visit for health benefit plan coverage of services provided via telemedicine, or requirements to utilize telemedicine when a physician has determined that it is not appropriate.

Technology is rapidly changing the health care landscape and it is incumbent upon us to work with others to ask and answer these challenging questions in order for telehealth in Colorado to live up to its promise.

It has been a great year, this is my final letter as your President – thank you for your membership in the Colorado Medical Society, and for all you do for the people of Colorado.