# Presentation: 024035

## Remote Health Care Services(the patient care side of HIT)Current Support,  Trends andOutstanding Barriers 

**Jonathan D. Linkous, Executive Director, American Telemedicine Association**

**April 26, 2007**

## Federal Support for Remote Health Care

**2. Project Funding**

**Direct Remote Health Services**

**Federal Support ****for**** Remote Health Care**

## Medicare Reimbursement

** ****Diagnostic Services**
** ****Rural Interactive Consultations**
**  ****(aka “telehealth”)**

## Medicare Reimbursement

** ****Teleradiology**
** ****Pathology**
**Monitoring of certain vital signs**
** ****Cardiac**

**Diagnostic Services **

**Medicare Reimbursement**

## Medicare Reimbursement

**Largest number of remote medical services delivered**
**Fully integrated into the Medicare reimbursement system**
**No special codes or identifiers**
**Same rates**

**Medicare Reimbursement**

**Diagnostic Services **

## Medicare Reimbursement

**Covered by special CPT codes**
**Provided by physicians and Independent Diagnostic Testing Facilities**
**Primarily event based (some live)**

**Medicare Reimbursement**

**Diagnostic Services **

## Rural Interactive Consultations 

**Called “telehealth” by CMS**
**Program started in 1999, expanded each year**
**Reimburses live video telemedical services to non-metro areas**

**Medicare Reimbursement**

## Rural Interactive Consultations 

**Only designated sites**
**Live video only **
**	****(except AK and HI)**

**Rural Interactive Consultations**

**Medicare Reimbursement**

## Rural Interactive Consultations 

**Special identifier**
**Facility fee at**
** ****originating site**

**Rural Interactive Consultations**

**Medicare Reimbursement**

## 2. Federal Project Funding

** ****Research**

** ****Demonstrations**** **

** ****Subsidies**

## Federal Project Funding

** ****Defense - TATRC**
** ****HHS - HRSA, OAT, NIH, AHRQ**
** ****Agriculture - RUC**
** ****FCC - USAC**

**Federal Project Funding**

## Federal Project Funding

**Total Estimated Federal Project Funding for Remote Health Care (FY 2006): $375 million**

## Remote Health Services Provided Directly by Federal Agencies

## Veterans HealthLarge provider of remote healthOperates through VISNs

**350,000 services delivered remotely in 2003**
**25,000 homes with remote monitoring**
**100,000 remote diabetic retinopathy assessments in 2006**

**Direct Federal Services**

**Notes:**
Adam Darkins, MD
Office: 202-273-8563
Veterans Administration
Vermont Avenue
Washington, DC

## Other Federal Service Providers

**Direct Federal Services**

** ****DOD**
** ****DOJ - Prisons**
** ****Indian Health Service**
** ****NASA**

## Non-Federal Support for Remote Health Care

## Medicaid – What’s CoveredRemote diagnosis of images: all statesReimbursement for other telehealth  services: 34 states

**State Support**

**Notes:**
Contact:
Mark Thomas, P.E. 
Office: 301-443-7998 
Fax: 301-443-8405 
Div of Facilities & Env Engineering 
Indian Health Service, DHHS 
12300 Twinbrook Parkway, # 600B 
Rockville, MD 20852

## Medicaid - RulesSome states include facility feesMost do not restrict reimbursement by geographic area or type of provider

**State Support**

**Notes:**
Contact:
Mark Thomas, P.E. 
Office: 301-443-7998 
Fax: 301-443-8405 
Div of Facilities & Env Engineering 
Indian Health Service, DHHS 
12300 Twinbrook Parkway, # 600B 
Rockville, MD 20852

## Other State Support24 states provide non-Medicaid funding for remote health care in 2006State funding for remote healthcare in prisons in many states – paid on a fee-for-service or capitated basis

**State Support**

**Notes:**
Contact:
Mark Thomas, P.E. 
Office: 301-443-7998 
Fax: 301-443-8405 
Div of Facilities & Env Engineering 
Indian Health Service, DHHS 
12300 Twinbrook Parkway, # 600B 
Rockville, MD 20852

## Private payers provide widespread coverage for remote health servicesNot uniform but growing in number and amount of coverage 

**Private Payers**

**Notes:**
Contact:
Mark Thomas, P.E. 
Office: 301-443-7998 
Fax: 301-443-8405 
Div of Facilities & Env Engineering 
Indian Health Service, DHHS 
12300 Twinbrook Parkway, # 600B 
Rockville, MD 20852

## State Requirements6 states require private payer reimbursement:- California- Hawaii- Kentucky- Louisiana- Oklahoma- Texas

**Private Payers**

**Notes:**
Contact:
Mark Thomas, P.E. 
Office: 301-443-7998 
Fax: 301-443-8405 
Div of Facilities & Env Engineering 
Indian Health Service, DHHS 
12300 Twinbrook Parkway, # 600B 
Rockville, MD 20852

## Reimbursement ProcessMost do not require special codesAlmost all reimbursement is at same rates as face-to-faceFacility fees rare

**Private Payers**

**Notes:**
Contact:
Mark Thomas, P.E. 
Office: 301-443-7998 
Fax: 301-443-8405 
Div of Facilities & Env Engineering 
Indian Health Service, DHHS 
12300 Twinbrook Parkway, # 600B 
Rockville, MD 20852

## Private Payers

**Growing coverage (about 20 major insurers plus some employers)**
**Rates range from $25-$50**
**May be based on time charge ($5 per 5 minutes)**
**Some based on annual member fee**

**Private Payers**

**Notes:**
Contact:
Mark Thomas, P.E. 
Office: 301-443-7998 
Fax: 301-443-8405 
Div of Facilities & Env Engineering 
Indian Health Service, DHHS 
12300 Twinbrook Parkway, # 600B 
Rockville, MD 20852

## TRENDS

_**Medicare:**_** payments small, less than projections; slow growth in coverage**

_**Federal projects:**_** reduced funds for projects, increased military funding (primarily earmarks)**

_**Direct federal services:**_** rapidly increased use of remote health care to meet growing demand**

**Notes:**
Contact:
Mark Thomas, P.E. 
Office: 301-443-7998 
Fax: 301-443-8405 
Div of Facilities & Env Engineering 
Indian Health Service, DHHS 
12300 Twinbrook Parkway, # 600B 
Rockville, MD 20852

## TRENDS

_**State support:**_** steady increase in  Medicaid coverage and other support**

_**Private payer:**_** increased coverage of remote health care services across the board**

**Notes:**
Contact:
Mark Thomas, P.E. 
Office: 301-443-7998 
Fax: 301-443-8405 
Div of Facilities & Env Engineering 
Indian Health Service, DHHS 
12300 Twinbrook Parkway, # 600B 
Rockville, MD 20852

## Barriers

**Medicare Coverage**
**Remote Consultations**
** ****Limited services, facilities, geography, type of provider**
**Diagnostic Services**
** ****Continuous cardiac monitoring**
** ****Other vital sign monitoring services must be in-office or clinic**
** ****No home telehealth incentives  **

## Other Barriers

**Uniform Medicaid coverage**
**Harmonized State licensure requirements**
**Consistent road maps for providers and related quality assurance mechanisms**