chris pittman the politics of telemedicine

The Politics of Telemedicine

C. Christopher Pittman, M.D.

Chair, FMA Advisory Committee on Healthcare Information Technology

President-Elect, FMA Political Action Committee

AMA Alternate Delegate, American College of Phlebology

Immediate Past President, Hillsborough County Medical Association

HELPING PHYSICIANS PRACTICE MEDICINE


I do not have relevant financial

relationships with any commercial

interests.

Conflict of Interest Disclosure


Health Care Issues

● Expanding insurance coverage

● Expanding access to high quality medicine

● Potential shortage of primary care doctors and nurses in certain regions of Florida

● Telemedicine allows physicians to remotely diagnose and treat patients.

● Homebound patient can “see” a physician for periodic checkups

● Physician with a difficult diagnosis can consult a specialist online

● The use of new technologies can:

● improve patient access

● allow existing pool of physicians to reach more patients

● allow physicians to remotely supervise mid-level providers

● save on costs



Political Issues

● Telemedicine and new technologies should not be used as an excuse to allow unlicensed or poorly

credentialed physicians from out-of-state to engage in medical or regulatory subterfuge.

● “Dial-a-doc” programs should not displace quality health care regulated by the Florida Board of Medicine

and other licensing and credentialing agencies.

● Telemedicine should supplement care from local physicians, not supplant them.

● New laws should not allow managed care companies to evade network adequacy requirements by

replacing local physicians with unlicensed doctors at out-of-state call-in centers.

● Managed care companies should not be allowed to rely on unregulated physicians — who answer to

nobody in Florida — to deny coverage for claims or override the decisions of a Florida doctor.



FMA Position

● FMA supports the concept of telemedicine and believes that technology holds great promise for expanding access to care, however, we remain committed to defeating any legislative proposals that fall far short in the area of patient protection.

●The FMA feels strongly that a Florida medical license is necessary in order to ensure accountability and protect patients.

●There are over 10,000 Florida licensed physicians who practice in other states, so requiring a Florida license is not an excessive burden.



FMA Position

● Let’s use new technologies to expand access to care and to better serve Floridians.

● Let’s also be wary and ensure that every physician who practices telemedicine —in-state

or out-of-state — be held to the same standards of governance and accountability that we

have in place for Florida doctors.

● FMA believes Florida laws:

● ensure high quality health care

● protect patients

● limit costs

● ensure accountability



FMA Position

●The FMA is supportive of the expanded use of telemedicine to modernize the delivery of healthcare.

●Uniform standards should be established for physicians to maintain patient safety though three (3) key components:

1. Definition2. Accountability3. Parity in Reimbursement



DEFINITION

●Telemedicine is the health care delivery, diagnosis, consultation, treatment, monitoring, or the transfer of medical data via the use of telecommunications services to establish a physician-patient relationship, to evaluate a patient, or to treat a patient.

●The practice of telemedicine should only be conducted with the appropriate technology and encryption to comply with HIPAA. The physician practicing telemedicine must establish a physician-patient relationship and have the patient's informed consent.



ACCOUNTABILITY●Physicians practicing telemedicine in Florida must be licensed in Florida.

PARITY REIMBURSEMENT

●Parity for face-to-face consults and telemedicine consults must apply in the private insurance market as well as in Medicaid.

●Physicians expend the same amount of time, skill, and expertise when conducting a consult whether it be face-to-face or through telecommunications.



THE FIVE PILLARS OF EXPANDED ACCESS TO CARE

●The FMA has identified how to effectively and immediately address the shortage of primary care and family physicians in Florida:

1. Increasing the in-state residency slots for family practice2. Redirecting funds for loan forgiveness to family practitioners3. Expanding collaboration between PAs, ARNPs and Physicians4. Fully enacting fair payment for Medicaid services5. Codifying and regulating telemedicine



Summary FMA Position

● We should be forward-thinking, however, we should not invite or incentivize unscrupulous behavior.

● The Florida Medical Association supports Florida licensure of physicians who provide evaluation and

treatment via telemedicine.

● Telemedicine is a medical service and should be reimbursable like any other medical service provided by a

physician.

● FMA is working to address potential doctor shortage without sacrificing quality or putting patients at risk.

● Telemedicine is just one pillar in a larger plan to meet this challenge



THANK YOU FOR YOUR ATTENTION


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Telemedicine Expansion at the National Level

● Report of the State Medical Boards’ Appropriate Regulation of Telemedicine (SMART) Workgroup, MODEL

POLICY FOR THE APPROPRIATE USE OF TELEMEDICINE TECHNOLOGIES IN THE PRACTICE OF MEDICINE, April 2014

● Alliance for Connected Care is a 501(c)(6) organization formed to create a statutory and regulatory environment

in which every provider in America is permitted to deliver and be adequately compensated for providing safe,

high quality care using Connected Care at his or her discretion, regardless of care delivery location or

technological modality.


chris pittman the politics of telemedicine

Healthcare

local physicians

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unregulated physicians

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existing pool of physicians

quality health care

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