telemedicine: challenges and opportunities
TRANSCRIPT
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Telemedicine: Challenges
and OpportunitiesDavid Harlow JD MPHTHE HARLOW GROUP
LLCblog • healthblawg.com
twitter • @healthblawg Health Law SymposiumBostonMay 20, 2016
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Dynamic Tension
One foot in the past, one foot in the future.
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Cost & Quality
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Telemedicine Modalities
Synchronous Asynchronous
Remote Monitoring Mobile Health
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Live Video (Synchronous)Image credit: IntelFreePress via Flickr CC
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Market Driven
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Health Insurance Exchange - Network Adequacy• Colorado to recognize telemedicine
providers for network adequacy requirements for some specialties (2017)• Seems to be isolated instance thus far,
even though NAIC has built telemedicine providers into its model approach to assessing network adequacy• Urban Institute report
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Employee Benefits > Medicare > Medicaid
Employee Health Benefit
Medicare
Medicaid2016 expansion
50-State Coverage & Reimbursement
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Limited by State Medical Boards
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Interstate MedicalLicensure Compactlicenseportability.org
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Can practice limits imposed by a medical board be an antitrust violation?
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North Carolina – Teeth Whitening
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The Supremes said: “a state board on which a controlling number of decisionmakers are active market participants in the occupation the board regulates” may invoke the state action defense only when two requirements are satisfied: first, the challenged restraint must be clearly articulated and affirmatively expressed as state policy; and second, the policy must be actively supervised by a state official (or state agency) that is not a participant in the market that is being regulated. N.C. State Bd. of Dental Exam’rs v. FTC, 135 S. Ct. 1101, 1114 (2015).
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FTC Guidance (October 2015)
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Texas – Board Bars Prescription Without F2F Encounter & Teladoc Sues• This fight has dragged on for five years already …• Initial bar: By letter … Eventually: By regulation • Teladoc won in US District Court, Texas Medical
Board appealed to 5th Circuit Court of Appeals
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Bringing up the rear …
• Indiana’s F2F rule for Rx writing has been eliminated (except for controlled substances) effective July 1, 2016. • Alaska, Arkansas & Texas
still require F2F visit to establish physician-patient relationship
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Massachusetts• Prescribing physician must have physician-
patient relationship• Rule arose in context of online
pharmacies• State licensure required (not part of
compact)
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Expanding into chronic and behavioral health
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Asynchronous (Store & Forward)
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Services that are not “health care services” but rather “informational” services
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Remote Monitoring
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Mobile Health (Apps)
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Link to recent reports & discussion
Data privacy and security issues
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Progress . . .
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Thank You David Harlow JD MPHTHE HARLOW GROUP
LLC