HIMSS mHealth Committee Telehealth Executive Summary Recommendations

1. Physician Focus
Group
Perspectives on Telehealth
Policy and Reimbursement

2. Problem Statement
Often reimbursement is noted as a barrier to adoption of
new and novel technologies including mobile health.
HIMSS organized a group of distinguished physicians to
discuss the state of telehealth reimbursement.
The group addressed the following key areas:
1. Reimbursement Issues
2. Concerns Regarding Quality and Patient Safety
3. Opportunities to Better Leverage Technology

3. Primary Objectives of Focus Group
• Identify barriers to adoption in light of the growing
availability of novel mHealth technologies.
• Compare and contrast reimbursement, policy and
regulatory issues between traditional telehealth models
and new alternative and concierge models of healthcare
delivery.
• Identify areas and opportunities (both financial and
technological) for physicians to better leverage and
implement technology in the delivery of healthcare.

4. Perceived Barriers to Increased Use of
Telehealth and mHealth
• Payment
– Greatest barrier to use
– Lack of appropriate reimbursement models for effort
• Technology
– Innovation is still evolving, need improvements in hardware
– Lack of flexibility in application of technology
– Rural connectivity – wireline and wireless improvements for
coverage and access
• Regulatory
– Ability for policy to keep current

5. Perceived Barriers to Increased Use of
Telemedicine and mHealth
• Clinical
– Validity and effectiveness of interventions
– Consumer acceptance
– Increased virtual access could lead to potential over utilization
– Quality of services provided in virtual encounters
– Confusing to implement based on specialty
– Visit documentation and EHR integration needed to support
continuity of care

6. Reimbursement, Policy, and
Regulatory Issues
• Ability for policy to keep current with technological
advancements
• Scope of service, prescribing regulations
• Definitions of practice, i.e., what constitutes a provider
encounter or establishment of relationship
• Data storage of virtual encounter: length of retention
• Documentation requirements for payment in emerging
models of care

7. Reimbursement, Policy, and
Regulatory Issues
• Reimbursement
- Hampered by CMS and Congressional Budget Office (CBO)
(scoring). CBO scoring lacks comprehensive
understanding of care delivery, overestimates potential
cost(s), benefits not well studied
- Reimbursement restrictions: Need to remove
reimbursement restrictions, i.e., only beneficiaries in a
health professional shortage area (HPSA) or not in a
metropolitan statistical area (MSA) eligible
• BIPA 2000 study request of CMS did not occur – CMS reimbursed
only $12 million in telehealth claims nationwide in 2013

8. Recommendations & Opportunities

9. State Reimbursement, Policy, and
Regulatory - Recommendations
• Communication with state Medical Boards and
legislators should be enhanced
• Expand Medicaid coverage models
• State HIE models should facilitate telehealth collaborations
• States can and should submit a State Plan Amendment to
include telehealth for dual eligibles
• Consideration (by Medicaid) for removing State Plan
Amendment in the event telehealth or remote patient
monitoring services are employed for Dual Eligibles
• Interstate Licensure – Must be modified to optimize utility of
telehealth
•

10. Federal Reimbursement, Policy, and
Regulatory – Recommendations
• Streamline and improve FCC Universal Service Fund
(USF) for healthcare – example covers EMS providers
• Include telehealth in Meaningful Use
• Medicare should provide broader coverage for CPT
codes of care coordination and remote patient
monitoring
• Ensure CMMI (Center for Medicare & Medicaid
Innovation) explores the implementation and adoption
of telehealth and mHealth and validates their
technological and financial benefits to improving
healthcare delivery

11. Clinical – Opportunities
• Expanded use of mobile and wireless
technology as an intermediary and an adjunct
between visits
• Patient empowerment and engagement
• Need to expand definitions of originating sites to
other locations of care i.e. patient’s home or
long term care facility

12. Educational – Opportunities
• Educational programs needed for all clinical stakeholders
about the utility of telehealth
• Introduce the use of technology (telehealth & mHealth) and
billing into medical education
• Training needed in virtual visit communication and analysis
• Federation of State Medical Boards (FSMB) unifies physician
practices among states, no similar body for other providers
• Work with the specialty societies to develop practice
guidelines for the appropriate provision of telehealth
particularly for the direct to consumer models; practice
guidelines will also help establish credibility with payers

13. Educational/Financial – Opportunities
• Provide standardized training to providers and
medical billers which enables better
understanding of telehealth reimbursement
opportunities
• Expanded industry dialogue on bringing forth
requests for new CPT Codes for new or existing
procedures
• Specifically, work with AMA to help determine
opportunities to define services and better
understand coding and valuation processes

14. Contributors
Name Title Affiliation
Ricky Bloomfield, MD Director, Mobile Technology Strategy Assistant
Professor, Internal Medicine-Pediatrics
Duke Medicine
Duke Medicine
Guenevere Burke, MD Department of Emergency Medicine
GW Medical Faculty Associates
George Washington University
Harry Greenspun, MD Director Deloitte Center for Health Solutions
Peter Hollmann, MD Chair, CPT Editorial Panel American Medical Association
Shaiv Kapadia, MD Shaiv Kapadia, MD FACC
Principal and Founder
C3 Nexus
Susie Lew, MD Professor of Medicine; Division of Renal Diseases and
Hypertension
George Washington University
Karen S. Rheuban, MD Senior Associate Dean for CME and External Affairs
Medical Director, Office of Telemedicine
University of Virginia
Brian Rothman, MD Medical Director, Perioperative Vanderbilt University Medical Center
Neal Sikka, MD Associate Professor
Chief, Section of Innovative Practice & Telehealth
Department of Emergency Medicine
GW Medical Faculty Associates
George Washington University
Nick van Terheyden, MD Chief Medical Information Officer Nuance Communications

15. Reviewers
Name Title Affiliation
Rebecca Kartje, MD, MBA University of Illinois at Chicago
Karen Remley, MD, MBA, FAAP Chief Medical Director – Virginia Anthem Blue Cross and Blue Shield
Douglas Smith, MD, LTC, FACEP Executive Vice President Emcare

16. Staff
Name Title Affiliation
Robert Jarrin, JD Senior Director, Govt. Affairs
HIMSS mHealth Committee Chair (volunteer)
Qualcomm Incorporated
David Collins, MHA, CPHQ,
CPHIMS, FHIMSS
Senior Director, Health Information Systems HIMSS
Thomas Martin, Ph.D., MBA Director, Health Information Systems HIMSS