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services), and allow patients to be treated at a lower level of care REFERENCES
(including home healthcare). The would be required to develop a
methodology within four years to address these needs. To address 1 http://www.americantelemed.org/about-telemedicine/what-is-
potential costs, the draft requires the ’ chief actuary to ensure pay- telemedicine#.VNEwKcUxpyI
ments “would reduce (or would not result in any increase in) net
program spending.” 2 http://www.texmed.org/Template.aspx?id=30999&terms=telehealth#glossary
3 http://www.globalmed.com/additional-resources/telehealth-telecare-and-telemed-
Since telemedicine affects practitioners and hospitals, the Amer-
ican Hospital Association (AHA) agrees, in theory, with the goal icine-whats-the-difference.php
of expanding coverage of telehealth services. The AHA argues ge- 4 http://www.gpo.gov/fdsys/pkg/BILLS-112hr6719ih/html/BILLS-
ographical restrictions must be addressed in the legislation, since
Medicare only pays for telehealth services for facilities located in 112hr6719ih.htm
rural Health Professional Shortage areas. The AHA also noted that 5 http://energycommerce.house.gov/sites/republicans.energycommerce.
“only 75 individual service codes out of more than 10,000 physi-
cian services covered through the Medicare physician fee schedule house.gov/files/114/Analysis/Cures/20150127-Cures-Discussion-Document-Sec-
are approved for payment when delivered via telehealth.” 6 tion-by-Section.pdf
6 http://news.aha.org/article/aha-calls-for-more-global-approach-to-coverage-in-
Only time will tell if this latest legislative draft will make it out house-telehealth-proposal
of committee. Advocates and opponents must make their concerns
heard to have productive dialogue. The end result should be Pamela C. Smith, PhD, is a professor in the de-
changes to the reimbursement system that provide benefits to all partment of accounting at the University of Texas
interested parties – without significantly raising costs. at San Antonio.

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36 San Antonio Medicine • April 2015