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BUSINESS OF
Telemedicine
legislation
may gain
momentum
By Pamela C. Smith, PhD
Medicare Part B allows payments for telehealth services (42 CFR
§410.78), including “office or outpatient visits, subsequent hospital
care services (with the limitation of one telehealth visit every three (D-Calif.) put forth the Telehealth Promotion Act of 2012. The
days).”
Defining telehealth services requires understanding such terms
as “asynchronous store and forward technologies,” “distant site,”
“interactive telecommunications system” and “originating site.”
These terms on the surface might require a law degree to truly un-
derstand. In simple terms, according to the American Telemedicine
Association (a nonprofit telemedicine advocacy group), telemedi-
cine “is the use of medical information exchanged from one site to
another via electronic communications to improve a patient’s clin-
ical health status.” 1
Oftentimes, the words telehealth and telemedicine are used in-
terchangeably, but each has a distinct definition. According to the
Texas Medical Association, telehealth “refers to a broad scope of re-
mote healthcare services that may include clinical care but also en-
compasses education and administrative components.”
Telemedicine “refers specifically to the delivery of remote clinical
services” and is “not considered a separate medical specialty.”2 A
third term, used more in the telehealth industry, is telecare, which
“refers to technology that allows patients to stay safe and independ-
ent in their own homes, through the use of telecommunications
technology.”3
Currently, Medicare reimburses for services provided to bene-
ficiaries who seek care at approved facilities in designated rural
areas. Legislators over the years have viewed these reimbursement
rules as antiquated and oblivious to today’s high-tech environ-
ment. Congressional members have attempted to update the re-
MEDICINE
imbursement regulations to better meet the demands of our mo-
bile population. For example, in 2012, Rep. Mike Thompson
bill sought to allow telehealth services to be covered “to the same
extent the item or service would be covered if furnished in the
same location of the beneficiary, and benefits shall not be denied
… solely on the basis that the item or service is being furnished
via a telecommunications system.” 4
Despite this bill failing to get out of committee, the telemedicine
topic is not dead. In July 2014, Thompson again sought to change
the rules surrounding telehealth services. Serving on the House En-
ergy and Commerce Subcommittee, Thompson, along with nine
cosponsors, introduced HR 5380, the Medicare Telehealth Parity
Act of 2014, in another attempt to change the way telemedicine
services are reimbursed. The bill proposed to expand telehealth
services to urban areas, lift restrictions on “store and forward” tech-
nology [i.e., video conferencing technologies], and authorize pay-
ments for remote patient monitoring for those with chronic health
conditions.
As in prior history, the Medicare Telehealth Parity Act of 2014
also failed to get out of committee. However, less than five months
later, on Jan. 27, Rep. Fred Upton (R-Mich.) led the House Energy
and Commerce Committee to release a discussion draft entitled the
21st Century Cures Act. The Energy and Commerce Committee
argues the provisions “would advance opportunities for telemedicine
and new technologies to improve the delivery of quality healthcare
services to Medicare beneficiaries.” 5 Particularly, the draft is seeking
to include services that meet unmet service needs, are substitutes
for in-person visits, are proven to reduce admissions (or other costly
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