Broadband Aids Telehealth, But There Are Limits

Widespread implementation of telehealth could save the U.S. health care system $4.28 billion annually, by reducing transfers of patients, office visits, said Vo. Of particular cost-reduction value is the ability to link a patient and the primary-care physician to a remote specialist by video, Vo said. In addition to reducing the number of in-person visits, the electronic consultation will reduce redundant or overlapping tests that are ordered separately by multiple providers, the most significant source of cost savings.

However, the current national IT infrastructure limits the effectiveness and capacity of telehealth, Vo said. The nature of an effective and proficient telemedicine practice depends largely on its operational protocols and networks, he said. The popularity and expansion of online video usage in the healthcare industry increases Internet traffic, increasing the potential for congestion that causes transmission delays or jitter, he said. The delays can make medical images unusable or destroy the feasibility of emerging telehealth services such as home monitoring or prevent procedures in which experienced providers guide and perform remote operations, Vo said. Maximizing telehealth’s potential requires enhancing existing information technology and encouraging broadband adoption and the deployment of smart networks that provide fast, reliable and secure transmissions for telehealth service, he said.

Challenges also come from the economics of telehealth. Care providers worry that their revenues may decline in a telehealth environment, Vo said. Providers must bear the cost of required infrastructure investments, but current insurance reimbursement policies tend to favor traditional medicine and may not compensate the providers for telehealth services, he said.

Meanwhile, telehealth has gained support from Congress. The House Commerce Committee has not yet scheduled a markup of HR-6179, a health information technology interoperability bill passed June 3 by the Health Subcommittee, a committee spokeswoman said, but there is continuing interest in the legislation. Dozens of bills have been introduced in this Congress offering ideas on how to transfer from a paper to an electronic health records system. The House Health Subcommittee also passed a health IT bill in June, which includes a $113 million grant through 2013 for health providers facing financial hurdles in getting equipment needed to digitize paper records (WID June 26 p4). There is an e-prescription provision in HR-6357, the Medicare bill that includes incentives to do electronic prescriptions, said a committee spokeswoman.

Congress overrode President Bush’s veto of another Medicare bill that addresses issues including averting scheduled cuts in physician fees and adding new originating sites for Medicare reimbursement, American Telemedicine Association CEO Jonathan Linkous told the briefing. Under the new law, as of Jan. 1, 2009, skilled nursing facilities, in-hospital dialysis centers and community mental health centers will be originating sites for Medicare reimbursement, Linkous said. ATA submitted the proposal to add new originating sites for Medicare reimbursement earlier. The bill passed the House June 24 and passed the Senate July 9. On July 15, President Bush vetoed the bill. Congress overrode the veto later that day, making the bill law.