Published by Epstein Becker Green
Posted on December 22nd, 2015
by Rene Quashie
As 2015 winds down, I think it is safe to say that
it has been a whirlwind year in telehealth. According to the National
Conference of State Legislatures (NCSL), over 200
telehealth-related bills were introduced in 42 states. The Federation
of State Medical Boards (FSMB) has launched an interstate
physician licensure compact that creates a new pathway to expedite physician
licensure in multiple states. Twelve states (with Wisconsin
being the latest) have so far enacted the licensure compact. Many
states such as Colorado, Iowa, and Louisiana released regulations or policies
that in my view took a more progressive approach to telehealth regulation.
Activity has not just been limited to the states. Congress has
introduced a number of telehealth-related bills such as the TELE-MED
Act of 2015 which permits certain Medicare providers licensed in a state to
provide telemedicine services to certain Medicare beneficiaries in a different
state without having to be licensed in that state. In addition, a number
of reports,
surveys, and white
papers have been published on all aspects of telehealth. After many
false dawns, telehealth has truly arrived. But many issues remain to be
addressed.
Now we look forward to a new year. What can we expect? In
addition to a continuation of what has occurred in 2015, there are a few other
issues and/or trends that bear watching. Here are a few:
The Rise of Compacts to Address Licensure Issues
The use of compacts to address licensure issues will continue to gain steam
in 2016. I have already mentioned FSMBfs interstate physician licensure
compact. As many of you know, nurses (RNs and LPNs/VNs) have long had a licensure compact
in which a nurse who declares a compact state as his or her primary state of
residence can practice (physically and remotely) in other compact states without
having to obtain another license. There are 25 states that are members of
the nurse compact.
Other providers are getting in on the act. Recently, the National
Council of State Boards of Nursing, a non-profit association comprising 59
boards of nursing, released a draft compact for advanced practice registered
nurses (e.g., nurse practitioners). The
draft APRN compact essentially follows the framework of the nurse licensure
compact allowing APRNs to practice in any participating state with just once
license. One interesting change in the draft APRN compact not included in the
nurse compact is the requirement that states gimplement procedures for
considering the criminal history records of applicants for initial APRN
licensure.h I expect a number of states to enact the APRN compact in the
coming years.
Note that psychologists, physical
therapists, counselors, and EMS personnel are just a few of the provider
groups that have considered or are considering compact models in some
fashion.
Telehealth Accreditation
While there have been some accreditation programs that have touched on
telehealth, I believe that 2016 will be the year in which telehealth
accreditation takes on new significance. Two recent examples highlight my
point. About a year ago, the American Telemedicine Association launched
an accreditation program for online consultations in which ATA accredits
organizations that provide online, real-time health services complying with
certain standards. Among the examples the ATA offers of what kind of the
kind of organizations the program would accredit is
an employer providing its employees with online, real-time telehealth
services.
More recently, URAC, a longstanding accrediting organization, has launched
its own telehealth
accreditation program for providers involved in consultations with
facilities, consumers, and other health care providers through televideo and
other electronic methods. URACfs accreditation
standards were developed by an expert panel that included health systems,
hospitals, health plans, telemedicine companies, and academic medical
centers.
The Voice of Large Employers
I believe 2016 will be the year large employers will be heard loud and clear
in the telehealth regulatory debates that are sure to take place. The fact
is many Americans receive their health insurance through their employers.
And, according to the National Business Group on Health, 74
percent of large employers are expected to offer telehealth in 2016 compared
to 48 percent in 2015. Given the important role employers play in health
care, and how telehealth is increasingly being used by employers, it is only
logical that employers would ultimately play a significant role in our ongoing
telehealth regulatory debate.
One group is leading the charge. The ERISA Industry Committee (ERIC), the only
nonprofit national association advocating solely for the employee benefit and
compensation interests of the countryfs largest employers, earlier this year launched
a telehealth initiative to promote policies that facilitate access to
telehealth for employees to have expanded access to health care services.
ERIC will be actively involved in the major telehealth discussions that occur
next year both at the state and federal levels giving large employers a
significant voice not usually heard from in telehealth regulatory circles.
Wearable Market Poised for Breakout
As I have written before in previous blog posts, the healthcare wearables
market is projected to significantly increase in the next few years. Generally
speaking, wearables are devices (which usually include microchips or sensors)
that, among other functions, collect data and track fitness and wellness. Market
research is bullish. For example, Soreon Research, a leading independent
research firm, projects
that the wearable healthcare market will
reach $41 billion by 2020—with diabetes, obesity, sleep disorders, and
cardiovascular disease as the largest growth segments in the market. From
my perspective, a combination of the ability to collect data along with big data
analytics capabilities will drive this market. And as the market booms and
the technology
becomes more sophisticated, legal and regulatory issues loom. Here are
a few issues of which to be mindful:
- Data privacy and security (who has access to the data, who owns the data,
how long the data will be used, etc.).
- Potential changes to malpractice liability (clinicians having access to
more information regarding a particular patient, providers ability to review
the voluminous data, etc.).
- Employer issues (wellness programs, ADA concerns, etc.)
- FDA.
I have only touched on a few issues. Other issues such as reimbursement
(particularly Medicare), use of telehealth in ACOs and similar models,
antitrust, use of diagnostics and peripherals, scope of practice, and privacy
and security will be some of the frontline telehealth issues in 2016. We
look forward to addressing all of those issues throughout next year.
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2015 Epstein Becker Green, P.C.