The Center for Telehealth and e-Health Law's January
WashingtonLive Brown Bag seminar on the Telehealth Agenda for the 111th Congress was held on Monday, January 26, 2009. Seminar participants from Washington and around the country heard from two key Congressional staff members involved in telehealth and health care policy: Travis Robey, health care aide to Representative Mike Thompson (D-CA) and Jordanna Davis, Legislative Assistant to Senator Sheldon Whitehouse (D-RI).
Both Congressman Thompson and Senator Whitehouse have made healthcare reform a clear priority. Congressman Thompson is a member of the House Ways and Means Committee, a key committee with jurisdiction over health care, and is active on telehealth matters. In the Senate, Senator Whitehouse made health care reform the subject of the first three bills he introduced.
Early discussion focused on the current stimulus package (S. 1). In opening remarks, Robey discussed the prominence of telehealth in the House version of the Stimulus bill. Most notably, $2 billion has been set aside for health information technology grants. While there are no specific allocations yet, telemedicine is likely to receive some of the funding.
Additionally, Robey noted the placement of telemedicine in the stimulus plan requires the Secretary of Health and Human Services (HHS) to take telemedicine into consideration for greater healthreform. HHS Secretary-Designate Tom Daschle, Robey said, should make setting standards of interoperability a top priority.
Speaking about the Senate version of the Stimulus bill, Davis discussed the provisions being made for telehealth projects. These included maintaining and increasing funding for existing programs, the creation of a state revolving loan fund for telehealth providers, extension and clinical education services, the instituting a policy and standards committee, and the revision of current privacy laws. As to future developments in telehealth legislation, Davis suggested that legislators are working towards the creation of extension services to better understand developments in telehealth, as well as increase funding for interstate coordination efforts.
Robey also noted that Rep. Thompson is drafting an updated version of the Medicare Telehealth Enhancement Act, which the Congressman previously introduced in 2008 (HR6163). If passed, the legislation would, among other things, eliminate the rural designation for telemedicine reimbursement put in place for Medicare purposes and expand Medicare reimbursements to all providers of telehealth services. Additionally, the bill would expand patient monitoring services, expand store and forward capabilities of information services, and create an advisory committee on telehealth reimbursements. Finally, it would reauthorize the two current HRSA grant programs in place for telemedicine, as well as increase available telehealth grant dollars.
Questions from audience members touched on issues including the certification process for electronic medical records, qualification for telehealth “adoption dollars,” and the public-private partnership on telemedicine issues. Speaking of the certification process, incentives for certified electronic records, and what the specific standards for system integration would be, Davis and Robey noted that the bill requires the HHS Secretary to designate such standards. Currently, there are none in place.
In terms of qualification for adoption dollars, incentives will begin in 2011 and end in 2013. The House version of the bill is written so that implementation in 2011 through 2013 will lead to equal grant dollars; this would be particularly helpful in situations in which centers are seeking niche products that are still in development.
Discussion also focused on the creation of a broader telehealth advisory committee within CMS to assist with any regulation they may develop or change related to telehealth. Robey explained that the concept is being integrated into the House bill being drafted by Rep. Thompson. Specifically, the draft bill includes a provision advising CMS on a new ethics code for a variety of telehealth issues, including reimbursements. In the Senate, Davis responded that Senator Whitehouse envisions the creation of a larger network of telehealth providers and experts from the academic arena, representing all geographic areas of the country as well as multiple perspectives.
Later, discussion turned to the past targeting of telehealth services towards rural areas, and how new legislation would attempt to bridge this apparent divide with Members representing urban and suburban areas. Davis noted that in light of the current “Medicare balloon” facing the country, telehealth is a financially efficient solution. She offered an anecdote about one of Senator Whitehouse’s elderly constituents, who, rather than enter an expensive nursing home facility or make regular visits to a clinic, had her blood pressure and other vitals monitored remotely with the help of a remote monitoring telehealth device. This, Davis explained, was one example of the way in which telehealth can ultimately help to cut costs. Additionally, as funding for public transportation is cut, many people are without means to physically get to the doctor’s office, and telehealth offers a practical, cost-saving solution.
Finally, Davis and Robey predicted that Congress would begin work on healthcare reform later this spring. Following work on the stimulus package and on new energy legislation, President Obama has made it known that healthcare reform will be a top priority. Robey noted that Congressional staff have been discussing the issue, and that groundwork has already begun to be laid for legislative action. As an example of such groundwork in the Senate, Davis pointed to the three new subcommittees, chaired by Senators Harkin, Mikulski, and Bingaman, that Chairman Edward Kennedy recently created.
The entire $825 billion stimulus package will come to the House floor for a vote on Wednesday, January 28; following that, it will be sent to the Senate for consideration. The House bill calls for a total of $20 billion to be allocated for health IT purposes; of this, $2 billion will go towards grants, and $18 billion towards provider incentives. The Senate Appropriations Committee recommended $5 billion for a similar program.
Contact CTeL for information on how you can get access to a recording of this Brown Bag seminar.
