On October 23, an op-ed from Dr. Elena Rios, President and CEO of the National Hispanic Medical Association ran in the Orange County Register:
Elena Rios: Why Americans need telemedicine
Now that implementation of the Affordable Care Act is upon us, and people are starting to enroll in the exchanges, it’s important to look at how the role of technology can better facilitate coordinated care, lower costs and increase access to care for all Americans.
Ten thousand baby boomers are enrolling in Medicare every day, and doctors are finding it increasingly difficult to honor their oaths and provide what patients need in a cost-effective way. This is especially true for California, which – at more than 5 million enrollees – has the largest number of Medicare beneficiaries of any state. And that number is only continuing to rise. Projections indicate that by 2030, California’s entire elderly population (those 65 and over) will be more than double what it was in 2000.
In the face of growing demand for care and a shrinking number of primary care physicians, a willingness to move past outdated medical structures is imperative. Embracing technological innovations like telemedicine is a key to ensuring that Medicare flourish into the 21st century.
Telemedicine provides an avenue for patients to obtain quality care that would not otherwise be available. Telemedicine will be crucial to connecting disproportionately disadvantaged Hispanic Americans to the best doctors and providers, which are often out of reach. 39 percent of Hispanics use a Medicare advantage plan, significantly higher than the 20 percent rate for whites. Moreover, Hispanic Americans make up 14 percent of Medicare Advantage enrollees, compared to six percent of whites. Incorporating telemedicine into Medicare will allow the less fortunate, where Hispanics are overrepresented, to obtain top-notch health care regardless of income, and save taxpayers’ money in the process.
Currently, health care providers are required to obtain multiple state licenses and adhere to multiple state rules in order to provide telemedicine services across state lines. Such requirements put barriers between patients and high-quality care delivered across state lines. Current state medical licensing laws do not reflect new innovations and growing technologies. Patients are restricted from receiving remote medical services by physicians not licensed in their own state, even if that same physician is licensed, credentialed, privileged and providing high quality health care in other states.
Congress must step forward and clear the way to help doctors help patients. Thankfully, Reps. Devin Nunes (R-CA) and Frank Pallone (D-NJ) have introduced the TELEmedicine for MEDicare Act (H.R. 3077) which allows for Medicare doctors who are physically licensed in one state to provide care to patients across state lines without obtaining an additional license.
This is not a new concept, in 2011 Congress passed the Servicemembers’ Telemedicine and E-Health Portability Act which allows doctors at the Department of Defense to work across different states using only one state license, among other important changes. In addition to this, the Department of Veterans Affairs (VA) requires a doctor to have just one active, unrestricted state license to practice in any VA facility nationwide.
These reforms have been incredibly successful, with a 53 percent reduction in bed days or hospitalizations for those using a home telehealth program. VA’s home telehealth program has an annual cost per patient of $1,600, a far cry from the $13,000 required for direct home care, or the staggering $77,000 yearly fee for nursing home care.
Applying these rules to Medicare is a crucial step for rural, African-American, and Hispanic American Medicare enrollees who don’t have convenient access to a doctor. Expanded telehealth will allow doctors to reach those without immediate personal access, allowing for more equitable care across racial, economic, and geographic lines. For example, 82 percent of Medicare patients are afflicted with one or more chronic diseases like heart disease and diabetes.
Approximately half of Hispanic Americans residing in the Southwest, yet the eight of the top ten hospitals (as ranked by U.S. News and World Report) in both diabetes and heart disease are in other parts of the country. Telemedicine will allow Hispanic Americans nationwide to receive treatment from the best doctors and hospitals regardless of where either is located. Connecting these underserved patients to the best care Medicare can offer fulfills a crucial piece of the program’s mission.
Almost every medical colleague of mine became a doctor to save lives and help other people. Nothing is more frustrating than being able to help a patient but being blocked from doing so by some external force. Doctors will jump at the self-evident opportunities telehealth provides to help patients and improve their outcomes. In turn, patients will benefit from greater, timelier attention from doctors to whom they will have far greater access.
The benefits will be felt to an even greater degree among Hispanic Americans who rely disproportionately on Medicare to provide them with health care. The unqualified success of these reforms in other parts of the government ensures that nobody, neither the doctors who enable the program nor the people who depend on it, will see anything but improvement if Reps. Nunes and Pallone succeed in passing this badly-needed reform.
Elena V. Rios, M.D., M.S.P.H.. is President & CEO of the National Hispanic Medical Association