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Walking the Fine Line between the Delivery of Health Care Services and Information/Educational Support

The explosion in digital health solutions that connect consumers with licensed health care providers (e.g., nurses, nutritionists, physicians) and laypersons who have certain informal training (e.g., wellness guide, lifestyle coach, outreach partner) has the potential to blur the lines between what constitutes the practice of a licensed health care profession and what does not (usually because the service is intended to be merely informational or educational). Why does it matter which side of the line a particular service falls on? If a service is one that is delivered by a licensed health care professional, there are various state laws and regulations that may govern the activity, and different potential causes of action that may apply in the event a consumer/patient is injured in the process.

  1. If a digital health solution connects a consumer to an individual who is engaged in an activity that is normally performed by a licensed health care professional, state laws and regulations governing health care professionals likely apply.

As background, state professional boards regulate individuals who deliver health care services to the public (e.g., nursing, psychology, medicine, phlebotomy). What falls within the definition of a specific health care service can be very broad and varies state to state.  (more…)




Virtual Care Advancement | Outlook on CHRONIC Care Act and Other Federal Legislation

The Senate’s unanimous passage of the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 (S.870) on September 26th is an encouraging step forward for modernizing telehealth access and reimbursement. The bipartisan, budget-neutral bill aims to improve health outcomes for Medicare beneficiaries living with chronic conditions and includes key provisions expanding access to telehealth. A summary of the key telehealth provisions under the CHRONIC Care Act can be found here.

The bill now moves to the House Subcommittee on Health and may be adopted in its current form or integrated into existing House bills. The House has already advanced three separate bills this year with telehealth provisions similar to those included in the CHRONIC Care Act: expanding telehealth services under Medicare Advantage (HR 3727), expanding telehealth for stroke patients (HR 1148), and expanding the use of telehealth to facilitate the use of home dialysis (HR 3178). With seemingly aligned goals between the two chambers, the House may accept the remaining provisions of the CHRONIC Care Act, or negotiate minor changes and incorporate the CHRONIC Care Act into another priority health care related bill, such as extending federal funding for the Children’s Health Insurance Program, as a vehicle for passage this calendar year.

The recent momentum of federal legislation focused on expanding telehealth services to Medicare beneficiaries signals Congress’ continued consideration of telehealth’s ability to improve patient health and lower the costs of health care delivery. In light of this increased legislative activity, health care providers, commercial payers and telehealth technology companies should be mindful of the following.

  • Consider developing or participating in studies designed to test the efficacy and efficiency (including costs) of telemedicine programs.
  • Continue exploring ways to tailor their care delivery and revenue models to provide telehealth services to Medicare beneficiaries.
  • Offer Center for Medicare and Medicaid Services (CMS) and MedPAC insights and guidance on ways to provide the Federal government agencies overseeing Medicare coverage and payment for telehealth services the best available industry information.
  • Focus operational goals to achieve cost and value goals that are of concern to the government.



Home Care: The Digital Health Opportunity

A recent article in Kaiser Health News highlights the health risks associated with the increased effort to get patients home—namely, the need for families to gain and effectively deploy the skills needed to care for themselves and family members. The article highlights the risks (and increased rates) of infections, particularly in relation to catheters. However, it does not take much imagination to identify other conditions where at home care is critical.

Concise and easy to follow instructions are key, of course, but information technology can play a role here as well. While the business plan for this type of digital health strategy may not be as clear as others, this is the type of sector that could demonstrate the digital health opportunity in the effort to increase value in health care delivery.




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