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Telemedicine – The New Standard of Care

Across the health care sector, telemedicine is naturally and strategically being integrated into health care delivery and treatment plans as targeted and efficient solutions to specific health issues by hospitals, medical groups and drug-to-consumer telemedicine companies.

Telemedicine is no longer viewed as a secondary option for care—it is a new standard of care that is both expected by patients and popular with providers. Consumers expect to see health care adapt—like many other industries already have—to fit within their daily lives and schedules. Whether it’s electronic check-in procedures or better automated systems, health care providers are beginning to treat their patients a little bit more like customers, and see telemedicine and patient engagement tools as a means of improving customer loyalty and engagement while reducing costs.

However, complex billing structure and payor and reimbursement issues can create significant hurdles for health care providers looking to advance telemedicine programs. Telemedicine billing requires special attention, and if not enough consideration is given on the front end of programs, organizations may be surprised to find that that something they thought was a billable service is, in fact, not.

The Bipartisan Budget Act, which provided for the reimbursement of the distance provider, significantly increased the telemedicine use cases that are approved under the Medicare reimbursement structure. However, because Congress will now pay for it, there is a new expectation that hospitals that do not have particular areas of expertise available on-site will investigate opportunities to incorporate a telehealth programs that ensure adequate patient care.

The standard of care continues to improve as patients have greater access to  nationwide physicians and  as new technology like telestroke and clinical decision support tools become more widely available. For example, a stroke neurologist in one New York can now diagnose a stroke patient in Florida, and then facilitate an emergency room physician to treat that stroke. Telestroke programs check off all of the right boxes: better quality care, better access to care, and overall lower cost of care.

As use cases like this continue to be integrated into health care delivery and familiarity builds around how telemedicine can be used effectively, expectations shift around the standard of care and new questions arise around the risks of integrating—or failing to integrate—telehealth programs. If the tools are available and easily accessible, and if there is a supportive reimbursement model, how much a part of the standard of care does telemedicine become and what is the risk of failing to embrace these tools? If hospitals choose not to implement telehealth programs, and then patients suffer harm as a result, for example a delayed diagnosis and treatment of a stroke, could that lead to increased medical malpractice suits or other types of liability?

In the newest episode of the Of Digital Interest podcast, McDermott Digital Health partners, Lisa Schmitz Mazur and Dale Van Demark, share their perspectives on these questions and the various barriers, risks and opportunities associated with the rise of telemedicine and other technological advancements in health care delivery. Access this [...]

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The TCPA: An Unexpected Deterrent to Patient Engagement Tools

In an age where providers are increasingly taking the management of their patient’s health online and out of the doctor’s office, the creation of scalable and nimble patient engagement tools can serve to improve patient experience, health care outcomes and health care costs. While the level of enthusiasm for these tools is at an all-time high, there is a growing concern about the unexpected deterrent to the adoption of these tools from an unlikely source: the Telephone Consumer Protection Act of 1991 (TCPA).

Many professionals in the health industry have come to share two misconceptions about the TCPA: first, that the TCPA only applies to marketing phone calls or text message “spam,” and second, that the TCPA does not apply to communications from HIPAA covered entities to their patients/health plan members. These misconceptions can be costly mistakes for covered entities that have designed their patient engagement outreach programs without include a TCPA compliance strategy.

Compliance Challenges

As discussed in a previous post, the TCPA was originally intended to curb abusive telemarketing calls. When applying the law to smarter and increasingly innovative technologies (especially those that we see in the patient engagement world), the TCPA poses significant compliance challenges for the users of these tools that arguably threaten to curb meaningful progress on important public health and policy goals.

Despite its initial scope of addressing robocalls, the TCPA also applies to many automated communications between health care providers and their patients, and between plans and their members. There is a diverse array of technical consent requirements that apply depending on what type of phone call you make. For instance, most auto-dialed marketing calls to cell phones require prior express written consent, meaning that the caller must first obtain written consent before making the call. To make compliance more compliance, callers remain responsible for proving consent and the accuracy of the numbers dialed.

Indeed, the TCPA presents a serious challenge for patient engagement tools, especially when violations of the TCPA can yield statutory damages of up to $1,500 per call or text message. While Federal Communications Commission orders over the past several years have added some clarity and a “safe harbor” for HIPAA-covered entities to help entities achieve compliance, there is still no “free pass” from the TCPA’s requirements. Therefore, covered entities and the business associates who work for them should not assume that compliance with HIPAA offers any security of defense against a successful claim under the TCPA.

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