Copyright 1999 Federal News Service, Inc.
Federal News Service
SEPTEMBER 15, 1999, WEDNESDAY
SECTION: IN THE NEWS
LENGTH:
1495 words
HEADLINE: PREPARED TESTIMONY OF
LTC
RONALD K. POROPATICH, MD
MEMBER, BOARD OF DIRECTORS
AMERICAN
TELEMEDICINE ASSOCIATION
BEFORE THE SENATE COMMERCE,
SCIENCE AND TRANSPORTATION COMMITTEE
SCIENCE, TECHNOLOGY AND SPACE
SUBCOMMITTEE
BODY:
Thank you Mr. Chairman.
My name is Doctor Ronald K. Poropatich. I am an elected member of the Board
of Directors of the American Telemedicine Association and provide these remarks
today on behalf of the Association. I, am a practicing physician in pulmonary
and critical care medicine with over 7 years of direct experience using
telemedicine. I am also a Lieutenant Colonel in the United States Army and the
Director of the Telemedicine Directorate at Walter Reed Army Medical Center in
Washington, DC and also serve on the staff of the Telemedicine and Advanced
Technology Research Center at the U.S. Army Medical Research and Material
Command at Ft. Detrick, Maryland. However, I am here today strictly on behalf of
the ATA and my remarks do not necessarily reflect the position of the U.S.
Department of Defense.
The American Telemedicine Association represents
physicians, other healthcare professionals, technologists and companies involved
in developing telemedical systems and providing healthcare services via
telecommunications. We are a non-profit membership-based organization,
established in 1993, which serves to promote telemedicine and resolve barriers
to its deployment.
In my remarks today I would like to briefly point out a
few of the critical national issues we believe inhibits the growth of
telemedicine. These serve as a barrier to realizing the potential benefits of
telemedicine to expand access by all Americans to quality medical services and
reduce the cost of providing healthcare services.
Many of the obstacles
facing the use and deployment of telemedicine today require changes in existing
laws and regulations. I will highlight several specific areas that should be
addressed by the federal and state governments in the United States.
1. Lack
of Payment for Services: Despite many years of successful telemedicine
demonstrations and the rapidly expanding deployment of telemedical services in
the private sector and in other countries, the U.S. lags behind in recognizing
and paying for medical services provided via telemedicine. Medicare currently
reimburses for several different types of remote services including
teleradiology, remote patient monitoring and live video consultations with
patients residing in remote Health Professional Shortage Areas. However, broad
reimbursement for telemedicine services is still unavailable. This failure to
provide coverage of telemedical services has put a brake on the growth of
telemedicine, restricted access to health services by many Americans and
hampered the ability of the U.S. healthcare industry to use telemedicine in
reducing costs and increasing the quality of care.
Knowing the crisis facing
the cost of providing healthcare and the cost associated with increasing access
to health services, ATA has three specific priorities for providing Medicare
coverage of telemedicine services. Each of these priorities costs little or
nothing in additional federal outlays and will help expand access to needed
medical services by the American consumer.
a) First the Health Care
Financing Administration (HCFA) should clarify that it can fully reimburse for
telepathology since this is a service, similar to teleradiology, which can
easily be conducted remotely and does not require a direct physician-patient
consultation. This can be simply accomplished by HCFA today and does not require
any additional legislation. We are hopeful that HCFA will clarify this issue
before the end of this year.
b) Second, we urge Congress to eliminate
existing flaws in the current Medicare program supporting telemedicine services
to residents of rural Health Professional Shortage Areas. For example, the
program does not reimburse for medical consultations provided using store-
forward technology. This is a very efficient and appropriate way of delivering
patient information to a medical specialist and is being practiced today in the
military, in other countries and in demonstration projects across this country.
ATA fully supports legislation introduced by both Senator Kent Conrad (D-ND) and
Senator Max Baucus (D-MT) to amend this program.
c) Finally, when HCFA
introduces a Prospective Payment System (PPS) for home healthcare services next
year the provision of telemedical services to the home should be an allowable
service that can be used by home healthcare agencies in providing services to
the homebound patient. Studies have shown that the use of telehomecare can
improve patient care and reduce the utilization of acute care services. The use
of telehomecare under PPS will cost NO additional federal dollars, it can help
improve services to the patient and it can help homecare agencies to continue
providing services at lower costs. We strongly urge Congress to include language
this year under the Balanced Budget Act Amendments Bill that directs HCFA to
allow these telehomecare services.2. Improved Access to Telecommunications
Networks: The deployment of telemedical links to rural and suburban medical
centers require communications networks that are reliable and capable of
handling large amounts of data in a short time. Homecare applications that
require interactive video as well as clinical applications involving large
patient data files will benefit greatly from the availability of broadband
networks. Congress established a program under the Telecommunications Reform Act
of 1996 to provide improved access to high-speed data lines by rural health
centers. Although well intentioned, this program has fallen far short of its
potential. The application process as it exists today is burdensome,
complicated, causes substantial hardship on applicants, and creates a barrier on
getting the program benefits out to the intended beneficiaries. In addition,
eligible services and program beneficiaries are unduly limited. In a letter to
the FCC in March 1999 ATA called for specific changes in the program by both the
Federal Communications Commission and Congress. I have included this letter in
my written testimony.
ATA is also a member of the IAdvance Coalition, a
group promoting improved broadband deployment of the Internet.
The Internet is becoming the preferred platform for the delivery of telemedical
services and can be an important vehicle for providing health services to the
individual at home. It is therefore important that Congress help ensure that
high-speed access to the Internet is available throughout the country including
to rural communities and individual homes.
3. State Medical Licensure:
Currently each state requires separate medical licenses for physicians
practicing inside state boundaries. Telemedicine challenges this by allowing for
the practice of medicine across state lines. Some states have enacted
restrictive laws to keep out health professionals licensed in other states. This
has been viewed by some as efforts to protect the economic markets of the
professionals residing within the state. Earlier this year the ATA Board of
Directors adopted a position on state licensure that preserves the right of
states to continue to license medical professionals while allowing access by
patients and primary care physicians within the states to services of qualified
health professionals located in other locations. I have included a copy of this
statement in my written testimony.
4. Other key policy issues: There are
several other important issues and concerns that may require federal policies.
These include protection of healthcare and telecommunications entities from
undue liability arising out of the use of telemedicine and ensuring patient
privacy and confidentiality in the transmission of medical information and
electronic storage of personal medical information. Within the military we have
addressed the privacy issues by establishing a strict policy of requiring a
separate secure server to be used for all medical transactions with encryption
of all medical related files.
In my responsibilities within the military I
have witnessed a tremendous growth in the use of telemedicine in the delivery of
healthcare. The results of research and service efforts at the Telemedicine and
Advanced Technology Research Center at the U.S. Army Medical Research and
Material Command have enabled us to provide cost effective and expanded access
to medical specialty care where none was available before. At Walter Reed Army
Medical Center we are now providing well over 3,000 medical consults per year to
armed forces personnel and their families worldwide. In some ways the efforts
achieved by the military has provided a model that might be adopted by civilian
medical organizations. However, in the military we have not been faced with many
of the barriers I have described here. It is the hope of the American
Telemedicine Association that Congress will help eliminate many of these
barriers so that all people throughout the United States cant from the potential
of telemedicine.
Thank you.
END
LOAD-DATE:
September 17, 1999 
