Broadband Communities

AUG-SEP 2013

BROADBAND COMMUNITIES is the leading source of information on digital and broadband technologies for buildings and communities. Our editorial aims to accelerate the deployment of Fiber-To-The-Home and Fiber-To-The-Premises.

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Page 114 of 122

TELEMEDICINE Medicare Reimbursement For Telemedicine One reason telemedicine has been slow to catch on is that regulatory agencies still have a rotary-dial mindset in a broadband world. By W. James Mac Naughton, Esq. A large and growing body of clinical evidence shows that telemedicine improves health care outcomes and saves money.1 Common sense dictates that putting patients in front of doctors electronically instead of physically whenever possible saves time (and therefore money) as long as the quality of care is not compromised. Indeed, there is no technical reason in today's connected world that most visits to a doctor's ofce should be any more time-consuming or complicated than making a Skype call. However, most doctor visits remain time-consuming and complicated because the insurance coverage to pay for telemedicine is as antiquated as a rotary phone. All current health insurance programs came into existence during an era when interactions between health care professionals and patients were face-to-face and rotary phones were used to make appointments. Remote interactions were considered legitimate only when the distances were so great that there was no meaningful possibility for personal contact between a rural patient and an urban specialist. Tus insurance coverage for telemedicine currently covers only rural patients, and it covers them only under certain circumstances. Medicare is a case in point. Te federal government is the Big Dog in fnancing medical care. Even before the advent of the Afordable Care Act, the federal government paid more than 40 percent of all health care costs in the U.S. 106 | BROADBAND COMMUNITIES | through Medicare, Medicaid and health care coverage for federal workers and the military. Medicare, which covers most Americans 65 and older, pays for about 20 percent of the national health care bill every year. Tis accounts for half of all federal expenditures. Medicare greatly infuences the standard for what Medicaid does and does not cover and, to a lesser extent, infuences what private insurance does and does not cover. 2 Medicare pays for the delivery of telemedicine only in rural areas. Tis sets the current level of expectations for other insurance reimbursements for telemedicine. Medicare's payment rules are set by federal regulation. Te relevant regulation (47 C.F.R. ยง410.78) authorizes reimbursement for telemedicine services to Medicare-eligible patients depending on (1) where the service is provided, (2) who provides the service, (3) what service is provided, and (4) what telecommunications facilities are used to provide the service. LOCATION OF SERvICE Medicare will reimburse for medical services provided to Medicare-eligible patients located in a Health Professional Shortage Area (HPSA) or in a county outside a Metropolitan Statistical Area (MSA). Tese are, generally speaking, rural areas. HPSAs can be identifed at http:// Counties outside MSAs can be identifed by downloading OMB Bulletin No. | August/september 2013

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