Telemedicine encompasses technology well beyond the telephone.

Policy ideas that have surfaced in recent years concerning telemedicine have intersected with a number of other factors, including implementation of the Affordable Care Act (ACA), congressional elections, and an established, nearly-ubiquitous broadband infrastructure throughout most of North America.

In the year 2000, only 3% of American adults had high speed broadband. In mid-2013, that figure had risen to 70%. The technological groundwork and the devices that take advantage of it are there to support telemedicine, and an increasing number of legislators, medical providers, and ordinary consumers want it.

Back in 1999, a section of the Social Security Act regulating how Medicare reimburses service provided through telemedicine was enacted. At that time, telemedicine was only considered an issue for people who lived in rural or remote areas and therefore did not have easy access to healthcare. Now, however, virtual care is seen as a convenience for millions of Americans in rural and urban settings and everywhere in between. 2015 may be a critical year that brings telemedicine into the mainstream.

Bipartisanship and Telemedicine

Bipartisanship is a rarity in Washington these days, but telemedicine is one issue both sides of the aisle support. There are many reasons for this:

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• Constituents like the concept and can see its advantages
  
• It makes good use of technology that is widely used in non-healthcare sectors
  
• It looks promising as far as containing healthcare costs
  

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• It increases access to healthcare, including specialist services
  

Additionally, the fact that telemedicine is separate from the ACA allows both ACA supporters and detractors in legislatures to rally around it without fear of political reprisal. Finally, the 114th Congress will be the last before the next presidential election cycle, and lawmakers interested in either running for president or raising their profile should their party win the presidency could embrace telemedicine as one of the few paths forward in an otherwise bitterly divisive Congressional atmosphere.

Value-Based Care, the ACA, and Telemedicine

Value-based care refers to a broad range of reform efforts from both the ACA and insurers designed to move the healthcare industry away from the fee-for-service reimbursement model. The goals of value-based healthcare are reducing costs and improving patient outcomes and is designed to reward care providers for healthcare quality rather than volume, as is the case today.

Telemedicine appears poised to help achieve the goals of value-based care as healthcare providers and insurers look for ways to increase value in healthcare delivery. Practices like ongoing remote monitoring of patients, and services that allow patients to check in with providers through telemedicine have so far largely been received positively by both patients and providers.

Some new telemedicine services that are being rolled out, such as programs by employer-based insurers that allow telemedicine services through secure video conferencing technology, demonstrate value immediately, when employees take less time off work for routine appointments and avoid some of the unpredictability of the traditional office visit.

Consumer Demand for Access and Convenience

Consumers today carry with them everywhere devices that give them countless ways to keep in touch with family, friends, work colleagues, and providers of other types of professional services. Since connectivity is so entrenched in millions of Americans’ lives, consumers want to use it for healthcare services where possible for the time and transportation savings if nothing else. No longer reserved for rural residents, telemedicine can offer intangible benefits such as avoiding a crowded waiting room full of sick children when seeing about a child’s earache, for example.

The convenience of telemedicine is one of its strongest selling points.

Telemedicine may be growing slowly in the US, but that growth acknowledges and begins to address consumers’ desire for healthcare to evolve with technology along with so many other aspects of life. Fulfilling these needs will require several changes:

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• Changes to Medicare to allow reimbursement for more telemedicine services
  
• Addressing state licensing laws concerning doctors in one state treating patients in another
  
• Policy on reimbursement rates for medical services provided by telemedicine
  
• Insurers addressing physician reimbursement to physicians for telemedicine services
  

What Could Happen on Capitol Hill in 2015 

Telemedicine advocates in Washington are lobbying for the Centers for Medicare and Medicaid Services (CMS) to loosen Medicare restrictions in order to better coordinate care for Medicare patients. This is expected to lead to availability of more telemedicine services under Medicare rules.

Additionally, several bills have been introduced in Congress with bipartisan support that could address some of the issues that are currently holding back expansion of telemedicine. Among them are (as of October 10, 2014):

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• Telehealth Enhancement Act of 2013 (introduced in October 2013), sponsored by Reps Gregg Harper (R-MS) and Mike Thompson (D-CA). This bill addresses FCC rules on telecommunications between healthcare providers and patients, telemedicine services and Medicare reimbursement, and new Medicaid optional packages for high-risk pregnancies.
  
• Telehealth Modernization Act of 2013 (introduced in December 2013), sponsored by Reps Doris Matsui (D-CA) and Bill Johnson (R-OH). It allows states to authorize healthcare providers to deliver healthcare via telemedicine, including accessing medical histories, providing diagnoses, documenting treatment, and prescribing certain medications.
  

Conclusion

Momentum for expansion of telemedicine has been increasing for several years, as broadband technology has become standard and as telecommunications devices utilizing broadband have grown in sophistication and affordability. Implementation of the ACA, consumer demand, and rare bipartisan support in the nation’s capital have combined to raise the profile of telemedicine in legislatures at the state and federal levels.

In 2015, the 114th Congress will be sworn in. While divisiveness between the two parties may slow or stall legislation on a number of issues, telemedicine is one of the few that receives bipartisan support. With a presidential election looming in 2016, both parties may use telemedicine as an issue on which to focus, since it has a better chance of moving forward through the legislative process between now and then.

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