Growing Telehealth Field in Spotlight: Bill to provide regulatory framework, but not over-prescribe

telehealthWhen iNDIGO Health Partners a year and a half ago embarked on a new avenue – telemedicine – it wanted to make sure the hospital patients it assists understood and consented to the different type of doctor-patient encounter.

Through community hospitals using iNDIGO Telehealth, patients might be seen by nighttime doctors hundreds of miles away via video screen and other technology. It’s important patients know the type of treatment they might receive and telehealth’s limitations, including the inability of a doctor to “reach through the screen and touch you,” said Susan Willis, vice president of clinical program development for the Traverse City-based private hospitalist group, which provides in-person and select virtual physician staffing to hospitals.

Such patient consent, she said, is “what we consider best practice.”

Under a telehealth bill moving through the state Legislature, patient consent or consultation will be required procedure. It’s among elements in Senate Bill 753, legislation designed to provide a regulatory framework for telehealth without being too prescriptive in a healthcare field that is evolving, said sponsor Sen. Peter MacGregor, R-Rockford.

“The purpose was not to try and restrict…but to try and encourage and enable more facilities, more hospitals, more doctors,” to offer and use telehealth, while providing patient protections, he said.

Michigan’s public health code is silent on the provision of telehealth, MacGregor said, “so we needed to have some sort of basis, foundation.”

Bill specifics
The bill, which has passed the Senate unanimously, would amend the public health code in several ways. For one, it defines telehealth as “the use of electronic information and telecommunication technologies to support or promote long-distance clinical healthcare, patient and professional health-related education, public health, or health administration.” Telehealth may include, but is not limited to, telemedicine as defined under Michigan’s insurance code.

Prior to providing a telehealth service, health professionals would have to consult with patients about receiving the service or obtain their consent.

The bill specifies that except for controlled substances, telehealth providers who are licensed to prescribe drugs, such as doctors, can prescribe drugs via telehealth. It’s a practice that already occurs in remote medical treatment but the language provides a regulatory underpinning for the prescribing.

“This goes so far as to say, the boundary that you should consider as regulators…should include initial visits which may include prescriptions,” said Colin Ford, senior director of state and federal government relations for the Michigan State Medical Society.

The medical society was among healthcare interests that participated in discussions on the legislation with MacGregor’s office. “They wanted to make sure that they really had a lot of core things happen, which is to allow the advancement of technology but to have the regulatory safeguards in place for patients,” Ford said.

One important aspect, he said, is that the bill carves out a role for professional boards, like the Michigan Board of Medicine.

The Michigan Department of Licensing and Regulatory Affairs, in consultation with a board, is authorized under the bill to draw up rules to further-define aspects of the bill, if needed. And the bill allows disciplinary subcommittees within the professional licensing boards to place restrictions or conditions on a health professional’s ability to provide a telehealth service, if they find the provider has violated elements of the legislation.

“Referring back to the professional boards, is what’s crucial,” Ford said. “They’re really in charge of ensuring that the public health is protected.”

Added benefit?
In northwest Michigan, one telemedicine avenue is through Teladoc, the nation’s oldest and largest telehealth provider. Cadillac-based 44North, a group health benefits broker that submitted comments in support of SB 753 to the Senate Health Policy Committee, sells Teladoc as an optional benefit that helps employers reduce their healthcare spending “and give employees an added value to their healthcare plan,” said Noel Parsons, 44North business development manager.

44North helps employers design health insurance and benefit plans and manage their healthcare programs. Of the approximately 15,000 individuals in Michigan accessing Teladoc through 44North’s clients, about 3,500 are in Grand Traverse, Kalkaska, Benzie and Leelanau counties.

Teladoc works like this: Individuals call Teladoc to request a doctor’s services, and after a short consultation are paired with a licensed Michigan doctor who participates in Teladoc and who will meet via telephone, computer webcam or mobile app. The doctors can diagnose and treat many common, non-emergency medical conditions and, if needed, write and send prescriptions to the patients’ pharmacy of choice.

Parsons said he sees the legislation as “supporting what telemedicine companies in Michigan are already doing, and keeping everybody in the same line. I think it’ll increase the usage of telemedicine in the state altogether, from practicing physicians…to programs like Teladoc.

“It’s creating more awareness, it’s further cementing the fact that telemedicine is an acceptable product for people to use,” Parsons said. And, he said, “you’ve got to have these guidelines going forward, if everybody’s going to jump in the game.”

Willis, at iNDIGO Health Partners, agreed. “I think these are good changes to be made,” she said. “You build in too many limitations, and the benefits of telemedicine get removed. But…there’s got to be some guidance.”

With the five and soon six community hospitals around the state where iNDIGO provides remote in-patient coverage at night, telehealth consent is standard inclusion in every patient admittance – whether or not that patient ultimately is treated remotely.

“We want to know in advance that they have consented…to that type of medical encounter,” Willis said. A cart wheeled into a patient’s room has a computer, screen, and high-definition camera allowing the remote doctor to see monitors like EKG machines. The cart also contains an electronic stethoscope used by an in-room nurse who serves as a presenter and who is guided by the iNDIGO provider.

Willis said when she speaks with patients, she outlines aspects like the ability to see a doctor in nighttime hours instead of having to wait until morning, and the fact that the doctor’s presence is virtual rather than physical “but you can still talk to him in real time. A lot of patients, if you tell them this is like Skyping, they understand it.”

Munson and telehealth
Telehealth’s use is growing, said Peter Marinoff, president of Munson Healthcare’s Paul Oliver Memorial Hospital in Frankfort and the lead for Munson Healthcare’s telehealth initiatives. Through Munson Healthcare’s REMEC TeleHealth Network, services like remote consultations connecting Munson hospital patients with oncologists, pediatric physicians and bleeding disorder specialists are currently provided and Munson is looking to further-expand telehealth physician connections and accessibility in the Munson Healthcare region, Marinoff said.

The goal is “to bring care close to home,” he said. “We support the use of telehealth technology, because it’s going to improve access to care for northern Michigan residents. And it can help us to provide care more quickly, and reduce the need for patients to travel.”

He said Munson Healthcare would like to see some language in SB 753 clarified but the organization supports the overall goal of the legislation. “I think what the bill is looking to do is to create a better framework for everybody involved. We support that,” he said.

MacGregor’s bill has been referred to the House Committee on Health Policy, where a hearing is expected in September.

Amy Lane is a freelance journalist and former reporter for Crain’s Detroit Business, where she covered business, state government, energy and utilities for nearly 25 years.