Telehealth, Telemedicine

1. The Politics of Telemedicine
C. Christopher Pittman, M.D.
Chair, FMA Advisory Committee on Healthcare Information Technology
President-Elect, FMA Political Action Committee
AMA Alternate Delegate, American College of Phlebology
Immediate Past President, Hillsborough County Medical Association

2. HELPING PHYSICIANS PRACTICE MEDICINE
C. Christopher Pittman, M.D.
I do not have relevant financial
relationships with any commercial
interests.
Conflict of Interest Disclosure

3. HELPING PHYSICIANS PRACTICE MEDICINE
Health Care Issues
● Expanding insurance coverage
● Expanding access to high quality medicine
● Potential shortage of primary care doctors and nurses in certain regions of Florida
● Telemedicine allows physicians to remotely diagnose and treat patients.
● Homebound patient can “see” a physician for periodic checkups
● Physician with a difficult diagnosis can consult a specialist online
● The use of new technologies can:
● improve patient access
● allow existing pool of physicians to reach more patients
● allow physicians to remotely supervise mid-level providers
● save on costs
The Politics of Telemedicine

4. HELPING PHYSICIANS PRACTICE MEDICINE
Political Issues
● Telemedicine and new technologies should not be used as an excuse to allow unlicensed or poorly
credentialed physicians from out-of-state to engage in medical or regulatory subterfuge.
● “Dial-a-doc” programs should not displace quality health care regulated by the Florida Board of Medicine
and other licensing and credentialing agencies.
● Telemedicine should supplement care from local physicians, not supplant them.
● New laws should not allow managed care companies to evade network adequacy requirements by
replacing local physicians with unlicensed doctors at out-of-state call-in centers.
● Managed care companies should not be allowed to rely on unregulated physicians — who answer to
nobody in Florida — to deny coverage for claims or override the decisions of a Florida doctor.
The Politics of Telemedicine

5. HELPING PHYSICIANS PRACTICE MEDICINE
FMA Position
●FMA supports the concept of telemedicine and believes that technology holds great
promise for expanding access to care, however, we remain committed to defeating any
legislative proposals that fall far short in the area of patient protection.
●The FMA feels strongly that a Florida medical license is necessary in order to ensure
accountability and protect patients.
●There are over 10,000 Florida licensed physicians who practice in other states, so
requiring a Florida license is not an excessive burden.
The Politics of Telemedicine

6. HELPING PHYSICIANS PRACTICE MEDICINE
FMA Position
●Let’s use new technologies to expand access to care and to better serve Floridians.
●Let’s also be wary and ensure that every physician who practices telemedicine —in-state
or out-of-state — be held to the same standards of governance and accountability that we
have in place for Florida doctors.
●FMA believes Florida laws:
● ensure high quality health care
● protect patients
● limit costs
● ensure accountability
The Politics of Telemedicine

7. HELPING PHYSICIANS PRACTICE MEDICINE
FMA Position
●The FMA is supportive of the expanded use of telemedicine to modernize the
delivery of healthcare.
●Uniform standards should be established for physicians to maintain patient safety
though three (3) key components:
1. Definition
2. Accountability
3. Parity in Reimbursement
The Politics of Telemedicine

8. HELPING PHYSICIANS PRACTICE MEDICINE
DEFINITION
●Telemedicine is the health care delivery, diagnosis, consultation, treatment,
monitoring, or the transfer of medical data via the use of
telecommunications services to establish a physician-patient relationship, to
evaluate a patient, or to treat a patient.
●The practice of telemedicine should only be conducted with the appropriate
technology and encryption to comply with HIPAA. The physician practicing
telemedicine must establish a physician-patient relationship and have the
patient's informed consent.
The Politics of Telemedicine

9. HELPING PHYSICIANS PRACTICE MEDICINE
ACCOUNTABILITY
●Physicians practicing telemedicine in Florida must be licensed in Florida.
PARITY REIMBURSEMENT
●Parity for face-to-face consults and telemedicine consults must apply in the
private insurance market as well as in Medicaid.
●Physicians expend the same amount of time, skill, and expertise when
conducting a consult whether it be face-to-face or through
telecommunications.
The Politics of Telemedicine

10. HELPING PHYSICIANS PRACTICE MEDICINE
THE FIVE PILLARS OF EXPANDED ACCESS TO CARE
●The FMA has identified how to effectively and immediately address the shortage of
primary care and family physicians in Florida:
1. Increasing the in-state residency slots for family practice
2. Redirecting funds for loan forgiveness to family practitioners
3. Expanding collaboration between PAs, ARNPs and Physicians
4. Fully enacting fair payment for Medicaid services
5. Codifying and regulating telemedicine
The Politics of Telemedicine

11. HELPING PHYSICIANS PRACTICE MEDICINE
Summary FMA Position
● We should be forward-thinking, however, we should not invite or incentivize unscrupulous behavior.
● The Florida Medical Association supports Florida licensure of physicians who provide evaluation and
treatment via telemedicine.
● Telemedicine is a medical service and should be reimbursable like any other medical service provided by a
physician.
● FMA is working to address potential doctor shortage without sacrificing quality or putting patients at risk.
● Telemedicine is just one pillar in a larger plan to meet this challenge
The Politics of Telemedicine

12. HELPING PHYSICIANS PRACTICE MEDICINE
THANK YOU FOR YOUR ATTENTION
C. Christopher Pittman, M.D.
cpittman@vein911.com
The Politics of Telemedicine

13. HELPING PHYSICIANS PRACTICE MEDICINE
Telemedicine Expansion at the National Level
● Report of the State Medical Boards’ Appropriate Regulation of Telemedicine (SMART) Workgroup, MODEL
POLICY FOR THE APPROPRIATE USE OF TELEMEDICINE TECHNOLOGIES IN THE PRACTICE OF MEDICINE, April 2014
● Alliance for Connected Care is a 501(c)(6) organization formed to create a statutory and regulatory environment
in which every provider in America is permitted to deliver and be adequately compensated for providing safe,
high quality care using Connected Care at his or her discretion, regardless of care delivery location or
technological modality.
The Politics of Telemedicine