Florida lawmakers say they have to expand access to doctors now that millions of uninsured people in the state are set to gain health insurance through the Affordable Care Act. One tool they may encourage is telemedicine.
But there's a problem, as state Rep. Cary Pigman explains: Insurers don't pay for it. It's not that they can't, they just don't. Neither does Medicare.
Neither does Florida Medicaid -- the joint state and federal program for low-income children, pregnant women, and disabled adults -- except for a few special waiver programs funded with grants. If the Legislature were to authorize Medicaid to pay for telemedicine on a routine basis, Pigman said, it might have a domino effect with other insurers.
"I believe if we can show it as being a sensible and successful endeavor the private insurers will be on board as well," Pigman said. "In speaking with a few insurers, they’re not fundamentally opposed to it right now."
Pigman, a Republican from rural north Florida, has teamed up with Jacksonville Democrat Mia Jones as co-sponsors of a bill that would authorize, or maybe even require, insurers to pay for consults via telemedicine. (HB 499 started out requiring coverage, but it died in committee in May, so the language is expected to be tweaked.)
Both will serve on the new Joint Committee on Health Care Workforce Innovation. Pigman will serve as vice chair; Jones is ranking member.
Pigman and Jones co-sponsored a symposium on telemedicine recently at the Mayo Clinic Jacksonville in hopes of gaining wider support from lawmakers and lobbyists. Physicians who are already engaged in telemedicine under grants or private contracts offered impressive results in lives and money saved.
Dr. Kevin Barrett, director of Mayo's Telestroke program, demonstrated how he could examine a stroke patient by video conference, with another doctor or nurse on the other end of the camera.
Other presenters included:
--Dr. Anne Burdick, associate dean for telehealth at University of Miami. She said that as a dermatologist, she has diagnosed skin diseases via videoconference for more than 3,000 patients. UM telemedicine clients include the Miami-Dade public schools, state programs that insure low-income children and two cruise lines, as well as other private companies.
--Dr. Kim Landry, a practicing emergency physician and medical director for fire and rescue teams around Pensacola. A program there enables a paramedic answering a 911 call to connect to Dr. Landry via videolink, enabling the physician to conduct an immediate evaluation of whether patients need to go to the hospital. Eight out of 10 times they don't, he said.
"It has made life a lot easier for many sick patients," he said. Not to mention forgoing the bill for the ambulance.
"Telemedicine can bridge the gap between health care providers and patients, which allows for more patients in more locations to receive quality, cost-effectiv e health care," Landry said. "Telemedicine is to health care as a smart phone is to communications."
--Dr. Toree Malasanos, a pediatric endocrinologist who runs the University of Florida FITE (Florida Initiative in Telehealth and Education) program. She holds weekly teleconference sessions with nurses and teen-age patients at a clinic in Daytona Beach -- a big improvement for all concerned from the days when she and her team got up at 4 a.m. once every three months to drive there to see a whole herd of patients.
The time between exams for these teens has fallen from 149 days to 89 days, Malasanos said, and the number of hospital days for the patient group has gone down 88 percent. "Each dollar invested saved $4," she said.
--Dr. Peter Pappas of Melbourne, representing Health First and Holmes Regional Medical Center. He talked about "SparrowNet," which links the state health department and the state's trauma centers, and a "tele-ICU" system, which uses mobile carts to bring continuous monitoring to the bedsides of patients who are critically ill and could end up in the intensive care unit.
After using the mobile carts with 340 patients, "we've been able to prevent ICU admissions for 102 patients," he said.