[ORTCCTelehealth-TAO] ORTCCTelehealth Digest, Vol 30, Issue 1

[cctualatin at speakeasy.net]

Dear All,

It may be my past and current experience working with European Medical 
Researchers and
Healthcare Services that causes me to wonder if anything realistic will 
result here from current
efforts to reform Healthcare Services. The conflicts between Urban and 
Rural, East and West,
North and South plus in-between is a patch-work quilt.

The current and proposed state of affairs tends to elevate the 
reputation of many European
Systems at a minimum.

I am curious about Telemedicine in the US as to:
-direct Patient/Doctor communications, interviews, diagnoses, treatment 
and rehabilitation
-Hospital Telemedicine Centers to which Doctors are contracted
-Ratings and Evaluations
-Patient Choice
-Quality of Care
-Funding for Telemedicine-based Care in whole or in part
-Reimbursement
-Privileging at multiple Hospitals

As an example, a Patient in the UK chooses the Physician and/or Hospital 
within the Country
and may change for specific procedures. They do have a 'Home' site but 
using Internet-
based rating and evaluations they can choose Facilities and Personnel 
based on these. They
may also choose to engage in Medical Tourism and request reimbursement.

BTW: The Physicians in the UK are the highest paid in the EU.

What do the Patients want throughout the EU:

Healthcare on their Cellular Phones and PDAs and choice.

Some Countries have Constitutional rights to quality Healthcare Services.

My intersts:
-Quality Healthcare Services and Practitioners
-Equality in Urban and Rural Services
-Equal Access and choice everywhere.
-Excellent Public Health Facilities and Personnel
-Adequate Funding and based upon need.
-Public disclosure and publication of all legislation current and 
proposed plus
Committee proceedings.

Leaving the Rural population behind shoould not be an option.

Regards!

-Dr Thomas Clark





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> Today's Topics:
>
>    1. H.R. 3962 Telehealth Provisions (Catherine Britain)
>    2. Re: H.R. 3962 Telehealth Provisions (Catherine Britain)
>    3. Re: H.R. 3962 Telehealth Provisions (Catherine Britain)
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Sun, 1 Nov 2009 10:42:52 -0800
> From: Catherine Britain <csbritain at gmail.com>
> To: TAO Listserv <ortcctelehealth at listsmart.osl.state.or.us>,
> 	csbritain at gmail.com, john at jirwinconsulting.com,	"Andrews, Larry"
> 	<lgandrews at newqc.com>,	"anndreajacobs329 at hotmail.com"
> 	<anndreajacobs329 at hotmail.com>,	"Bell, Eddie"
> 	<eddie.bell at providence.org>,	Beth Welty <bwelty at ch-alliance.org>,
> 	"beths at cfmpdx.com" <beths at cfmpdx.com>,	Bridget Haggerty
> 	<haggerty at ohsu.edu>,	"Burrell, Jill" <JBurrell at peacehealth.org>,
> 	Carolyn A Hancock <carolyn.a.hancock at state.or.us>,	Christopher TAMARIN
> 	<Christopher.Tamarin at state.or.us>,	"cibulat at ohsu.edu"
> 	<cibulat at ohsu.edu>,	Courtni Dresser <courtni at theoma.org>,
> 	"dave.weis at providence.org" <dave.weis at providence.org>,	"Doug A. Romer,
> 	RN" <Dar01 at grh.org>,	"dskinner at samhealth.org"
> 	<dskinner at samhealth.org>,	"ebrown5722 at comcast.net"
> 	<ebrown5722 at comcast.net>,	Ed Parker <edparker at teleport.com>,
> 	"fdb at heneryassociates.com" <fdb at heneryassociates.com>,	"Gluckman,
> 	ROBERT A, MD" <robert.gluckman at providence.org>,	"gnikkel at aocweb.org"
> 	<gnikkel at aocweb.org>,	"grodigu at lhs.org" <grodigu at lhs.org>,	"Grunberg,
> 	Keith" <KGrunberg at chartercom.com>,	"Hartson, Marci R"
> 	<Marci.Hartson at providence.org>,	"Jacobo, Bess"
> 	<BJacobo at peacehealth.org>,	"jhowe at cascadehealth.org"
> 	<jhowe at cascadehealth.org>,	Jo Bell <mjbell at wbcable.net>, John DeSocio
> 	<desocioj at ohsu.edu>,	"jschnadig at acumentra.org"
> 	<jschnadig at acumentra.org>,	Kerry Silvey <ksilvey at uoregon.edu>, Kim E
> 	Wirtz <kewirtz at regence.com>,	Kimberly Hoffman <hoffman at ohsu.edu>,
> 	"knightri at ohsu.edu" <knightri at ohsu.edu>,	Kristi Kernutt
> 	<kkernutt at pacificsource.com>,	"krola at ohsu.edu" <krola at ohsu.edu>, Larry
> 	Bundy <LBundy at bluecc.edu>,	Lesley Jones <LESJONES at lhs.org>,	"Linda
> 	Farris, MD" <linda.farris at lifewisehealth.com>,
> 	"Lisa.X.Hynes at healthnet.com" <lisa.x.hynes at healthnet.com>,	"Lordan,
> 	Denny" <LordanD at inhs.org>,	"mandicj at odscompanies.com"
> 	<mandicj at odscompanies.com>,	"Mary.M.Castaneda at healthnet.com"
> 	<Mary.M.Castaneda at healthnet.com>,	Miles Ellenby <ellenbym at ohsu.edu>,
> 	"mrb at ipaso.com" <mrb at ipaso.com>,	"Natalie.H.Norton at kp.org"
> 	<Natalie.H.Norton at kp.org>,	"Olson, Sandra" <solson at asante.org>,	"Phil
> 	Hirsch, PhD" <phil.hirsch at accesspsych.org>,
> 	"ralph.h.summers at state.or.us" <ralph.h.summers at state.or.us>,
> 	"rbusek at lipa.net" <rbusek at lipa.net>,	"Rice, Jackie"
> 	<jrice at peacehealth.org>,	Robert Duehmig <duehmigr at ohsu.edu>, Scott
> 	Ekblad <ekblads at ohsu.edu>,	Sen MonnesAnderson
> 	<Monnesanderson.Sen at state.or.us>,
> 	"sen.jasonatkinson at state.or.us\"Shannon.L.Moss at kp.org\""
> 	<Shannon.L.Moss at kp.org>, Stacy Aguas <SAguas at acumentra.org>,	Steve
> 	Marks <smarks at pacificsource.com>,	"Sue Palsbo, PhD"
> 	<sue.palsbo at obslap.com>,	ThieleCirka Sandy
> 	<Sandy.Thielecirka at state.or.us>,	"Tom & Linda Roe"
> 	<tom-linda-roe at comcast.net>
> Subject: [ORTCCTelehealth-TAO] H.R. 3962 Telehealth Provisions
> Message-ID:
> 	<98e3e3ac0911011042k1bda244bg8bb3530396eab66 at mail.gmail.com>
> Content-Type: text/plain; charset="iso-8859-1"
>
> Good Morning,
>
> I hope this finds you all well on this first day of November.  I just
> returned from a Northwest Telehealth Resource Center Board of Directors
> Meeting in Billings MT. During the meeting we received a briefing from Jon
> Linkous and staff at the ATA regarding the telehealth provisions of H.R.
> 3962, the House's combined versions of Health Care Reform.  I have attached
> a summary of the these provisions to this message.
> There are two important provisions missing from this bill:
> 1.  The CMS distinction between urban and rural has not been removed.  The
> reason for this is because the Congressional Budget Office attached a $100M
> price tag to this provision.  Since none of the provisions in the reform
> package are supposed to raise healthcare costs, this provision was not
> included.
>
> 2.  There is no privileging by proxy included in the bill.  The bill does
> allow hospitals to accept credentialling packages for providers from
> hospitals under CMS, but hospitals must continue their own privileging
> processes.  The concern here is not for hospitals as much as for physicians
> and practitioners.  Privileging must be included in every physician's
> record, and it remains in the record for as long as the physician
> practices.  When a physician practices telemedically, he must be privileged
> at every hospital receiving services from him telemedically.  If a physician
> moves or if a service is no longer needed at a hospital, or if a physician
> decides that the cost of maintaining privileges is too high (say he sees
> only 2 patients per year and pays $1K for privileges), his record will show
> a loss of privileges at that hospital.  A lot of activity on his record may
> cause payers, malpractice insurers and other hospitals seeking to hire him
> to question his privileging record.  This creates alot of extra work and
> documentation for practitioners, and they risk of loss of insurance or
> potential practice opportunities.  As a result, some physicians are no
> longer willing to practice telemedically.
>
> A combined version of the Senate bills is in the works but none of the
> telehealth provisions are the same as those in the House bill which might
> actually help when both bills finally reach Conference Committee.
>
> Our advocates in Washington are continuing to work long and hard to see that
> the provisions remain in the bill and to find some way to get others added.
> There is always the option to carry forward separate legislation for
> telemedicine, but it will be much more difficult to get passed than if it is
> included in the reform packages.  I'll try to keep you posted in this fast
> changing environment.  Please let me know if you have questions or comments
> that can be forwarded either to ATA or TLI.
>
> Remember democracy is not a spectator sport, and much is at stake for the
> future of telemedicine in Oregon.
>
> Kind regards,
> Cathy
>