The Medicare program, and the 49 million elderly and disabled Americans who rely on it, are facing an uphill battle when it comes to quality and cost.
Some 10,000 baby boomers sign up for Medicare each day. This first wave will push total program enrollment from 50.7 million in 2012 to 81 million in 2030. Considering that adults age 65 and over account for the highest level of health care spending among all age cohorts, an increasingly larger share of taxpayer dollars will flow to Medicare services.
Access, already an issue, will become a major headache. As more medical students choose to enter higher-paying specialty fields — just 8 percent of medical students enter family medicine — there is an increasing shortage of primary care providers. Already, more than 60 million Americans lack access to primary care services, according to the Kaiser Family Foundation.
The majority of Medicare’s costs come from the treatment of chronic illnesses such as heart disease and diabetes. In fact, about 82 percent of Medicare beneficiaries have one or more chronic conditions.
Fortunately, there are proven solutions to help patients better manage chronic diseases and access primary care providers that are already reducing costs and addressing the shortage issue. Unfortunately, constrained by the Medicare law, most seniors and the disabled do not have access to these solutions.
Telemedicine is transforming the delivery of care by bringing health care providers and patients together virtually. Often, because of disease, transportation or mobility issues, Medicare beneficiaries are not able to travel long distances to receive the treatment they need. For this group, telemedicine has the potential to increase access to care, improve patient outcomes and combat rising health care costs. By remotely monitoring or consulting with a patient, providers are able to be involved proactively with their care, anywhere and at any time.
The potential benefits of telemedicine are currently blocked by an archaic system of licensure laws that bind providers to state boundaries and rations care because of accidents of geography. Health care providers are required to obtain multiple state licenses and adhere to multiple state rules to provide telemedicine services to their patients across state lines.
So even if a physician is licensed, credentialed, privileged and providing quality health care in other states, patients are restricted from receiving remote medical services from that same physician if they are unlicensed in the patient’s own state. While they were written to protect patients, these outdated laws are now hurting those that need telemedicine the most, namely seniors and the disabled.
However, the federal government has effectively implemented a national telemedicine framework, working in conjunction with state medical boards, to expand telemedicine opportunities to members of the Department of Defense and Veterans Affairs.
The Servicemembers’ Telemedicine and E-Health Portability Act, passed in 2011, expands the current DOD state licensure exemption to allow credentialed health care professionals to work across state borders without having to obtain a new state license. It also expands the definition of an exempt health care professional to include qualified DOD civilians and contractors, while removing the current service location requirement to allow for care regardless of where the health care professional or patient is located.
At the VA, only one active, unrestricted state license is required to practice in every VA facility across all 50 states, a policy that has proved to be successful for improved patient outcomes and reduced costs.
Assessments have shown a 53 percent reduction in bed days or hospitalizations for those under the home telehealth program and a 25 percent reduction through clinical video telehealth. The programs have also saved nearly $2,000 per patient per year.
The DOD and VA, just like Medicare, are federal programs, so federal rules apply. Unlike the VA and DOD, Congress has not yet made the necessary changes to the Medicare law to promote telemedicine across state lines. That should be fixed.
Fortunately, bipartisan legislation introduced by Reps. Devin Nunes, R-Calif., and Frank Pallone Jr., D-N.J., would do just that. The bill lifts geographic licensure restrictions in Medicare, just as Congress eliminated these restrictions for the DOD and VA, by allowing Medicare providers to treat Medicare patients electronically across state lines without the need to obtain multiple state licenses.
If the VA experience can be duplicated in Medicare, seniors and the disabled can expect increased access to care. Taxpayers and beneficiaries will reap the benefits of lower costs. The bill also creates a refreshing opportunity for those on both sides of the aisle to work together on health care legislation.
Access and cost issues will plague Medicare for the foreseeable future. I am hopeful the Nunes-Pallone bill will be enacted this Congress so seniors, the disabled and taxpayers can begin realizing the benefits Congress has already established for veterans and servicemembers.
Joel White is the executive director of the Health IT Now Coalition.