AMA House of Delegates

Electronic devices can help deliver care in a way that is especially vital in remote areas, says Barbara L. McAneny, MD, an Albuquerque, N.M., oncologist. Photo by Peter Wynn Thompson /

AMA meeting: Delegates seek pay for care delivered via telemedicine

The AMA will advocate for pilot projects testing new payment models for treatment delivered via Web portals and other electronic formats.

By — Posted June 28, 2010

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In an era when virtual medicine is becoming more common, physicians deserve separate payment for the care they provide via telephone, e-mail, Web portals and other electronic means, according to the AMA House of Delegates.

"We want insurers and Medicare to recognize this is going to be a true form of health care delivery, not just a convenience," said Barbara L. McAneny, MD, then chair of the AMA Council on Medical Service, whose report the house adopted. "This should be a separately reimbursable and Medicare-payable expense."

All "non-face-to-face electronic visits" should be adequately paid for, according to the newly adopted policy.

The Association has had policy seeking such payment since 2000, but the new policy also directs the AMA to advocate "pilot projects of innovative payment models be structured to include incentive payments for the use of electronic communications such as Web portals, remote patient monitoring, real-time virtual office visits, and e-mail and telephone communications."

It is unlikely that Congress will approve more money to pay for telemedicine, so the AMA should focus on pressuring states and private health plans to pay, said Donna Sweet, MD, a Wichita, Kan., internist and member of the Council on Medical Service.

Twelve states mandate that health plans cover virtual care, with Virginia in April being the latest to enact such legislation. Meanwhile, telecom firm Cisco Systems Inc., announced in January a $10 million pilot partnership with Long Beach, Calif.-based health plan Molina Healthcare to create 15 telehealth sites across underserved areas of the state.

In reference committee testimony, some delegates said expanding telemedicine could exacerbate existing disparities in access to health care. But Dr. McAneny, an Albuquerque, N.M., oncologist, disagreed.

"I work with a clinic that serves the Navajo Nation, and the patients text me on their cell phones all the time," said Dr. McAneny, who was elected June 15 to the AMA Board of Trustees. "Addressing disparities is important, and I absolutely think electronics will make it easier for patients to access physicians even when they live 100 miles away or more."

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Meeting notes: Medical practice

Issue: Communication between patients and physicians is essential to good care. Interpreters often are needed for non-English speaking or hearing-impaired patients referred from emergency departments. Interpreting services usually are offered at a physician's expense and often cost more than the doctor is paid for his or her services.

Proposed action: Study the feasibility of requiring hospitals to provide and pay for interpreter services for the follow-up care of patients who physicians are required to accept as a result of a patient's emergency department visit. [Adopted]

Issue: Physicians in some individual and small practices will have difficulty meeting the proposed Centers for Medicare & Medicaid Services' meaningful use standards for electronic medical records, such as computerized physician order entry for 80% of patient services. Therefore, they will not receive the federal bonuses available for successful EMR adoption.

Proposed action: Work with the Dept. of Health and Human Services to improve the incentive requirements to maximize physician participation. [Adopted]

Issue: CMS relaxed the standards for physicians to qualify for bonus payments for electronic prescribing. However, it has not done so for the Medicare Physician Quality Reporting Initiative.

Proposed action: Ask Congress to delay mandatory physician participation in the Physician Quality Reporting Initiative until it is made more physician-friendly and reporting standards made less arduous. [Adopted]

Issue: Patients often have a poor understanding of proposed medical interventions' benefits and risks, and can have trouble visualizing how treatments could affect their lives.

Proposed action: Adopt policy recognizing the value of "shared decision-making" tools that help patients understand clinical information about their conditions, treatment options and potential outcomes while helping them integrate their personal values in making health care decisions. Payers should not require use of the decision aids, however, and the Association will support efforts to test the tools' effect and develop quality standards for them. [Adopted]

Issue: Many Veterans Health Administration patients are unaware of benefits available to them, especially prescription drug benefits. The number of enrollees in the VHA benefits plan is expected to increase by nearly 300,000 in 2011, when the VHA will open enrollment for Priority Group 8 veterans -- those with no service-connected disabilities and whose income and assets are above certain geographic thresholds. That could affect care delivery to veterans in Priority Groups 1 to 7.

Proposed action: Encourage the VHA to continue and strengthen its outreach and educational efforts to veterans already enrolled in its health benefit plans to increase awareness of the available benefits, including pharmacy benefits. [Adopted]

Issue: Physician rating websites have little policing to ensure that people posting to them are really patients and not imposters or competitors. The sites also do little policing of posters who make libelous or fraudulent statements. Physicians have little recourse to correct wrong information posted to the sites.

Proposed action: Work with Congress to enact legislation that would better police website operators. [Referred]

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