Comment Letter to the Federation of State Medical Boards Regarding the Draft Interstate Medical Licensure Compact
The Alliance submitted comments on the draft Interstate Medical Licensure Compact (the “Compact”). The Alliance recommended several additions to strengthen the draft Compact.
- Recommend that FSMB more clearly demonstrate the value that will be added as a result of the establishment of a Commission including additional detail on the Commission’s role in facilitating expedited licensure determinations; the streamlined communication channels between the home state, the Commission, and other member states; and the timeframe for expedited licensure.
- We recommend that FSMB include a timeframe in the document that specifies the length of time estimated for end-to-end processing.
- The Compact is a policy document, but in order for the vision encompassed in the document to become reality, there must be interoperable information technology (IT) systems in place.
- We recommend that FSMB clearly outline the eligibility requirements physicians will have to satisfy to be eligible to participate in the expedited process in the Compact.
Former Senators Daschle, Lott, Breaux Form Bipartisan Alliance to Improve Healthcare Delivery through Connected Care
WASHINGTON, DC – Led by former U.S. Senate Majority Leaders Tom Daschle and Trent Lott, and former Senator John Breaux, the Alliance for Connected Care (www.connectwithcare.org) was launched today to promote policy reform around telehealth and remote patient monitoring. Long thought of as an issue affecting only rural areas, advances in technology and broadband deployment have fostered new models of delivery in health care settings across the country. From management of chronic disease, improved access to specialty and convenient primary care and mental health services, telehealth is fast becoming an integral component in the delivery of American health care.
The three former senators are leading a diverse coalition working to raise awareness among policymakers about the advancements in telehealth, and to establish a regulatory environment in which patients have more access to connected care and medical providers are empowered to deliver safe, high-quality care using advanced delivery methods.
Board members of the Alliance include Verizon, WellPoint, CVS, Walgreens, Teladoc, HealthSpot, Doctor on Demand, Welch Allyn, MDLIVE, Care Innovations and Cardinal Health.
“Increased adoption and use of new and innovative technologies is at the core of many of the payment and delivery reforms being tested across the nation and is also central to increasing patient engagement. We must ensure that our regulatory environment appropriately balances the exciting advances in technology for patients, while still maintaining safeguards that allow innovation,” Senator Daschle said. “To put it in perspective, the legal structure around telehealth was established in 2000 when cell phones were still just phones.”
“It is time to make connected care a bipartisan priority in Washington,” said Senator Lott. “Imagine an elderly woman with diabetes who can consult a doctor about managing her disease without having to leave her home; or a working parent who can video chat with his child’s pediatrician; or a patient in need of mental health services, but too afraid to go to an office, now able to access care through a laptop; or a doctor who can monitor a patient already discharged from the hospital. We must improve access to the kinds of innovation that can improve patients’ lives.”
“Despite this rapidly developing technology, and increasing interest among patients and physicians in using connected care tools, legal and regulatory barriers continue to limit mainstream acceptance of the technology,” said Senator Breaux. “Fully realizing the promise of connected care demands urgency among policymakers to foster a regulatory structure that enables safe use of remote patient care technology.”
Alliance leaders noted that the U.S. Department of Veterans Affairs has been a pioneer in connected care, with nearly half a million veterans receiving more than 1.4 million remote care contacts during fiscal year 2012. Commercial insurers, large employers and Medicaid are also much further ahead in covering telehealth services than Medicare. In fact, 20 states and the District of Columbia require coverage of telehealth by commercial carrier and 45 states allow reimbursement of telehealth services in Medicaid.
Alliance representatives noted that, to date, policies and regulations have emphasized keeping people out of the hospital with prevention, chronic disease management, care coordination and readmission penalties. But government health care programs generally do not reimburse home health agencies for remote patient monitoring or pay for patients to check in with care providers from their homes via real-time video.
Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial
Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial
Importance: Only about half of patients with high blood pressure (BP) in the United States have their BP controlled. Practical, robust, and sustainable models are needed to improve BP control in patients with uncontrolled hypertension.
Objectives: To determine whether an intervention combining home BP telemonitoring with pharmacist case management improves BP control compared with usual care and to determine whether BP control is maintained after the intervention is stopped.
Design, setting, and patients: A cluster randomized clinical trial of 450 adults with uncontrolled BP recruited from 14,692 patients with electronic medical records across 16 primary care clinics in an integrated health system in Minneapolis-St Paul, Minnesota, with 12 months of intervention and 6 months of postintervention follow-up.
Interventions: Eight clinics were randomized to provide usual care to patients (n = 222) and 8 clinics were randomized to provide a telemonitoring intervention (n = 228). Intervention patients received home BP telemonitors and transmitted BP data to pharmacists who adjusted antihypertensive therapy accordingly.
Main outcomes and measures: Control of systolic BP to less than 140 mm Hg and diastolic BP to less than 90 mm Hg (<130/80 mm Hg in patients with diabetes or chronic kidney disease) at 6 and 12 months. Secondary outcomes were change in BP, patient satisfaction, and BP control at 18 months (6 months after intervention stopped).
Results: At baseline, enrollees were 45% women, 82% white, mean (SD) age was 61.1 (12.0) years, and mean systolic BP was 148 mm Hg and diastolic BP was 85 mm Hg. Blood pressure was controlled at both 6 and 12 months in 57.2% (95% CI, 44.8% to 68.7%) of patients in the telemonitoring intervention group vs 30.0% (95% CI, 23.2% to 37.8%) of patients in the usual care group (P = .001). At 18 months (6 months of postintervention follow-up), BP was controlled in 71.8% (95% CI, 65.0% to 77.8%) of patients in the telemonitoring intervention group vs 57.1% (95% CI, 51.5% to 62.6%) of patients in the usual care group (P = .003). Compared with the usual care group, systolic BP decreased more from baseline among patients in the telemonitoring intervention group at 6 months (-10.7 mm Hg [95% CI, -14.3 to -7.3 mm Hg]; P<.001), at 12 months (-9.7 mm Hg [95% CI, -13.4 to -6.0 mm Hg]; P<.001), and at 18 months (-6.6 mm Hg [95% CI, -10.7 to -2.5 mm Hg]; P = .004). Compared with the usual care group, diastolic BP decreased more from baseline among patients in the telemonitoring intervention group at 6 months (-6.0 mm Hg [95% CI, -8.6 to -3.4 mm Hg]; P<.001), at 12 months (-5.1 mm Hg [95% CI, -7.4 to -2.8 mm Hg]; P<.001), and at 18 months (-3.0 mm Hg [95% CI, -6.3 to 0.3 mm Hg]; P = .07).
Conclusions and relevance: Home BP telemonitoring and pharmacist case management achieved better BP control compared with usual care during 12 months of intervention that persisted during 6 months of postintervention follow-up.
Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial
The Whole Systems Demonstrator (WSD) trial found that telehealth was associated with lower rates of emergency hospital admissions than usual care amongst patients with long-term health conditions. However, admission rates increased amongst the control group shortly after recruitment, leading to concerns about whether the estimated treatment effect reflected telehealth, or was an artefact of the trial. We have conducted further analyses of this issue, and summarise these below as they have implications for the generalisability of the WSD trial. Attention to generalisability is important because trials typically estimate treatment effects for the sample of individuals recruited, rather than for the whole target population. The two might differ due to differences in the patients, centres or treatments.