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Florida lawmakers to explore telemedicine

Lung X-ray for Pulse story about lung cancer.
Published Feb. 10, 2014

TALLAHASSEE — The doctors at Moffitt Cancer Center use advanced communications technology to diagnose patients in Argentina, Colombia and Brazil.

Helping patients in remote parts of Florida or other states, however, is not so easy.

For one, insurance companies in Florida aren't required to reimburse doctors for telemedicine services, meaning physicians aren't guaranteed payment for Web-based consultations or diagnostic test interpretations. What's more, many doctors don't have the licenses to practice in other states, or the credentials to practice at other hospitals.

"It's a lot easier to do (telemedicine) internationally," said Dr. Karen Fields, Moffitt's medical director for strategic alliances. "But there's a huge market, and there are opportunities in the state of Florida."

The Florida Legislature wants to help.

Over the next few weeks, state lawmakers will consider creating statewide standards for telemedicine. They also will debate establishing reimbursement requirements, as well as a system for registering out-of-state telemedicine providers in Florida.

"Our goal is to create fertile ground for this kind of technology to be used," said state Rep. Jose Oliva, a Miami Republican who chairs the House Select Committee on Health Care Workforce Innovation.

The discussion is taking place as the Legislature shifts its focus from Medicaid expansion, which observers consider unlikely in an election year, to less controversial health care issues like addressing a shortage of primary care physicians.

Telemedicine is hardly a new concept — and is already in use in some Florida hospitals.

At Jackson Memorial Hospital's Ryder Trauma Center in Miami, doctors provide round-the-clock consultation services to five clinics serving U.S. contractors in Iraq, medical director Nicholas Namais said.

Ryder also provides some telemedicine services to patients in Florida.

An example: Trauma surgeons in Miami use the technology to help determine if patients in the Florida Keys should be stabilized in a local hospital or airlifted to Jackson.

Many of Moffitt's telemedicine efforts involve international patients. Highly specialized doctors in Tampa review X-rays and pathology slides, and collaborate with doctors overseas.

Moffitt also has established a network with several other hospitals and health care organizations in Florida. Experts participate in video conferences known as "tumor boards" to diagnose challenging cases.

Fields, the medical director of strategic alliances, said Moffitt would like to use telemedicine to assist more patients in Florida and other states. But the licensing and credentialing issues are daunting.

State law also limits the type of medications that can be prescribed online.

Last week, four experts told a House panel that telemedicine could help patients in rural counties lacking specialists and mental health providers.

Meanwhile, the Senate Health Policy Committee heard a proposal by Sen. Arthenia Joyner, D-Tampa, that would require insurance providers to reimburse telemedicine services as if they were face-to-face encounters with doctors.

The bill also sought to establish standards of care and a process that would enable out-of-state telehealth providers to register in Florida.

After taking public comments, Senate Health Policy Committee Chairman Aaron Bean delayed a vote on the proposal, saying the committee needed another week to revise the language.

There will be many questions to answer moving forward.

Among them: Should telehealth services be reimbursed at the same rate as in-person services?

Tamela Perdue, of the Associated Industries of Florida, cautioned the Legislature against being overprescriptive.

"We certainly love everything to allow the free market to work at its fullest," she told lawmakers last week. "Letting people negotiate for best rates and letting the market do its work is certainly our suggestion."

The Florida Medical Association will be keeping a close watch on licensing issues, lobbyist Holly Miller said.

"Telemedicine should be performed by a licensed physician," she said.

Sen. Eleanor Sobel, a Hollywood Democrat, raised similar concerns about quality last week.

"People in other states do not have the same high standards that we do," Sobel said. "I want to ensure that the health care providers from other states are licensed here in Florida."

Kathleen McGrory can be reached at kmcgrory@MiamiHerald.com.

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