Telemedicine

Sleep medicine, by its very nature, is a technology-driven medical specialty. From polysomnography and HSAT to PAP machines and hypoglossal nerve stimulators, sleep specialists have implemented innovative technology to treat sleep illness. Moreover, consumer sleep technologies now are transforming the way populations consider their sleep health.

Two major drivers of telemedicine development are a high volume of demand for a particular clinical service, and a highly critical need for clinical expertise to deliver the service. These drivers are directly relevant to the field of sleep medicine today.

In addition, the current population of the United States is estimated to be approximately 325 million people, and presently there are approximately 7,500 board-certified sleep specialists. This means that the ratio of people to sleep specialists in the United States is more than 43,000:1. In comparison, an area that has a ratio of people to psychiatrists greater than or equal to 30,000:1 could be eligible for designation by the United States Health Resources and Services Administration as a mental health shortage area.

There are geographic barriers to high-quality sleep care, with board-certified sleep physicians and accredited sleep centers clustering in more urban, highly populated areas. Building and filling sleep medicine fellowship programs, creating novel educational pathways to board eligibility, and fostering the development of sleep teams all are effective strategies to address this problem. None of these solutions has more immediate potential to overcome these challenges than telemedicine, which can dramatically increase sleep medicine accessibility and clinical efficacy.

To address this issue, in January 2016, the American Academy of Sleep Medicine (AASM) officially launched SleepTM, a state-of-the-art telemedicine platform that was designed specifically for the sleep field and subsequently began developing multiple resources and educational opportunities to equip sleep specialists to implement a telemedicine program.

The AASM is also tracking and supporting telemedicine legislation at the state and federal level. A few of these bills include:

• The CHRONIC Care Act (S. 870) – Which would increase the use of telehealth services for individuals in Medicare Advantage (MA) plans. If the MA plan provides a service as an additional telehealth benefit, an individual enrollee will have the discretion as to whether to receive such service as an additional telehealth benefit. In addition, the bill also would allow Accountable Care Organizations (ACO) the ability to expand their use of telehealth services.
• House Resolution 2948 – Extends term “originating site” to federally qualified health center, home telehealth sites, and any rural health clinic, prohibits application of the originating site facility fee to the additional sites, extends Medicare coverage to remote patient management services for certain chronic health conditions, and directs the government accountability office to study the effectiveness of using specified telehealth services between therapy providers and patients, any associated savings, and the potential for greater use of telehealth services for other forms of therapy.
• House Resolution 2066 – The legislation would authorize an ACO to include coverage of telehealth and remote patient monitoring services as supplemental health care benefits to the same extent as a Medicare Advantage plan is permitted to provide such coverage of such services as supplemental health care. It would recognize telehealth services and remote patient monitoring in the national pilot program on payment bundling; and include among originating sites (at which an eligible telehealth individual is located at the time a service is furnished via a telecommunications system), but without receiving payment of a facility fee, any critical access hospitals, sole community hospitals, home telehealth sites, as well as specified others.

In addition, the AASM supports the Interstate Medical Licensure Compact (IMLC), a voluntary pathway to expedite licensure for qualified physicians who wish to practice telemedicine in multiple states. The IMLC was launched in 2014 by the Federation of State Medical Boards. The objective of the IMLC was to create a process that would make it easy for physicians to practice telemedicine across state lines, thereby easing the nation’s growing doctor shortage, and improve patient access to specialists.

States accepting applications and issuing licenses include Alabama, Arizona, Colorado, Idaho, Illinois, Iowa, Kansas, Maine, Mississippi, Montana, Nebraska, Nevada, New Hampshire, South Dakota, Tennessee, Utah, Washington, West Virginia, Wisconsin and Wyoming. Minnesota is issuing licenses, and IMLC has been passed, but implementation delayed, in Georgia, Kentucky, North Dakota, Maryland, Michigan, Oklahoma, Pennsylvania, Vermont, Washington DC.

Two other states – Florida and South Carolina – have introduced legislation to join the compact.

Among other eligibility criteria, to apply for expedited licensure, a physician must have a full, unrestricted medical license in the Compact Member State and have a primary residence in the state of principal licensure, have at least one-quarter of a medical practice in that state or be employed by a healthcare system in that state.

Under terms of the compact, each member state retains its right to regulate clinicians and take punitive action, if necessary.