The Doctor Will Interface with You Now: Telemedicine Moves Closer in NJ

Lilo H. Stainton | June 13, 2017 | Health Care
Among the issues to iron out, do connections between patients and providers have to be real time?

Warby Parker’s Prescription Check app lets users take a basic eye test with a cellphone and home computer.
Lawmakers in New Jersey are one step closer to a consensus on how to regulate the use of telemedicine, a common practice in modern healthcare that is growing quickly and subject to state laws almost everywhere else in the nation.

After months of negotiations behind the scenes, the Assembly health committee approved a measure on Monday that would legally define the practice, who is eligible, and what technology can be used. The bill, which passed the Senate in early November, was amended to help ensure the new practice doesn’t force out brick-and-mortar providers; another change calls for a new state commission to review data from the practice to ensure it isn’t harming existing providers.

Telemedicine — essentially the use of technology instead of in-person consultations — is already in limited use in New Jersey. A number of hospital systems have programs, or pilot projects; Rutgers University is testing a limited system in Newark; and a national company, PlushCare, announced in April that it would add the Garden State to a list of 17 others where it was already operating. Other providers are eager to join the market.

Real-time only

But several organizations, including representatives from the Inspira Health Network, which serves patients in several rural counties in South Jersey, testified Monday that the bill could actually prohibit the use of a certain type of technology now at work here and in other states. The concern is that one clause in the proposal appears to prohibit systems that don’t connect the patient and provider in real-time; some groups use software that enables physicians to review a patient’s record in detail before responding. They urged lawmakers to consider a minor language change to ensure these systems would remain legal.

Lead Assembly sponsor, Pamela Lampitt (D-Burlington) said later she remained open to further improvements if changes ensured the provision of the “highest quality care” for patients; Assemblyman Herb Conaway, (D-Burlington), a physician who chairs the health panel, also suggested he was willing to consider additional amendments.

“From the outset of this legislation the ultimate goal has been expanding access to affordable healthcare while ensuring high-quality care and patient safety,” Lampitt added, noting that they were mindful not to curb innovation in the process. “While we sought to be as permissive as possible with the type of technologies that may be used, it was also important that we balance technology with the need to maintain standard of care.”

Telemedicine eye exam

The technological concern even caused Warby Parker, the national online eyewear retailer, to recently suspend the rollout of a new telemedicine eye exam in the Garden State, according to the company’s general counsel, Adam Greenberg. The Prescription Check system, now in use in New York, Florida, California, and Virginia, allows users to take a basic eye test with a cellphone and a home computer; it is limited to those without a history of eye problems and does not replace a full eye-health check.

“We actually had plans to launch (in New Jersey) last week, but we put them on hold,” Greenberg explained, “until we know if it would be legal in the state or not.”

Although the issue has been on the Legislature’s agenda for several years, New Jersey remains one of the few states that does not have a legal definition or any specific guidelines for the use of telemedicine. Two-thirds of the states also have laws requiring insurance to cover the use of this technology, according to a report released last summer by the U.S. Department of Health and Human Services, and more than 60 percent of all healthcare institutions are using it in some form.

The practice has been embraced by a wide range of healthcare advocates for its potential to improve access to physicians, including hard-to-find specialists, for patients in rural areas or communities that lack provider options, or those bedridden at home or in a nursing home or other long-term facility. But some doctors groups, while supporting the practice in concept, have raised concerns about how it could divert patients — and healthcare dollars — to out-of-state providers.

Reaching consensus

Those concerns helped drive negotiations on the amendments and many of the speakers praised the lead sponsors — Lampitt, Conaway, and Sen. Joe Vitale (D-Middlesex), who teamed up with other colleagues from both parties — for their work to reach consensus. Among others, the changes pleased the New Jersey Business and Industry Association, who had raised concerns about language in the original bill that they worried would actually escalate costs. Various physician specialty groups, nurses, hospitals, and pharmacists also supported the bill, as well as Teledoc, a national telemedicine provider.

The 53-page bill (A-1464) first introduced in early 2015, would allow a wide range of providers to use telemedicine to help screen and treat their patients, as long as they hold a New Jersey license. The measure also requires insurance companies to cover the practice, although these visits can be billed at lower rates than in-person treatment.

The proposal, which passed the Senate health committee in September, defines telemedicine as technology that helps connect the provider to a remote patient through the use of two-way videoconferencing, or similar technology, and “store and forward” technology, in which a patient’s symptoms are saved in a system and forwarded to the physician for analysis not in real time. It would not permit the use of instant messaging, text messages, or audio-only calls for this practice.

According to Conaway, the committee chair, the amendments would also ensure that payments provided for these services reflect the actual cost of care in the Garden State and would help ensure national telemedicine providers refer patients to in-state physicians if a face-to-face appointment is necessary. It also requires all telemedicine providers to collect and report certain basic data on the patients they treat and the payments involved. The bill would also create a state commission to review those reports and ensure the new practice was not forcing traditional providers out of business.