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State Laws and Payor Differences Challenge Widespread Adoption of Telemedicine

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The widespread use of smartphones, fast internet connections, and changing standards in insurance coverage have many healthcare providers embracing telemedicine to improve healthcare delivery. More providers are communicating with their patients and medical colleagues via email, mobile apps, and even webcams than ever before. New technological advances allow patients to convey their vital signs and lab results to their healthcare providers via email and smartphones to manage their chronic illnesses from the comfort of their own homes. In this blog, we explore how telemedicine is helping to improve healthcare in locations where medical expertise is difficult to find or simply unavailable, but how state laws and payor policies regarding telemedicine still differ widely, challenging widespread adoption.

Telemedicine Advances Despite Many Hurdles

Rural areas in several states do not have on-site physicians 24/7. Remote support services for intensive-care units, and emergency rooms have been set up in these areas and these provide virtual care. With the help of mobile apps, a patient’s medicine compliance and adherence to their treatment can be tracked. However, most patients may not know what telemedicine refers to and very few physicians may actually be using it. Traditional doctor-patient in-person- visits are still the norm, despite the benefits that Telehealth offers patients: ease of access to quality care, low cost, and convenience.

Telemedicine rules and regulations also differ significantly from state to state and are continuously being updated. Physician groups are formulating their own guidelines based on what healthcare they consider appropriate to be delivered via telemedicine. Telemedicine critics raise doubts about the quality of care that will be delivered with the rapidly growing telemedicine sector. Finally, there is the big question of which physician services will be covered and paid for when delivered via telemedicine. Big federal plans like Medicaid cover a narrow range of services while insurance coverage varies among payors.

Interstate Medical Licensure Compact

So, while telemedicine improves patient care, it is associated with issues of licensing, credentialing, prescribing, treatment, and reimbursement that providers must be aware of. Physician licensing is not a challenge if an in-state physician is providing care via telemedicine because the physician will ideally have a medical license to practice in the state in which the hospital is located. Licensing issues occur when an out-of-state physician treats a patient via telemedicine because physicians need a medical license from the state in which the patient is located. Each individual state decides the licensing requirements that out-of-state physicians need to obtain to provide telemedicine. The Federation of State Medical Boards (FSMB) has adopted an Interstate Medical Licensure Compact, which if adopted by individual states would help ensure physician licensure across state borders and increase the number of physicians who can provide care via telemedicine.

Hospital Credentialing for Telemedicine Services

In addition to licensure, hospitals have to credential the physicians providing telemedicine services. This requires cumbersome paperwork as the physician will require credentialing not only at the hospital where he/she usually provides services at (the Distant Site) but also at the hospital where he/she provides telemedicine services to (the Originating Site). In 2011, the Centers for Medicare and Medicaid Services (CMS), enacted “proxy credentialing” enabling the Originating Site to rely on the credentialing by the Distant Site. As a result, hospitals can quickly request the assistance of specialists who are credentialed at a different hospital. For the use of proxy credentialing, the Originating Site has to sign an agreement with the Distant Site assuring that:

  1. The Distant Site is a Medicare-participating hospital;
  2. The physician has privileges at the Distant Site;
  3. The physician holds a medical license from the state in which the Originating Site is located; and
  4. The Originating Site will send the Distant Site any adverse actions and complaints related to the physician resulting from telemedicine services at the Originating Site.

With regard to the actual treatment, some states require that prior to providing telemedicine services, as well as once a year subsequently, an in-patient exam be carried out. Other states require an in-person exam only if patients seek telemedicine services from the comfort of their home or a location where medical care is not provided. Once the physician-patient relationship is established for provision of telemedicine services, some states require consent to be obtained. In addition to these requirements, there are regulations to determine when a prescription for a telemedicine encounter is written or called in. If individual states adopt the Model Policy for Telemedicine formulated by FSMB, then some of these limitations could be removed.

CMS Reimbursements for Telemedicine

Currently, CMS only reimburses telemedicine services provided via real-time video conference to patients located in a rural area and at a “qualified” Originating Site when receiving telemedicine treatment. If the above requirements are met, the Medicare reimbursement to the physician providing telemedicine services is the same amount that the physician would otherwise receive if the services had been delivered in person.

On the other hand, Medicaid reimbursement for telemedicine services is more varied, since states can decide whether to cover telemedicine and, if yes, then which specific services could be covered. States have various requirements and restrictions on Medicaid coverage with some states only providing coverage for crisis services while others cover only psychiatry services provided via telemedicine.

Collaboration Could Make Telemedicine More Accessible

The American Telemedicine Association, a non-profit organization comprising industry leaders and healthcare professionals, is taking the lead in helping find solutions to the challenges hindering the adoption of telemedicine. They provide education programs to provide all stakeholders like clinicians, administrators, and engineers with the skills for the best utilization of telemedicine services via remote healthcare technologies. The American Telehealth Network is another organization advancing telemedicine to improve access to healthcare by rural and underserved populations with several state and regional affiliates. It seems that if all stakeholders join together to resolve issues and bring parity all round, then telemedicine can advance with leaps and bounds, improving access to quality care for more patients — and not just in rural areas.

InfinxState Laws and Payor Differences Challenge Widespread Adoption of Telemedicine

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