So just what is telemedicine? In the simplest form, it’s a doctor in her
office looking at a screen with a camera pointing back at her, and a patient in
a remote location, doing the same. They
talk, look at each other, and have a standard encounter.
Simple, right? Well,
yes and no. Let’s look at that goes in
to making this situation possible. The topics I’ll cover include: Regulations,
Payments, Terminology, Technology, Medical Specialties, and Type of Patient
Visits.
Regulations
Federal - HIPAA
I’m guessing you’ve already thought about HIPAA and
protecting patient information. The
video and audio, and resulting data must be protected from prying eyes. That would mean some sort of encryption for
an Internet-based communications system, or a dedicated phone line. In short, think of security and privacy, just
as you would with in-clinic medicine. We’ll
revisit this when we discuss technology in a later post.
State Licensing
The location of the patient dictates licensing
requirements. Most states require a physician
to hold an unrestricted license from that state in order to practice telemedicine
on patients in that state. A very few
states, such as Alabama and Minnesota, have a telemedicine license available
for out-of-state telemedicine physicians.
Currently there is a patchwork of
state regulation or non-regulation with regard to telemedicine. However, there is movement on this and it
appears increased Federal involvement in the healthcare system is slowly bringing
clarity to telemedicine practiced across state lines. Though it is outside of the domain I’m
covering, I will mention that the Department of Defense and Veterans
Administration have their own policies on telemedicine when conducted on
federal property.
Hospital Credentialing
Most hospitals still require physicians to be credentialed
by them. They typically won’t accept the
fact that the physician is credentialed by another hospital. Telemedicine proponents encourage “hub and
spoke” credentialing. In the hub and
spoke model, a hub hospital credentials a doctor, and the spoke hospitals
accept that credential. For example, in
Iowa a physician would be credentialed by Iowa Health System’s Iowa Lutheran
Hospital-Des Moines, and that credential would be accepted by St Lukes Hospital
in Cedar Rapids, Iowa as well as Methodist Medical Center in Peoria, Illinois.
Payment
Private
Payment for telemedicine services varies from payer to
payer. Physicians and practice managers need
to check with potential private payers to see what their policies cover. This issue is one which has hampered the promotion
of telemedicine as it creates uncertainty for doctor and patient alike. Twelve states (California, Colorado, Georgia,
Hawaii, Kentucky, Louisiana, Maine, New Hampshire, Oklahoma, Oregon, Texas, and
Virginia) have regulations requiring private payer coverage for telehealth
services. But they don’t necessarily
require the same reimbursement rate as for face-to-face services.
Medicare
Medicare provides coverage for some telemedicine services. In March 2012 they further clarified coverage
for telemedicine services LINK. They
provide a list of CPT and HCPCS codes which qualify for telehealth services, as
well as guidance on modifiers (i.e. GT for “via interactive audio and video
telecommunications system” and GQ for “via asynchronous telecommunications
system”)
Medicaid
Medicaid allows for payment for telehealth services, but
since it is administered by each state, physicians will need to check with
their state Medicaid office for reimbursement policies and rates.
Next post we’ll dive into telemedicine terminology and
technology.
Disclaimer: I’m not an expert on telemedicine, I’m just looking at the landscape and trying to learn. If I’ve missed something important, or I’m (gasp) wrong about something, please let me know. I'll give you credit, incorporate changes and note it at the beginning of the post.
[Note: at the end of each post is a complete list of sources. This list may grow with each post in this series, so for the most complete listing refer to the final post in this telemedicine series.]
Disclaimer: I’m not an expert on telemedicine, I’m just looking at the landscape and trying to learn. If I’ve missed something important, or I’m (gasp) wrong about something, please let me know. I'll give you credit, incorporate changes and note it at the beginning of the post.
[Note: at the end of each post is a complete list of sources. This list may grow with each post in this series, so for the most complete listing refer to the final post in this telemedicine series.]
Sources:
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