Gone are the days when everyone has a family doctor following them from birth to death. Gone are the days when hospitals have specialists on staff 24 hours a day. Now companies like MDLive, Teladoc and LiveHealth Online offer patients video chat appointments with doctors any time of day or night. Numerous national teleradiology companies fill in for hospitals and practices needing subspecialty and shift coverage, using off-site physicians. The proliferation of strong internet and video service and other communication devices and programs means that telemedicine is poised for growth in all medical specialties. So what has been holding it back to date?
The current healthcare system already has its policies and procedures in place. Patients come into the office to be seen by a healthcare practitioner, who is licensed in that state. HIPAA forms are signed, insurance cards taken, health history forms completed. The patient is seen and a prescription might be written. This is all part of the patient’s health record and it remains on site.
With telemedicine solutions, the patient might be seen over a video conference. His records might be transmitted over state lines for a consultation. Her imaging study might be read halfway across the country, with reports sent back electronically – no personal contact made between anyone. This brings up a whole set of issues that policymakers are trying to sort through.
Reimbursement policies are thought to be one of the main factors holding back telemedicine. Payers are inconsistent about covering this service. Medicare pays for a few types of interactive telemedicine, including consultations that mimic face-to-face visits, for patients living in areas where there’s a health professional shortage, or designated rural area. Private payers and Medicaid don’t have blanket policies, but are determined by company or state program. Currently 20 states mandate that private payers reimburse for telemedicine services, and some insurance companies voluntarily cover it in other states too. PokitDok is paving the way for telemedicine companies to check insurance eligibility and apply reimbursements, increasing the attractiveness of telemedicine as an option from the patient's perspective.
Healthcare providers must often be licensed to practice medicine in the state where the patient resides in order to legally treat the patient or provide a consultation. Unless reciprocity is offered between states, or the provider gets licensed in additional states, telemedicine will be hampered by provider availability. It doesn’t help that each state’s licensing rules are different and it’s time consuming (plus expensive) to seek additional state licenses.
Rural versus urban
Providers like Medicare restrict paying for telemedicine visits unless they’re for patients in rural areas. Should guidelines be different for providing rural telemedicine care versus care in a more urban environment, where there might be more healthcare resources? Should it matter?
While lawsuits haven’t been abundant with telemedicine, the risk is there. Are new or additional insurance policies needed? Does the insurance company cover a doctor or healthcare extender in all states he or she is seeing patients? If a doctor is sued, what jurisdiction is used, the patient’s or the doctor’s? How does the liability change for treating a patient via telehealth versus in person?
Should there be additional training or certification of health care providers serving as telemedicine consultants? Should nurses, physician assistants or other health care extenders be allowed to see patients without physician supervision?
Until these issues are smoothed over, telemedicine won't realize its true potential and gain the adoption necessary to save our healthcare system millions annually.
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Tags: Healthcare consumerism, Telehealth