Before telemedicine can explode in use and deliver on its promise of better access and reduced cost, a few issues need to be overcome.
A study recently published in the journal Telemedicine and e-Health identified three regulatory and financial (as opposed to technical) barriers to telemedicine: physician licensing, physician credentialing and reimbursement, Becker’s Hospital Review reported.
While the field of telemedicine — the remote delivery of patient care — has been around for decades, state laws and industry practices continue to lag the technology.
Below is a description of each barrier identified in the study, along with a possible solution to each.
Reimbursement: This is the big one. Doctors and hospitals aren’t going to have much interest in providing telemedicine services, or buying the equipment needed to deliver them if they aren’t confident that they’ll get paid to offset those costs. Only a handful of states have passed laws around private payer reimbursement for telemedicine, and as is always the case with state laws, the specifics vary from state to state. Government payers like Medicare have their own set of limitations around telemedicine reimbursement, too.
The fix: It’s hardly complicated. Private insurers and the government need to loosen up their policies around payment to providers for telemedicine services or the telemedicine industry isn’t likely to go anywhere. You can’t hold off the advances of technology forever, so reimbursement reform around telemedicine seems more a question of when than if.
Physician licensing: Physicians need licenses for each state in which they practice telemedicine, in addition to a license in the state in which they physically practice medicine. That can be a problem for numerous reasons, including variations and sometimes conflicts among laws in different states. Plus, the licensing process can be complicated, lengthy and expensive.
The fix: A national telemedicine license. The American Telemedicine Association has created a website, FixLicensure.org, dedicated to this issue.
Physician credentialing: Somewhat similar to licensing, physician credentialing involves verifying information about doctors to ensure that they’re in good legal standing eligible to practice medicine. This can be a problem for hub-and-spoke health systems because a physician must be credentialed to work at each individual hospital in the organization. That can be a time-consuming, documentation-intensive and painful process.
The fix: Credentialing by proxy, in which a physician credentialed at the hub hospital is covered for all the spoke hospitals in the system. Electronic credentialing is another approach that could help save time and make the process less painful.
[Photo from flickr user Marcin Wichary]
Brandon, You accurately describe the three barriers. The so-called "national telemedicine license," however, has morphed into what aides for Senator Tom Udall of New Mexico call a "tandem license." They've chosen this route because telemedicine is medicine, so why limit a national license to just telemedicine. The Senator is proposing that physicians get a license in the state they plan to practice and along with it a second license that allows them to practice in any state that accepts the "tandem license" concept. With a tandem license, the physician could move to another state that accepts the tandem license and immediately begin practicing medicine there without having to be specifically licensed in that state. The tandem license would also be for doing telemedicine in any of the states hat accept telemedicine. There is an aspect of this that must be resolved - laws that define the establishment of the patient-doctor relationship. Why is that important? Unless the relationship has been established, a doctor in most states cannot prescribe prescription medication for a patient. Generally, the relationship is established by an in-person examination and a complete medical history. "If that's the case, then just pass a law that lets doctors prescribe prescription medication to anyone they want." Right? Well, that's what led to "Internet prescribing," which is illegal. This is when a physician simply writes a prescription for a patient he or she doesn't know, has never examined, and collects a fee for doing it. There has been patient harm, even deaths, due to "Internet prescribing." To remove this barrier, we need peer-reviewed research that reaches the conclusion a telemedicine examination using videoconferencing systems and medical devices is the same as an in-person physical exam. Today, we don't have that, and until we do, the medical community will oppose any legal erosion of the doctor-patient relationship, especially when it comes to opioids (narcotics).