Telemedicine provides an answer for expanding access to health care as well as saving time and money especially in rural areas. But with its benefits telemedicine brings risks involving privacy, confidentiality, credentialing, and failure of technology for health care providers. In a January 2013 article in iHealthBeat, Jonathan Linkous, Chief Executive Officer (CEO) of the American Telemedicine Association (ATA), stated that after 40 years of development, 2013 may be the year that the government lets go of the reticence it has demonstrated in adopting telemedicine. The ATA estimated that more than 10 million Americans have directly benefited from telemedicine services in the past year, more than double from three years ago. Linkous noted that there are more than 13,000 consumer health applications for the iPhone and provided specific examples of how Americans have benefited from remote medical services. Linkous said that among the barriers to deployment of telemedicine in the U.S. are reimbursement by Medicare and Medicaid, state-based standards of care and professional licensing, device regulation and telecommunications policy. Activity toward expanding access to telehealth services, however, has come from employers, health plans, the federal government, and state government, according to ATA .
Why Barriers Are Dropping
Linkous identified two reasons why telemedicine might get more attention in 2013. First, rising costs, provider shortages, and increasing demands for health care are forcing policymakers to seriously consider alternatives that were not looked at previously. Second, five new groups of supporters of telemedicine have emerged. Those supporters include state legislators who will be working with ATA to create model legislation; patient groups who will be advocating for public policy changes benefiting telemedicine; medical societies such as the American Psychiatric Association; private payers such as Wellpoint, Aetna, and UnitedHealth Group, who cover remote consultations and virtual physician visits; and health system CEOs. Three organizations of elected state law makers passed resolutions to expand state Medicaid coverage of telemedicine next year. In addition, sixteen states have adopted legislation requiring all private payers in the state to reimburse for telemedicine services and other states have proposed legislation. For example, on February 13, 2013, Sen. Ed Buttrey of Montana introduced Senate Bill 270, which states if a health insurer covers a service, the insurer would be required to cover services if provided via telemedicine. Furthermore, CMS established a new billing code covering remotely delivered inpatient psychologic management services that augments Medicare funding for psychiatrists by expanding the billing to include prescribing psychologists who provide rounds for patients with mental disorders in rural hospitals and removes the frequency limit.
Telemedicine Bill in Congress
Risks associated with telemedicine
According to a recently released White Paper, Telemedicine Risk Management: A Practical Guide for Understanding and Mitigating Patient Safety and Malpractice Exposure, “telemedicine can provide quality care in an efficient, cost-effective manner . . . while also improving outcomes.” The author points out, however, that physicians and hospitals can be exposed to new potential liabilities, including providing less than optimal care for patients, if telemedicine is not well managed. The white paper provides an overview of potential patient safety and malpractice risks associated with telemedicine as well as strategies and tactics for mitigating those risks. The white paper identifies the following risks associated with telemedicine:
- Privacy, security, and patient confidentiality: health care providers should verify the security of a telemedicine vendor’s systems and operations to protect patient information;
- Credentialing: Health care providers should ensure that telemedicine providers who are credentialed on the staff of a different hospital or licensed in another state or country are legally permitted to provide services to the receiving provider hospital;
- Informed consent: Physicians should discuss the benefits and risks of telemedicine with patients before obtaining a signed consent form;
- Ensuring reliability of the technology: ensure that the vendor is reliable and establish protocols for accuracy of information transfer as well as negotiating vendor responsibility in vendor contracts;
- Choose appropriate clinical context: Determine whether telemedicine is effective for the patient’s condition; and
- Telephone advice: Ensure that phone calls are triaged by a skilled clinical person who can document all clinically relevant information.
