Growth of Telemedicine Services Brings the Need to Address Associated Risks

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

As for Congress, the Telehealth Promotion Act of 2012 (H.R. 6719) introduced in the House or Representatives by Rep. Mike Thompson, addresses reimbursement and physician licensure.  Under the bill’s provisions, a medical benefit could not be excluded solely because it is furnished via a telecommunications system and Medicare, Medicaid, the Children’s Health Insurance Program, TRICARE, federal employee health plans, and the Department of Veterans Affairs would provide access to such services. The bill provides that providers in all federal health plans would only need to be licensed in the state of their physical location and would be free to treat eligible patients anywhere in the nation, according to the PRWeb. Other provisions related to the role of telehealth in the Medicare and Medicaid programs include: (1) incentivizing hospitals to lower readmissions with telemedicine by offering them a share of the total cost savings; (2) expanding the Medical Home coordinated-care option; (3) exempting Accountable Care Organizations (ACOs) from fee-for-service restrictions and allowing them to use telehealth in place of in-person care; (4) launching new pilot programs for remote patient monitoring for up to 10 HHS-designated conditions; (5) adjusting reimbursement timeliness for home health to better facilitate remote patient monitoring; and (6) creating a telemedicine service option in Medicaid to treat high-risk pregnancies, according to the PRWeb story.

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:

  1. Privacy, security, and patient confidentiality: health care providers should verify the security of a telemedicine vendor’s systems and operations to protect patient information;
  2. 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;
  3. Informed consent: Physicians should discuss the benefits and risks of telemedicine with patients before obtaining a signed consent form;
  4. 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;
  5. Choose appropriate clinical context: Determine whether telemedicine is effective for the patient’s condition; and
  6. Telephone advice: Ensure that phone calls are triaged by a skilled clinical person who can document all clinically relevant information.
The white paper advises providers to be familiar with the Medicare conditions of participation regarding credentialing and privileges related to telemedicine. It recommends that providers develop a risk management strategy and engage in proactive risk, quality and compliance activities related to telemedicine. In addition, the white paper provides specific tactics that providers may include in their telemedicine risk management programs.