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A patchwork of sometimes-restrictive licensure requirements, combined with limited payment, continues to slow down the adoption of telemedicine in many small medical practices, physicians testified before a subcommittee of the House of Representatives.
On July 31, physicians testified about the versatile use of telemedicine – from managing high-risk pregnancies at home to treating acute stroke patients in critical access hospitals. But despite early evidence showing decreased cost and improved quality, the adoption is being stifled, they said.
Source: House Small Business Committee
One challenge comes from Medicare, which pays physicians for telemedicine services under limited circumstances, such as when the patient is in a health professional shortage area. Even when Medicare does pay, the current fee (about $25) is generally too low to cover the cost of setting up and maintaining a telemedicine service, according to Dr. Karen Rheuban of the University of Virginia Center for Telehealth, Charlottesville.
The impact on adoption is clear from the low level of total payments that Medicare made for telemedicine – less than $12 million nationally last year, Dr. Rheuban testified.
Other challenges include varying state board regulations, confusing credentialing regulations, the inability to employ telemedicine across state lines, HIPAA privacy and security regulations, evolving technology platforms, and the cost of adequate bandwidth.
"Telehealth is a valuable tool to address the significant challenges of access to high-quality care, to mitigate workforce shortages, improve population health, and lower the cost of care," Dr. Rheuban testified before the House Committee on Small Business Subcommittee on Health and Technology. "There are many opportunities for small practices to integrate telehealth into everyday practice. However, even for large health care systems such as our own, managing and navigating the complex legal and regulatory environment, which impacts telehealth, can be very challenging."
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Even when Medicare does pay, the current fee is generally too low to cover the cost of setting up and maintaining a telemedicine service.
Dr. Brenda Dintiman, a dermatologist working in a small practice in Fairfax, Va., testified that she uses a tool that provides web-based and mobile access to telemedicine for her patients. But the lack of adequate payment is a barrier for her and other dermatologists, she said.
"While I face these barriers as a physician, it is ultimately the patients – often the most economically vulnerable – that are the most directly affected," Dr. Dintiman said.
Dr. Dintiman outlined some steps to expand the reach of telemedicine that are favored by the American Academy of Dermatology Association (AADA). For instance, Medicare could set an example for private insurers by expanding its payments for telemedicine services.
Changes in state licensure also are needed, she said. The AADA supports the telemedicine compact proposed by the Federation of State Medical Boards that would create a streamlined process for physicians to gain multiple state licenses. The AADA also favors further research on how telemedicine affects cost and quality, which could help make the case to insurers to begin making consistent and adequate payments for telemedicine services, Dr. Dintiman testified.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
