News Feature | December 16, 2014

Despite Benefits, Telemedicine Efforts Continue To Be Blocked

Christine Kern

By Christine Kern, contributing writer

CMS Increases Telemedicine Reimbursement

States moving at snail’s pace to allow video visits to help ease doctor shortages in rural areas.

Despite all indications telemedicine could provide cost-effective solutions for the predicted physician shortage, the practice of videoconferencing has been caught in the middle of a power struggle between insurers, physicians, and state officials who are reluctant to allow doctors to prescribe drugs or treatment to a patient they have never face to face, according to USA Today.

While some insurers have hopped on the telemedicine bandwagon, supporting the technology to help reduce overall healthcare costs and improve access to care, USA Today writes almost 30 states prevent reimbursement for video visits, which means that physicians do not practice telemedicine. The problem is that, while there is no organized opposition to telemedicine, state legislatures and medical boards have not been proactive in trying to get laws and guidelines changed to allow the practice.

And the states that are in the most dire need of medical access – places like Alabama, Arkansas, Missouri, Nebraska, and Texas – also are the most restrictive when it comes to guidelines concerning telemedicine, according to a study by the American Telemedicine Association.

Since 2010, 43 rural hospitals have closed, six of which were in Texas, and five each in Georgia and Alabama, according to the North Carolina Rural Health Research Program. This would indicate a growing need to meet the needs of rural populations, who are the most likely to lack access to appropriate healthcare options that telemedicine could supply.

Health IT Outcomes reports that, despite the regulatory and reimbursement hurdles, a 2014 Telemedicine Survey conducted by Foley & Lardner LLP demonstrated healthcare executives are moving forward with implementation of telemedicine. “Healthcare leaders tell us that their organizations are committed to continuing to implement telemedicine programs, even as they face challenges such as getting doctors to buy into the programs and insurers to pay for them,” write the report’s authors.

“The reimbursement landscape is already changing, and there are many viable options for getting compensated for practicing telemedicine,” said Larry Vernaglia, chair of Foley's Health Care Practice. “The smartest thing organizations can do now is to continue developing programs, and be ready for the law to catch up – because it will.”

According to USA Today, a number of state officials are concerned that doctors who treat patients on video remotely may not do appropriate follow-up. “All states want to guard against is the situation where I call up Dr. Smith, who I've never seen or talked to before and will never see or talk to again, and he prescribes me medicine,” Kevin O'Dwyer, attorney for the Arkansas Medical Board said.

O'Dwyer asserts that, when it comes to Arkansas, telemedicine advocates often wrongly “paint a picture of a poor patient out in the middle of nowhere hundreds of miles from the closest medical professional.” According to O’Dwyer, psychiatrists are the only specialists that are in short supply in the state.

But despite reticence of state and regulatory officials, the AMA estimates more than half of states will try to establish or upgrade telemedicine laws and regulations in 2015.