American College of Physicians Takes Cautions Stance on Telemedicine

Ultimately, there will be no holding telemedicine back.

While the US may still have plenty of wrinkles to iron out in the large scale roll-out of telemedicine services, initiatives are everywhere. Patients have welcomed the option of telemedicine, particularly for routine illnesses that strike outside of regular business hours. Insurers are getting on board as well, now that they realize telemedicine can prevent expensive emergency department and urgent care visits.

With physicians, it’s a bit of a mixed bag. Some are strongly in favor of telemedicine expansion while others are more cautious. For one thing, doctors want to make sure they’re paid for telemedicine services, and they want to find out for themselves what the best applications for telemedicine are. The American College of Physicians recently weighed in on telemedicine expansion in the US.

American College of Physicians Position Statement

On September 8, the American College of Physicians (ACP) published a position paper on telemedicine in the journal Annals of Internal Medicine. Their position covered 13 points, summarized here:

1. Telemedicine, as part of a patient’s longitudinal care, can be valuable and save money.
2. A valid patient-physician relationship must exist before professionally responsible telemedicine services can take place. Establishment of this relationship may take place via telemedicine.
3. Telemedicine should address the needs of those with financial, literacy, or technological disadvantages to make it easier to use.
4. The ACP supports use of federal funds to be used for the broadband infrastructure necessary to expand telemedicine.
5. Physicians must use their professional judgment on a case by case basis concerning the appropriateness of a telemedicine visit.
6. Physicians must ensure their telemedicine infrastructure is secure and complies with federal and state privacy regulations.
7. Standards of practice should be no different for telemedicine than for in-person visits.
8. Physicians should make sure their medical liability coverage includes coverage for services provided by telemedicine.
9. The ACP supports use of federal funds to establish evidence on safety, cost, and effectiveness of telemedicine.
10. Cross-state physician licensing needs to be streamlined.
11. Hospitals that receive telemedicine services should have “privilege by proxy” in terms of medical credentialing and privileging of the physicians that provide telemedicine services.
12. Medicare should lift geographical restrictions on telemedicine reimbursement, which are currently limited to underserved and rural areas.
13. Insurers should offer reimbursement for appropriately structured telemedicine communications when telemedicine is appropriate.

ACP: Action by Federal Payers Will Lead to Action by Private Insurers

The ACP is in favor of Medicare lifting geographic restrictions on telemedicine reimbursement because it will allow them to better serve Medicare patients. After all, if a person has mobility or transportation issues, he could live less than a mile from a doctor’s office and still not be able to get there. Two US Congressmen, Rep. Devin Nunes (R-CA) and Frank Pallone, Jr. (D-NJ) have introduced the TELE-MED (TELEmedicine for MEDicare) Act, which would allow Medicare providers to treat patients via telemedicine across state lines, and the ACP supports this measure.

One of the biggest hassles of telemedicine implementation has to do with the fact that physicians are licensed by states, so a doctor who wanted to practice medicine across state lines would have to ensure he or she was licensed in every state services were rendered. The ACP is hoping that if federal payers effectively deal with interstate provision of medical services, that states and private insurers will do the same.

Meanwhile, Telemedicine Initiatives Continue to Emerge

But while lawmakers on the state and federal levels work out the legislative side of telemedicine, healthcare providers are continuing to find innovative new uses for telemedicine. Mercer University School of Medicine in Macon, Georgia recently teamed up with local care agencies to bring emergency services to people in rural parts of the state that are at least 30 minutes away from a hospital.

When a rural resident needs medical help, they call 911 as they would in any emergency and an ambulance is dispatched. Under this program, however, the ambulances are equipped with telemedicine equipment that allows first responders to communicate with doctors and specialists from the scene of the emergency. Doctors can then provide first responders with instructions for treating patients on-site, and in some cases, a visit to an emergency department can be avoided altogether. In other cases, first responders can be instructed on how to care for patients en route to the hospital to improve outcomes.

Why the US Still Lags in Telemedicine Expansion

Despite the initiatives going on locally and the recent push for legislation that would help telemedicine expand, telemedicine in the US still lags behind that of other countries. Much of that has to do with how healthcare economics works in the US versus other countries. In Canada and the UK, for example, telemedicine has more traction. Reimbursement issues in these countries is less complex, because they have single payer healthcare.

In the US, reimbursement must consider public and / or private insurance coverage, making it more complex. But this should get better in coming years, as private insurers start seeing the benefits of telemedicine and federal payers like Medicare loosen the reins a bit on telemedicine reimbursement requirements.

Urban Residents May Benefit as Much as Rural Residents

Although telemedicine began as a way to deliver services to rural or remote residents, the biggest potential market for telemedicine could end up being city dwellers. The telehealth services at the University of Washington, which have been in place since January, have fielded hundreds of calls, and more than half have come from people who lived within a few miles of a hospital. It’s rapidly becoming clear that there are underserved urban areas and that mobility problems and lack of transportation can be just as limiting in a city as in rural areas.

Likewise, telemedicine can bring down medical costs for urban residents just as it can for rural residents. The Department of Health and Human Services distributes a number of grants for telemedicine projects and has already served hundreds of thousands of patient encounters. The Department estimates its programs have resulted in savings of $38 million in healthcare costs and $41.7 million in traveling costs between 2004 and 2010.

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