Indiana Joins Telemedicine Trend

Telemedicine services can cost appreciably less than traditional in-person medical services.
Telemedicine services can cost appreciably less than traditional in-person medical services.
Convenience and cost savings are two of the biggest drivers of telemedicine adoption.

Nearly half a million Americans are expected to see a doctor by using telemedicine technology in 2015, according to the American Telemedicine Association. Adoption of telemedicine in the United States expands mostly on a state-by-state basis, because physicians, nurses, and other healthcare providers are licensed by the states in which they practice. That means some states have embraced telemedicine more enthusiastically than others.

One state that has taken a very conservative approach to telemedicine expansion is Texas, which enacted rules earlier this year limiting the ways telemedicine could be delivered in that state. They were sued by a large Telemedicine provider called Teladoc, and it’s possible (some say likely) that the new rule will be reversed. The state of Indiana is considering new rules concerning telemedicine in that state, and they’re expected to expand consumer options in a state with large rural areas where gaining access to specialty care can be challenging.

New Telemedicine Rule Expected in Indiana
A pilot program approved by the Indiana Board of Medicine in April allows Indiana residents to access telemedicine without first having an in-person encounter with the telemedicine provider. Providers still must be licensed to practice in Indiana; they just don’t have to see a patient in person before seeing them via telemedicine. Indiana hasn’t formally changed its rule regarding telemedicine without a prior in-person visit, but based on the results of the pilot program, it is likely that the rule will be formally changed this autumn.

Indiana Has Already Enacted Telemedicine Parity Law
Effective July 1, 2015, Indiana telemedicine parity legislation goes into effect. Telemedicine parity laws simply require that insurers cover services provided by telemedicine the same way they cover in-person visits to healthcare facilities. Indiana’s law also makes it unnecessary for healthcare providers offering telemedicine services to have to obtain written consent for use of telemedicine.

Currently 27 states and the District of Columbia have telemedicine parity laws, but they vary considerably from state to state. For example, not all states authorize state-wide coverage without restrictions on providers or technologies. Forty-eight states mandate Medicaid coverage of telemedicine. Only about half specify which patient settings are appropriate for Medicaid reimbursement of services, while the other half formally recognize patient homes as acceptable originating sites for telemedicine visits.

Scott County Hospital Receives Grant Money for Telemedicine
Last September, the United States Department of Agriculture (USDA) announced that it was giving grant funds to Scott Memorial Hospital in Scottsburg, Indiana for the purchase of telemedicine equipment. The equipment will connect the hospital with specialists in Louisville Kentucky under the USDA’s Distance Learning and Telemedicine (DLT) program. The DLT program was designed for rural areas in order to help rural residents meet both healthcare and educational needs via advanced telecommunications technologies.

With the grant funds, special medical carts will be equipped with video conferencing technology as well as devices like digital stethoscopes that connect to specialists in Louisville who have their own laptop control stations. Ideally, the program will not only save patients time and money, it could prevent patients from having to travel to major regional medical centers to receive some types of specialist care.

Telemedicine and Mental Health Care in Rural Indiana
One of the most promising uses of telemedicine is in the delivery of mental health care, particularly in rural parts of Indiana where mental health services are scarce or unavailable. Psychiatric care can be provided through an encrypted video link to patients who are unable to access mental health services in person.

The typical mental health consumer in Bloomington Meadows Hospital drives 90 minutes to get there, and more than one in five are referred to the hospital by emergency departments. Many arrive by ambulance, so it’s easy to see how costs add up. Telemedicine programs in Indiana allow social workers to counsel patients via video link, and allow video group therapy sessions led by psychiatrists. The cost of the encryption technology can be well under $1,000 to the consumer, and considering the cost of regular psychiatric care (particularly if a long drive is involved), patients can definitely see a return on investment due to lower long term costs.

Provision of mental health services by telemedicine could be a game-changer.
Provision of mental health services by telemedicine could be a game-changer.

Provider Actions Regarding Telemedicine Adoption
Indiana providers who want to use telemedicine have to do more than buy the equipment and tell patients about the services. They need to ensure their malpractice insurance covers telemedicine liability, and they must make sure they’re licensed to practice in the states where their telemedicine patients are located. Telemedicine encounters with patients that involve protected health information (which is basically all encounters) must comply with HIPAA rules and must be encrypted.

Reimbursement also requires that certain conditions be met. Under Indiana law, healthcare providers must have “written policies and procedures for the use of patient-physician electronic mail,” and medical provider personnel must thoroughly understand all telemedicine requirements and procedures. Informed consent must take place through email, and certain information is mandatory in the consent emails. Documentation of healthcare services must be maintained for telemedicine just like it is for in-person physician visits.

Medicaid and Telemedicine in Indiana
Medicaid telemedicine services in Indiana must meet several criteria for providers to receive reimbursement. Medicaid is responsible for establishing reimbursement methodology for Federal Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Community Mental Health Centers (CMHCs), and Critical Access Hospitals (CAHs). Medicaid is also responsible for defining mileage requirements that determine whether telemedicine is reimbursed. For example, Medicaid may require that certain patients live a minimum distance away from providers before reimbursing telemedicine procedures. But as government healthcare initiatives go, Medicaid is adopting telemedicine at a much faster pace than Medicare is.

The state of Indiana has implemented legislation and policies that should make it easier for Hoosiers to gain access to medical services using telemedicine technology. This is great news for healthcare consumers in Indiana, because it makes more options possible regarding access to healthcare. is enthusiastic about the expansion of telemedicine in the US. Having served more than half a million satisfied customers with prescription name brand medications over the past 15 years, understands the many benefits of provision of medical services without hindrance by geography.

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