More Insurance Coverage For Telemedicine

MORE INSURANCE COVERAGE FOR TELEMEDICINE

By Matthew J. Effken. Telemedicine continues to be a growing part of the healthcare delivery system in the United States. According to the American Telemedicine Association, more than 10 million consumers directly benefited from using telemedicine last year, and a recent Harris Poll survey found that 27 percent consumers would choose telehealth options if they were available.

Now, claims-paying giant United Healthcare is expanding its in-network health insurance coverage to include video-based visits with approved doctors using real time audio and video links. Initially, coverage is limited to self-funded employers, but it will expand to United Healthcare employer-sponsored and individual plan participants in 2016.

Members can video chat directly with a doctor associated with one of three on-line healthcare providers that offer live on-line consultations with physicians via mobile phone, tablets or computer applications. The appeal of this option comes from 24/7 availability and reduced costs. A typical charge for a video consultations is around $50, which is already significantly less expensive that a visit to a doctor’s officer or urgent care facility. As a covered service, the patient cost may be reduced to the amount of the co-pay, making Telemedicine more affordable for more people.

More information is available at the following link:

http://www.uhc.com/news-room/2015-news-release-archive/unitedhealthcare-covers-virtual-care-physician-visits

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Study Indicates Telemedicine Consults May Save Money For Rural Emergency Departments Compared to Telephone Consults

By Matthew J. Effken. A recent study by researchers at the University of California-Davis has determined that pediatric telemedicine consultations saved money for rural emergency departments when compared to telephone consultations. The study found that even though installation and maintenance of telemedicine systems can be costly, such costs were more than made up for by reducing the number of patient transfers between hospitals.

According to the researchers, telemedicine consultations reduced the number of patients being transferred by 31 percent when compared to telephone consultations. Especially when taking into account the reduction in transfers by air ambulance, the researchers found telemedicine consultations provided an average savings of $4,462 per use.

The researchers worked with health economists to determine that the telemedicine consultations included in the study cost an average of $3,641 per use. Their analysis takes into account the substantial investment in equipment, software and IT resources necessary for a rural hospital to support telemedicine consultations. It also includes the costs urban hospitals must pay to have subspecialists on call to provide assistance.

The data for the study came from tracking interactions between the Pediatric Critical Care Telemedicine Program at UC Davis and eight rural California emergency departments between 2003 and 2009. The researchers looked at five conditions they deemed appropriate for treatment at rural hospitals: asthma, bronchiolitis, dehydration, fever and pneumonia.

The study was published in the journal Medical Decision Making.   Additional information regarding the study is available at the following link: http://www.ucdmc.ucdavis.edu/publish/news/children/10039

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Nebraska Passes Bill Expanding Telehealth Coverage

The Unicameral has passed a bill that expands the definition of telehealth, which will presumably expand Medicaid coverage for these services. Under the new law, telehealth includes all usage of medical information electronically exchanged between sites to aid providers in diagnosing or treating patients. The bill explicitly includes telemonitoring and “store-and-forward” technology in the definition of telehealth. It also removes language from the prior statute that excluded telephone conversations, e-mails, and faxes from the definition of telehealth consultations.

The bill makes a number of other minor changes to the state’s telehealth laws. Specifically, it prohibits changes in reimbursement rates that depend on the distance between a patient and her healthcare provider. Thus, as a result of this bill, Nebraska providers may be able to claim reimbursement for new services, and are protected from changing reimbursement rates based on distance.

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State Reimbursement Policies, Legal Issues Create Continued Challenges for Telemedicine

As telemedicine expands, state policies struggle to keep up. A recent study by the Center for Connected Health Policy highlights some of the issues on the state level. According to the study, 44 states allow some form of telemedicine coverage. However, state policies vary on how telemedicine is defined and on what is covered. Thus, physicians need to review state law to understand their potential revenue streams.

Other legal issues present challenges for physicians interested in telemedicine. States vary broadly on whether they allow physicians licensed in one jurisdiction to practice electronically in other states. Similarly, few states have addressed the issue of malpractice liability for telemedicine providers. Telemedicine presents a significant opportunity to expand physician markets. However, physicians need to have a clear understanding of the legal issues that accompany telemedicine practices before they explore this growing market.

© 2013 Parsonage Vandenack Williams LLC

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Telemedicine

WHAT IS TELEMEDICINE?

Telemedicine is the practice of using telecommunications technology to deliver enhanced medical care by allowing physicians to observe patients and patient data from different locations. There are currently a variety of telemedicine systems being used across the United States. These systems can encompass anything from a fax machine to sophisticated two-way audiovisual communication systems. Telemedicine has also developed to incorporate both “store-and-forward” and real time data transmission. Over the past several years, telemedicine has grown into a multi-billion dollar industry. It is likely that telemedicine will continue to grow, especially in rural areas. However, some important legal issues may be significant obstacles.

HOW IS TELEMEDICINE BEING USED?

Telemedicine is currently being used both in the United States and abroad for a variety of functions in the health care industry. One of the primary uses of telemedicine is providing health care services to isolated rural areas. For example, the Medical College of Georgia uses a sophisticated interactive television system with electronic medical equipment, cameras, and sensors to allow consulting physicians to examine and advise patients in rural areas. Telemedicine systems are also currently being used to provide continuing medical education to providers.

More radical uses of telemedicine have also been attempted on an experimental basis, and may be promising fields of future growth. For example, physicians have conducted surgeries remotely through the use of robotics. Furthermore, there have been government-sponsored programs involving the installation of telemedical equipment in the homes of home care patients.

LEGAL ISSUES IN TELEMEDICINE

Telemedicine faces several significant legal challenges. These issues include licensure and accreditation issues, malpractice issues, and insurance issues. Licensure is particularly problematic for telemedicine providers because medical licensure is governed by the states. Since licensure is a source of revenue for the states, proposals to nationalize licensure or to provide for multi-state licensure have been controversial.

Malpractice issues can also be significant. Although there is some question about whether certain types of telemedicine can constitute a physician-patient relationship, there is a significant likelihood that telemedical consults can expose physicians to additional liability. Since the ability to examine a patient is limited in a telemedicine consultation, this risk may become a serious legal issue. Finally, both professional liability and health insurers have typically not included telemedicine practice in their policies. As a result, many insurers are unlikely to pay for telemedical consults.

© 2012 Parsonage Vandenack Williams LLC

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