Telemedicine could play a critical role in helping the United States achieve the goals laid out in the new federal health care reform legislation, according to one industry expert, and now CMS has proposed rules that set out new credentialing and privileging processes for physicians and other health care professionals who provide telemedicine services.
Current CMS regulations require all hospitals, including those certified as critical-access hospitals, to privilege each physician who provides telemedicine services to a hospital's patients as if the physician were on-site. The proposed regulations would allow the governing body of a hospital whose patients receive telemedicine services to grant privileges based on recommendations from its medical staff, which, in turn, would rely on information provided by the distant-site hospital.
In the proposed rule, which appears in the May 26(edocket.access.gpo.gov) Federal Register, CMS said small hospitals were concerned about the "burden of privileging" the hundreds of specialty physicians at large academic medical centers that would be available to them via telemedicine resources.
The CMS proposal would "allow for the advancement of telemedicine nationwide while still protecting the health and safety of patients."
Hospitals could continue to use the current credentialing processes. And hospitals that choose the proposed option would be required to follow certain guidelines to guarantee accountability. For example, hospitals receiving telemedicine services would have to ensure that
- the distance-site hospital providing the services is a Medicare-participating hospital;
- each distant-site physician is privileged at the distant-site hospital providing the services;
- each distant-site physician holds a license issued by -- or recognized by -- the state in which hospital patients receiving the telemedicine services are located; and
- they perform internal reviews of each distant-site physician's performance of these privileges and send that information to the distant-site hospital for use in its periodic physician appraisals. At a minimum, the information provided to the distant-site hospital would have to include all adverse events that may result from telemedicine services provided by the distant-site physician and all complaints the hospital has received about his or her performance.
CMS will accept comments on the proposed rule through July 26.
Dale Alverson, M.D., is president of the American Telemedicine Association(www.americantelemed.org), or ATA, a Washington-based nonprofit organization established in 1993. He told AAFP News Now that telemedicine could play a critical role in helping the country achieve goals set out in the recently passed federal health care reform legislation.
ATA defines telemedicine as "the use of medical information exchanged from one site to another via electronic communications to improve patients' health status."
The technology improves patient access to health care services by "overcoming barriers of distance, time and travel costs, particularly for the underserved," said Alverson, who serves as medical director of the Center for Telehealth and Cybermedicine Research at the University of New Mexico Health Sciences Center in Albuquerque.
Telemedicine can help ease the burden of limited health care resources through the efficient distribution of subspecialty health care services, he added.
Alverson estimated that widespread use of telemedicine likely could save America's health care system billions of dollars. Some cost savings would come from reductions in patient hospitalizations and use of emergency services.
He pointed to screening for diabetic retinopathy -- the leading cause of acquired blindness in the United States -- as a good example of the cost savings the technology could help achieve. Early diagnosis via telemedicine could save a patient's vision, thus, avoiding patient rehabilitation costs and disability payments and, most importantly, allowing the patient to remain an independent and vibrant member of his or her community, said Alverson.
According to Alverson, however, multiple obstacles stand in the way of widespread implementation of telemedicine, including the lack of
- consistent and fair payment to physicians,
- an affordable broadband Internet infrastructure, and
- adequate standards and guidelines.