Telemedicine and Telehealth
Information about Telemedicine and Telehealth
The American Academy of Family Physicians (AAFP) supports expanded use of telemedicine as an appropriate and efficient means of improving health, when conducted in a manner supportive of longitudinal care and within the context of appropriate standards of care.
However, lack of training and inadequate payment pose barriers to the use of telemedicine. The AAFP believes that physicians should receive adequate payment for services that are reasonable, safe and effective, medically appropriate, and provided in accordance with accepted standards of medical practice. Available technological capabilities, as well as an existing physician-patient relationship, impact whether the standard of care can be achieved for a specific patient encounter type.
To provide expertise to AAFP members interested in telemedicine, the following information and resources can help guide you through the many aspects of telemedicine and the organizations that provide support to physicians seeking to start or expand telemedicine services.
What is the difference between telemedicine and telehealth?
Telemedicine is the practice of medicine using technology to deliver care at a distance. It occurs using a telecommunications infrastructure between a patient (at an originating or spoke site) and a physician or other practitioner licensed to practice medicine (at a distant or hub site).
Telehealth refers to a broad collection of electronic and telecommunications technologies that support health care delivery and services from distant locations. Telehealth technologies support virtual medical, health, and education services.
Watch: Business of Telemedicine
What resources are available for practices interested in telemedicine?
The following organizations can provide telemedicine and telehealth resources and assistance to your practice:
National Telehealth Resource Centers
The Center for Connected Health Policy (CCHP) is a nonprofit, nonpartisan organization. They work to use telehealth to improve health outcomes, care delivery, and cost effectiveness. Among the information and resources CCHP provide includes:
- Interactive map(www.cchpca.org) showing state laws and reimbursement policies;
- Infographic(www.cchpca.org) showing a summary of state laws;
- Fact sheets(www.cchpca.org) on proposed legislation and policy changes, research reports, and other policy information impacting telehealth;
- Publications(www.cchpca.org) addressing telehealth issues;
- Reports and policy briefs(www.cchpca.org); and
- Annual summary(www.cchpca.org) of state laws and reimbursement policies (click ‘Full Report’).
The Telehealth Technology Assessment Resource Center (TTAC) provides toolkits(www.telehealthtechnology.org), innovation updates(www.telehealthtechnology.org), and an archive of on-demand webinars(www.telehealthtechnology.org) to help telehealth users better understand technological capabilities used for remote examinations during a telehealth visit. According to their website, “TTAC aims to become the place for answers to questions about selecting appropriate technologies for your telehealth program.”
The 12 regional telehealth resource centers (TRCs)(www.telehealthresourcecenter.org) are federally funded. As such, they offer some assistance free of charge. The type of services provided and the amount of services provided free of charge vary by regional TRC.
How can Telehealth Resource Centers help you?
Telehealth Resource Centers (TRCs) help physicians incorporate telemedicine and telehealth into their practices, or expand upon existing telehealth offerings. TRCs assist physicians in much the same manner in which Regional Extension Centers (RECs) help physicians select and implement electronic health records (EHRs) into medical practices.
The Consortium of Telehealth Resource Centers(www.telehealthresourcecenter.org) defines TRCs as centers “established to provide assistance, education, and information to organizations and individuals who are actively providing or interested in providing medical care at a distance.” Further, the consortium’s charter from the Office for Advancement of Telehealth states their goal is to “assist in expanding the availability of health care to underserved populations. And because we are federally funded, the assistance we provide is generally free of charge.”
Telehealth Resource Centers can look at your practice’s mission, vision, and values, as well as your staffing and technology infrastructure to identify how to begin incorporating the use of telemedicine and telehealth into your practice. TRCs can help you identify what makes sense for your practice, how to begin providing telemedicine by starting small, and doing those services well before adding broader, more encompassing and more resource-intensive telemedicine services.
What legal, regulatory, and licensure issues affect telemedicine?
Legal and regulatory issues, including cross-state practice and reimbursement, may impact telehealth technologies and telemedicine services.
Developed by the CCHP, a number of legal and regulatory modules address such issues as cross-state licensure, privacy and security, medical malpractice and liability, credentialing and privileging, antitrust laws, EHRs, and much more. Visit the Telehealth Legal and Regulatory Module(www.telehealthresourcecenter.org) to review legal issues that may arise when providing telemedicine services.
Advances in health care delivery, such as telehealth, may necessitate processes for additional licensing for those services. This policy brief from CCHP(www.cchpca.org) summarizes the Federation of State Medical Boards’ (FSMB) proposal of the Interstate Medical Licensure Compact. For updates to the compact, see CCHP resources(www.cchpca.org), or Interstate Medical Licensure Compact resources(www.imlcc.org).
What reimbursement issues affect telemedicine?
Private payer and Medicaid reimbursement policies vary widely by state and private payer plans for telemedicine services. Conversely, Medicare coverage for telemedicine services is not variable, though coverage is limited to specific services within certain rural or health professional shortage areas (HPSAs) where patients receive care from a site deemed to be a valid ‘originating site.’ Visit CCHP’s Telehealth Reimbursement Module(www.telehealthresourcecenter.org) to learn more about these topics. Additionally, CCHP provides a Telehealth Reimbursement Fact Sheet(www.cchpca.org), which contains a brief summary about telemedicine reimbursements, and the TRC provides a brief overview of private payer law(www.telehealthresourcecenter.org).
Medicare and Medicaid Resources
The Centers for Medicare & Medicaid Services (CMS) makes changes to how they define Medicare telemedicine services on January 1 of each year. Familiarize yourself with Medicare telemedicine payments and details with the following resources:
- Telehealth Services Fact Sheet(www.cms.gov) – This resource applies to the Medicare fee-for-service (FFS) program only, and includes information about originating site, billing information, and the 2017 HCPCS/CPT codes for Medicare telemedicine services.
- Medicare Telehealth Payment Eligibility Analyzer(datawarehouse.hrsa.gov) – Check whether an address is eligible for Medicare telehealth originating site payment.
- Medicaid Telemedicine(www.medicaid.gov) – This resource offers guidelines for physicians and facilities, reimbursement information (HCPCS and CPT codes and modifiers), and Medicaid state plan amendments (SPA).
- American Medical Association (AMA) – Adopting Telemedicine in Practice(www.stepsforward.org)
- American Telemedicine Association (ATA)(www.americantelemed.org)
- State Policy Resource Center(www.americantelemed.org) – This resource monitors state telemedicine policies and provides a map of states with parity laws for private insurance coverage.
- Premium Content Access(americantelemed.site-ym.com) – Create a free premium content account to access such content as the ATA’s State Telemedicine Gaps Reports(www.americantelemed.org), which includes reports about physician practice standards and licensure, and coverage and reimbursement issues.