Telehealth
The growth of telehealth, or telemedicine, continues to expand across the country. Federal funds now support programs in 46 states. The Balanced Budget Act of 1997 required Medicare to pay for some services in health professions which are experiencing shortages in personnel. The focus of providing telehealth services continues to be primarily on physician teleconsultations, although other health care professionals are trying to find their niche in this new frontier. Barriers to the expansion of telehealth are significant. States must address certain concerns and issues, including reimbursement, licensure, malpractice, and patient privacy.
A major barrier to the expansion of telehealth services is the reimbursement issue. Most health insurance companies follow Medicare coverage and reimbursement policies. Because Medicare reimbursement is so limited, most health insurance companies will not pay for telehealth services. Kentucky resolved this issue by enacting a law mandating that private insurance and Medicaid pay for telehealth services just as they would for a face-to-face encounter with a health professional.
Licensure, especially as it affects providers who consult and diagnose across state lines, is another major issue. States take a very proprietary view of their health professional licensing infrastructure. The goal, of course, is protecting the residents of the state from unqualified or fraudulent providers. The most recent statistics report that states are taking action on the licensure issue. Twenty six states have laws regulating out-of-state telehealth practitioners. Twenty one states require full licesnure issues in a variety of ways.
As for nurses, the other practitioner most utilizing telehealth services, More than 20 states have adopted the Interstate Nurses Licensure Compact. The compact is a licensure model based on mutual recognition. Under it, the head of the nursing licensing board will administer the Compact for his/her state. You can read more about the Nurse Licensure Compact.
The Federal Health Resource and Services Administration offers a Web site devoted to telehealth issues. A link with this HRSA site provides the most recent Report to Congress on Telehealth/telemedicine issues. The Report provides an excellent summary of such telehealth issues as reimbursement, licensure, privacy, the use of the Internet in providing telehealth services, and clinical protocols and guidelines. The report also provides links to other telehealth Websites and sources of information. telehealth.hrsa.gov/pubs/report2001/exec.htm#current.
Other useful sites are the American Telemedicine Association and Telemedicine Information Exchange.
