Has telemedicine come of age?

From large facilities to small practices, telemedicine services are growing.

Telemedicine and telehealth services refer to the delivery of remote clinical services through technology.

In fact, 2014 may have marked a turning point for telemedicine driven by the number of newly insured through the Affordable Care Act, a physician shortage and the government’s desire to cut healthcare costs. About 900,000 households used video consultations with physicians in 2013. That number is expected to balloon to 22.6 million in 2018, according to Parks Associates, a market research firm.

The National Conference of State Legislatures reports that 43 states and the District of Columbia now provide some form of Medicaid reimbursement for telehealth services. Additionally, 20 states and the District of Columbia have enacted laws requiring that private insurance plans cover telehealth services.

The trend toward value-based purchasing models that pay one fee for an episode of care may also spur telehealth.

Due to telemedicine’s low cost, small practices that adopt telemedicine “may be better prepared to participate and succeed in new payment and delivery models, such as bundled payment,” said Megan McHugh, Ph.D., Northwestern University Feinberg School of Medicine, in her July 31, 2014, testimony before the House Committee on Small Business Subcommittee on Health and Technology.


To be sure, barriers exist to widespread adoption of telemedicine services, including low reimbursement and geographic restrictions. Additionally, state laws vary widely as to what is defined by telemedicine, which services are covered and who can provide those services.

California is among the states in the forefront in modernizing legislation to take advantage of new technologies. All health professionals licensed in California can deliver telehealth services.

Additionally, California has parity among clinical services regardless of whether they are delivered in person or through telehealth. Twenty states and the District of Columbia have passed parity laws.

The Centers for Medicare & Medicaid Services (CMS) has proposed to expand telehealth coverage. The 2015 Medicare Physician Fee Schedule adds annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management services to the list of covered services for Medicare beneficiaries. However, coverage remains restricted to beneficiaries in rural areas or counties outside of Metropolitan Statistical Areas.

Another barrier is licensing. All states require physicians to have a license to practice in the state in which the patient is located. Physicians seeking a license in multiple states must deal with varying medical board and credentialing regulations and costs. An exception is the Department of Defense, which allows physicians licensed in one state to provide services anywhere in the United States.

The Federation of State Medical Boards has proposed a Medical Licensure Compact. It would significantly reduce barriers to multiple-state licensure by making qualified physicians eligible for expedited licensure in all states participating in the compact.

On the national level, several telehealth bills are wending their way through Congress. One bill expands eligible providers and services and removes geographic restrictions.

Another bill eliminates the need for multiple state licenses for certain Medicare providers who offer telemedicine services to Medicare beneficiaries across state lines.

Getting online

A number of companies provide the resources to get a practice’s secure, HIPAA-compliant telehealth services up and running.

Alternatively, physicians can join a network, such as Teladoc, the largest provider of telehealth medical consultations in the nation. The company provides the software, helps set up the website, works with insurance companies for reimbursement and provides medical malpractice insurance for network physicians.

Visit the American Telemedicine Association at www.americantelemed.org for more information on telemedicine resources.

And before incorporating telemedicine into your practice, consult with a healthcare attorney to ensure you are in compliance with all state regulations.