In this post I link to and excerpt from the Medscape* Telemedicine: Can It Help Your Practice? Making Video Visits Successful for You and Your Patients Chapter 4:
Setting Up the Technology and Getting Reimbursed
Technological advances have made setting up video visits relatively easy. However, getting paid still comes with obstacles.
Many EHR systems—including Allscripts, Cerner, and Epic—provide basic telemedicine functions. However, platforms that are part of EHR systems are not usually as robust as self-standing telemedicine software, purchased separately.
Self-standing platforms may provide such features as appointment scheduling; managing upcoming patients waiting their turn; e-prescribing, sharing lab and imaging results; and controlling devices on the patient’s end, such as a remote camera, a digital stethoscope, and other scopes.
Vendors include Doxy.me, Zoom, and companies that also function as telemedicine providers and share their own platform technology, such as American Well, eVisit, Sherpaa, and Teladoc. Platforms range in cost from free for relatively simple solutions to more robust software that starts at around $200 a month.
The more expensive self-standing products provide extra services, such as 24/7 customer support. Vendors charge extra for a “white label” option, which puts the practice’s logo on everything the patient sees.
The downside of self-standing platforms is that they may not integrate with your EHR system or your patient portal, meaning that patient records have to be managed separately, and patients may need to download a second app to make a connection.
In these cases, you can manage your end of the transmission by setting up two screens for the telemedicine visit: one screen for the telemedicine connection and the other to enter documentation into your EHR.
However, some telemedicine systems can be integrated into certain EHR products. For example, the American Well platform integrates with Cerner.Use of Basic Teleconferencing Is Controversial
Some doctors like to use basic videoconferencing tools, such as Skype, FaceTime, and Google Hangouts, for telemedicine. These modalities are free and easy to use, but whether they fully comply with the Health Insurance Portability and Accountability Act (HIPAA) is a controversial matter.
HIPAA requires that patient data must be secure from hacking when they are transferred. All three of these services encrypt their data, but other HIPAA compliance issues remain under dispute. Specifically, HIPAA directs that the vendor must monitor data that are stored during transfer.
To vouch for this and other HIPAA compliance requirements, vendors provide customers with a business associate agreement (BAA), which takes responsibility for any breaches under their watch. However, Skype, FaceTime, and Google Hangouts do not offer BAAs for basic service. They say that they don’t need to, because they merely act as a “conduit” of data and do not store them.
There are no known lawsuits challenging this contention, and many small practices still use these platforms or telemedicine. However, some insurers won’t pay for telemedicine care that uses the non-BAA platforms, and some large organizations don’t allow their doctors to use these platforms. Look for no-cost and low-cost alternatives that do issue BAAs available to physicians.
Important Technology Issues to Pay Attention To
Verifying the patient’s identity
Store-and-forward interactions. This method does not require video or a real-time interaction between physician and patient. Patients access the service through the practice’s patient portal. The patient then answers prepared questions, adds comments, and may even send images. The doctor then reviews the patient’s transmission, makes a diagnosis, and sends it to the patient.
Point-of-care devices for the patient. If you designate a health facility for patients to use for telemedicine, you can furnish it with pan-tilt-zoom video cameras and special devices, such as a remote blood pressure monitor, stethoscope, and otoscope. If patients are in their homes, they can buy an inexpensive blood pressure monitor to use in the telemedicine visit. You will need to discuss this with them before the online visit.
Remote patient monitoring. Data from pulmonary, cardiac, diabetes, and other measurement devices in the patient’s home can be synched to software platforms with algorithms that alert your practice for certain events or findings.
Reimbursement From Medicare
Medicare payment is more or less limited to underserved rural areas, and telemedicine must be performed at a healthcare site and not at the patient’s home. Medicare makes two payments: a Part B payment to the doctor making the telemedicine visit, and a facility fee to the healthcare site hosting the patient at the other end.
Because of Medicare’s restrictions on use, fewer than 1% of beneficiaries in traditional Medicare have been using telemedicine each year, but Medicare has been broadening coverage in a few modest steps. For instance, the program has already broadened telemedicine coverage for patients with end-stage renal disease (ESRD) to all parts of the country and allows telemedicine in ESRD patients’ homes.
Medicare also has a pilot payment program for emergency medical services (EMS), called the Emergency Triage, Treat, and Transport (ET3) model, that pays for telemedicine between EMS responders and physicians.