AcuteCare Telemedicine Blog


Circumventing Persistent Barriers to Telemedicine Expansion

For professional care givers and others who believe in the costs reduction benefits and increased care availability derived from telemedical technology a few persistent barriers are proving to be frustrating and annoying. While the emerging innovations are poised to break out from the evaluation phase to full blown market utilization, proponents are using everything at their disposal to nudge a few remaining barriers that stand in the way of accelerated implementation.

The physician-doctor relationship requires an in-person medical visit.

It is a well-documented view that a face-to-face visit with a physician is essential to establishing a relationship with a patient and that the quality of the treatment will be somehow diminished without the one-on-one physical relationship.  Some of this push back is rooted in state regulations and laws or is the result of well-established educational standards and professional guidelines and norms.  Many doctors believe that in order to gather the necessary information about a patient’s medical condition they must meet in-person.  Although that may be true in some cases, doctors usually conduct a very general exam through conversation, not palpation.  As and practitioners become more confident and practiced in the new technology, relative improvements in confidence and personal skill-sets should chip away at the effectiveness of this factor as a barrier to meaningful progress.

The Robert J. Waters Center for Telemedicine and eHealth Law (CTeL) recently published its proposed “Electronic Examination for Telemedicine Prescribing. These templates “would ensure that patient safety would be upheld and would provide clarity for telemedicine providers who wrestle with prescribing in states where the use of an electronic ‘face-to-face’ examination is not specifically identified.”  The proposed statutory language would waive the face-to-face exam when “it would not normally be part of a typical face-to-face encounter with the patient for the specific services being provided.” 

Physicians are required to hold a valid medical license for each state in which they see patients.

Few physicians will advocate for a centralized federal bureaucracy to oversee medical licensing or propose that individual medical boards’ authority be diminished.  The    individual state licensing requirement is a holdover from when state medical boards tested licensed applicants.  Now the National Board of Medical Examiners administers, the United State Medical Licensing Examination (USMLE), and state medical boards just ask for verification indicating that an applicant has passed all three elements of the test.  Today each state has continued to have different requirements for practicing telemedicine, a formidable barrier to expansion of technology that is sure to remain for some time to come.  However, The Federation of State Medical Boards (FSMB) is reaching out to representatives of state medical boards to explore the idea of a streamlined licensing process so as to better accommodate the use of telemedicine. 

The point of medical care depends on the location of the patient.

A similar restriction to individual licensing, this requirement has an easier solution and one that is currently being addressed by legislation.  A comprehensive telemedicine bill, introduced in Congress by California Congressman Mike Thompson, would change the point of care to where the doctor is.  The significance of this simple proposal is that a physician could see patients anywhere in or from the state where he holds a valid license.  Thompson’s measure does not create a national telemedicine license because the last thing the medical care industry needs is another level of bureaucracy between the doctor and his patient.

Outdated limitations on Medicare reimbursement for telemedicine services.

In 2001, limitations in Medicare payments were implemented and were aimed at discouraging the adoption of telemedicine within urban areas. It was then widely believed that unrestrained doctors would overuse telemedicine and run up giant reimbursements.  Government accountants predicted that telemedicine visits would cost $30 million each year for the first five years, however, that prediction fell well-short of reality. In the 11 years since the reimbursements were approved, the total amount approved for telemedicine was just over $20 million.  It is time that restrictions better reflect historic results.

Delivering adequate healthcare in the 21st century demands significant change in the current healthcare delivery model and will require even more significant change in attitudes about well-established and equally well-intentioned processes, social norms and regulations born and reared in past decades and generations.


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