Telemedicine 2.0: it's all about access and wellness.

I wrote many articles on telemedicine when it was “fashionable” to discuss telemedicine and healthcare. This dates back to well over 10 years ago when physicians and other providers touted the benefits of telemedicine, not to mention the profits that could be gained from a more streamlined process of delivering healthcare. Now, with the ratification by the Supreme Court of the Patient Protection and Affordable Care Act (PPACA) and the alignment of Accountable Care Organizations (ACOs), telemedicine is again fashionable, although in a much different and more progressive way than 10 years ago. And now, proposed legislation for 2013 could bode well for telemedicine in this new landscape of healthcare reform. My articles on telemedicine over the years have focused on the utter complexities in the regulatory environment for setting up telemedicine companies and delivering healthcare via telemedicine. Countless numbers of regulatory issues acted as a barrier to proper licensure of physicians for telemedicine and varied considerably by state. Back then, there were many calls for reform by physicians asking for a more streamlined regulatory environment regarding telemedicine licensure; but years later, even today, the regulatory environment for telemedicine is mired with complexities. As recently as January 15, 2013, a new study showed that remote telemedicine visits by monitor, called e-visits, tend to be just as effective as office visits when treating patients for sinus infections and urinary tract infections. This recent article led me to ask the question: Have there been any reports that telemedicine services are bad for patients or somehow detrimental to patient health? I’m convinced that the answer is no, and that all we hear about in the use of telemedicine is improved access as well as improved healthcare for the patients who participate. After all, telemedicine, even if not effective, provides additional care to those who need it, provides higher quality care to those who need it, or provides care to those that would not have had any medical care without it. With all the touted benefits of telemedicine over the years, still no uniform system of telemedicine has been developed in the law that would approve physician licensure and the promotion of telemedicine across state lines. This regulatory barrier to telemedicine has admittedly prevented the nation from embracing widespread use of telemedicine. All that was developed in the law was a recent Centers for Medicare & Medicaid Services (CMS) rule regarding provider reimbursement. On May 5, 2011, CMS published a final rule entitled “Medicare and Medicaid Programs: Changes Affecting Hospital and Critical Access Hospital Conditions of Participation: Telemedicine Credentialing and Privileging” that implemented a new credentialing and privileging process for physicians and other practitioners providing telemedicine services. The final rule modifies the Medicare conditions of participation to permit hospitals to rely on the credentialing and privileging determinations of another hospital or telemedicine entity, rather than make an individualized decision based on the practitioner’s credentials and record. The final rule reduced the burden of the traditional credentialing and privileging process for Medicare-participating hospitals and Critical Access Hospitals (CAHs) in order to improve access to specialty services for patients while further reducing the regulatory burden imposed on hospitals and CAHs. But while CMS notably supported better access to telemedicine by making it easier for hospitals to use and get paid for telemedicine services through its rule, the rule did nothing to amend the overall regulatory/licensure problems among states’ laws that still exist for telemedicine.