Page 8 - Layout 1
P. 8
PRESIDENT’S
MESSAGE
Telemedicine Debate
Continues...
By Dr. Jayesh Shah, 2016 BCMS President
Telemedicine is becoming popular in the healthcare industry. “Telemedicine is viewed as a cost-effective alternative to the
There are more than a dozen telemedicine companies that are al- more traditional face-to-face way of providing medical care (e.g.,
ready working with doctors and patients and seen virtually for their face-to-face consultations or examinations between provider and
non-emergency visits. Telemedicine is also playing an important patient) that states can choose to cover under Medicaid. This def-
role for chronic disease management. After the patient comes for inition is modeled on Medicare’s definition of telehealth services.”
a doctor’s visit for the first initial complete evaluation, follow up (42 Code of Federal Regulations 410.78)
care can be done virtually.
“As CMS gets ready to pay primary care physicians on a different
At centers like Joslin Diabetes Center, doctors have started using model starting in 2017, from a fee-for-service to a monthly fee for
virtual visits for follow-up appointments with out-of-state patients. managing patients, provider practices will be able to participate in
Medicare, Medicaid, some United Health Care plans, some Hu- two ways. In Track 1, the agency will pay a monthly fee to practices
mana plans and a few more have approved payments for telehealth that provide specific services. That fee is in addition to the fee-for-
services. As telemedicine is trending upward, other insurance car- service payments under the Medicare Physician Fee Schedule for
riers will soon come on board. Are we ready for this new model? care. In Track 2, practices will also receive a monthly care manage-
ment fee, and instead of full Medicare fee-for-service payments for
Clearly there are some advantages evaluation and management services, they will receive reduced
of telemedicine: Medicare fee-for-service payments and up-front comprehensive
• Reduced health care costs primary care payments. This hybrid payment design will allow
• Easy access to referring physicians and specialists greater flexibility in how practices deliver care outside of the tradi-
• Easily accessible to patients - reduces travel time and related tional face-to-face encounter, the agency said. For example, prac-
tices might offer telemedicine visits or simply provide longer office
stresses for the patient, makes healthcare accessible to people, visits for patients with complex needs. Practices in both tracks will
especially to those living in remote areas receive upfront incentive payments that they might have to repay
if they do not perform well on quality and utilization metrics.”
However, problems facing telemedicine are
many and need to be resolved before I feel that there is a need to preserve the sanctity of a patient-
telemedicine becomes widespread. physician relationship. Part of our problem is not responding to
• Added cost for fast reliable broadband connections, technical the evolving trends and leading the way, rather than being pointed
out, complaining and wondering why we are losing ground.
training and equipment
• Complicated policies and reimbursement rules Telemedicine can be used as a valuable add-on service to enhance
• Quackery (how to verify a doctor’s credentials on the Internet) patient care rather than replacing much needed face-to-face inter-
• Special Licensing requirements action. In-person, face-to-face interaction between a physician and
• Decreased in-person visits can lead to misdiagnosis patient allows physicians to handle many complex social and psy-
• Decreased personal care and missing opportunities to hold chological issues pertaining to the patient and their family mem-
bers which cannot be achieved by telemedicine. Telemedicine lacks
hands and develop psychological consultation on some other the “touch” which has the power of healing.
family issues.
For more information on telehealth services,
According to CMS, “Telemedicine seeks to improve a patient’s please visit the CMS website.
health by permitting two-way, real-time interactive communica-
tion between the patient and the physician or practitioner at the Centers for Medicare & Medicaid Services (CMS)
distant site. This electronic communication means the use of in- Policy (visit www.cms.gov/medicare/medicare-general-informa-
teractive telecommunications equipment that includes, at a mini- tion/telehealth/index.html).
mum, audio and video equipment.”
The State of Texas Medical Board has answers to frequently
8 San Antonio Medicine • May 2016 asked questions pertaining to telemedicine at www.tmb.state.tx.us/
(Telemedicine FAQs).
