“The standard of care is the standard of care. Period.”
idea, which would require a statutory change, with lawmak- ers. If physicians don’t meet the heightened licensure stan- dards, nothing prevents them from pursuing a license the old- fashioned way by going through each state’s full application process, Ms. Robinson adds. The compact would not require federal approval but has
garnered some congressional support. The move also could help streamline hospital credentialing policies to promote telemedicine. In 2011, the Centers for Medicare & Medicaid Services (CMS) and Joint Commission promulgated rules allowing hos- pitals using telemedicine to rely on credentialing conducted at the distant facility where the physician is located when making local credentialing decisions.
But TMA officials say some physicians report hospitals still
frequently require complete credentialing, even when doctors in another geographic location only deliver services via tele- medicine.
As one of a number of payers that recognize telemedicine’s benefits in increasing access and decreasing costs, Texas Med- icaid is researching the credentialing barriers, as well as others, through its Quality Based Payment Advisory Committee. TMA and the Texas Hospital Association are working with the com- mittee to help develop a uniform approach to telemedicine credentialing in line with CMS and Joint Commission regula- tions and state rules. Committee Chair Mary Dale Peterson, MD, says part of
the problem may stem from the fact that hospitals must re- write their bylaws to incorporate telemedicine and the new CMS rules, and many have not done so. She also heads the children’s Medicaid managed care plan Driscoll Health Plan, which contracts with The University of Texas Medical Branch at Galveston to provide child psychiatry telemedicine services to medical professional shortage areas in South Texas.
Seeking payment parity Medicaid and TMA are looking at possible payment barriers. While the state revised Medicaid rules to eliminate rural
requirements for telemedicine payment, Medicare has not, and it only covers certain services, Dr. Peterson says. The discrepancy could pose problems when it comes to
providing telemedicine services for dual-eligible patients in Medicare and Medicaid, for example. “Telemedicine is a tool physicians can use to improve ac-
cess to care not only in rural areas but also in urban areas for people who have difficulties with transportation,” she said, adding Driscoll also supports tele-dermatology and sees both rural and urban shortages for pediatric specialists.
24 TEXAS MEDICINE July 2014
But Dr. Peterson agrees, “We have to do this safely.” Medicaid rules also say telemedicine means “the use of in- teractive telecommunications equipment that includes, at min- imum, audio and video equipment,” according to
Medicaid.gov. Dr. Peterson says Medicaid managed care plans have lee- way to pay for telehealth services, but the fee-for-service rates on which the state bases managed care plan payments are inadequate.
On the commercial side, rates tend to vary, but Ms. Voyles says health plans largely have adopted the same payment rules for telehealth services as for conventional care. Texas is one of 20 states that require private insurers to cover tele- health services as they do in-person care. However, in 2013 testimony before the Texas House Insur- ance Committee, Dr. Kim cautioned against insurers who con- tract under exclusive relationships with vendors that provide after-hours telephone access to physicians, while disallowing payment for the same activity among community physicians. House Bill 2017 by Rep. Four Price (R-Amarillo) would have required payment parity for such telephone consultations — without altering the standard of care under Texas’ regulatory and statutory framework for telephonic services, specifically demonstrating an established physician-patient relationship, Dr. Kim testified. On the contrary, TMA physicians testified against two other telemedicine bills introduced last session — House bills 1806 and 830 — that were inconsistent with care standards. When 32 Texas counties have no practicing physician at all, and 12 counties have no physician, no nurse practitioner, and no physician assistant, “we have to be flexible enough to figure out how to take care of patients where they are,” Ms. Voyles said. “But ultimately, patient safety has got to be the priority.” n
Amy Lynn Sorrel is associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at
amy.sorrel@
texmed.org.
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