The U.S. lacks uniform legislation regarding telemedicine—what it is, where it should be provided and how it should be paid for. Nonetheless, there is progress at both the federal and state levels—progress that is helping make telemedicine implementation easier and telemedicine services more accessible and affordable to people who need them.
Part of the difficulty of enacting telemedicine legislation stems from the fact that telemedicine, or telehealth, takes so many forms:
- It can mean a videoconference between a hospital patient surrounded by an onsite clinical team in consultation with a remote hospitalist, cardiologist or other specialist via Internet hookup. It can mean a visit at home with your physician on a smartphone or tablet. (These are examples of what the industry refers to as synchronous communication.)
- It can include store-and-forward services where medical data is transferred to a physician for later review without the need for real-time communication between doctor and patient. (This is called asynchronous communication.)
- It can also refer to remote patient monitoring, where a provider tracks healthcare data for a patient who has gone home from a hospital or care facility.
Telemedicine in all these forms addresses key issues in the U.S. healthcare system. A health policy brief by Y. Tony Yang in the August 15, 2016, edition of Health Affairs neatly sums it up: “ … telehealth can improve access to health care in populations that are underserved, such as rural areas, as 20 percent of Americans live in rural areas, but only 9 percent of physicians practice in these areas. Telehealth allows patients to access care through real-time appointments and specialist consultations and to reduce the amount of time and resources rural patients spend to access some health care resources.”
There are three avenues through which a provider can be paid (or reimbursed) for telemedicine care: Medicare, if the patient is 65 and over; Medicaid, if the patient is low income; or private pay or private insurance from third-party carriers such as Aetna or Blue Cross Blue Shield. Legislation at both the federal and state levels has been passed to address the requirements for enabling and controlling reimbursement through these three avenues. But there is still much work to be done as lawmakers continue to consider how best to incorporate telemedicine within current systems of reimbursement for healthcare services.