Telemedicine: An Emerging Health Care Trend

Providing remote clinical services may reduce costs and improve quality of care

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Advances in science and technology have led to creative new health care offerings such as telemedicine services, according to a speaker at the Health and Welfare Benefit Plans National Institute in Washington, D.C., on Oct. 7. But there isn't much regulation or guidance on telemedicine.

"We are always driven to look for new trends in health care, sometimes because of cost savings and other times because we think it will improve the quality of care," said Christine Keller, an attorney with Groom Law Group.

She noted that using technology to provide remote clinical services could reduce costs and increase access to patients in rural areas.

Remote Clinical Services

"Telemedicine could mean different things to different people," Keller said. Although the term is sometimes used interchangeably with telehealth, the U.S. Department of Health and Human Services (HHS) seems to use telehealth as a broader term than telemedicine.

The HHS refers to telehealth as "the use of telecommunications and information technologies to share information and provide clinical care, education, public health and administrative services at a distance."

Telemedicine more narrowly refers to remote clinical services and telecommunications between providers and patients.

Those communications may be made in a variety of ways, including by telephone, text message, e-mail, video and home monitoring devices, Keller said.

Telemedicine can be used to provide follow-up care or answer questions after an appointment, to monitor chronic conditions, and to diagnose and treat new medical conditions.

Not Much Guidance

The HHS, Internal Revenue Service and Department of Labor are known as the "tri-agencies" that work together to develop regulations for health plans.

"Looking at the regulatory landscape, not a lot has happened yet" with regard to telemedicine, Keller said. There are currently no regulations under the Internal Revenue Code or the Employee Retirement Income Security Act.

When the tri-agencies do put together guidance in this area, they will likely have an interest in whether the quality of care is the same with telemedicine as it is with in-person treatment, she noted.

In some situations, the remote care may be provided by the same doctors as the patient would see at an office, she explained. However, some telemedicine services may be provided by third parties. There may not be an established provider relationship, and the quality of the services might not have been assessed.

"When regulators start looking at this, I'm curious about whether they're going to wind up drawing a distinction between who is providing the telemedicine," she said.

State Laws

State licensing requirements serve as a barrier to the expansion of telemedicine, Keller said. If a state doesn't let out-of-state doctors contact patients within the state, that's going to make it difficult for the 50-state employer to offer telemedicine nationwide.

On the other hand, some states have parity laws that require insurance companies to reimburse for telemedicine services in the same way they would for in-person medical care.

She noted that state parity laws are applicable to insurance companies and wouldn't impact self-funded employer plans.

Federal Programs

The tri-agencies are still in the very early stages of figuring out what telemedicine is and what regulations are needed, Keller said.

"One of the factors that may influence them is that telemedicine is now starting to be used in federal programs," she noted. For example, telemedicine visits are now reimbursable under Medicare.

"I think as it becomes more widespread and accepted in the programs that the government is running, there will necessarily have to be some level of acceptance in the private sector," she said.

The Health and Welfare Benefit Plans National Institute is an annual legislative and regulatory update for employee benefits practitioners hosted by the American Bar Association's Joint Committee on Employee Benefits.

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