Small Physician Practices Face Barriers in Using Telemedicine

Small physician practices using telemedicine can make quality care more accessible to patients in underserved communities, but numerous barriers are preventing the technology from realizing its potential, according to a July 31 congressional hearing.

“The cost of technology, broadband availability, licensing requirements, and reimbursement rules from private insurers as well as Medicare and Medicaid may limit or delay the adoption of telemedicine,” said Rep. Chris Collins (R-N.Y.), chairman of the Small Business Subcommittee on Health and Technology.

Likewise, ranking member Rep. Janice Hahn (D-Calif.) made the case that telemedicine technology is ready today “however, our nation’s healthcare system is not.” Specifically, Hahn argued that “we as a country will have to address how telehealth is reimbursed, how and where doctors are able to practice remotely, and how to handle sensitive patient information.”

Karen Rheuban, M.D., professor of pediatrics and director of the University of Virginia Center for Telehealth, testified that the administrative and regulatory challenges for small group practices, in particular, can be overwhelming due to their inherent disadvantages compared to larger healthcare systems that can draw upon the expertise of contract attorneys, IT specialists, billing staffs, electronic health records, PACS services and other support systems.   

“Despite our country’s multi-billion dollar investment in telemedicine, broadband expansion and health information technologies, efforts to promulgate continued integration of telemedicine unfortunately still remain stifled by 20th Century federal and state barriers to more widespread adoption,” said Rheuban. For example, in contrast to the billions of dollars spent on technology, she revealed that last year Medicare reimbursed less than $12 million nationwide for telemedicine services.

Testifying on behalf of the American Academy of Dermatology Association, Brenda Dintiman, M.D., made the case that while there are several barriers to providing care via telemedicine the biggest obstacle is the lack of reimbursement for telehealth services. “Without reimbursement, providers and patients are unlikely to utilize telehealth,”said Dintiman.

Nonetheless, Megan McHugh, director of the Program in Health Policy and Implementation at Northwestern University’s Feinberg School of Medicine, told the subcommittee that the Centers for Medicare and Medicaid Services has gradually expanded reimbursement for telemedicine. “For example, just this year, CMS changed the geographic criteria for originating sites which will expand reimbursable telemedicine services to more rural Medicare beneficiaries,” said McHugh.

“Although research on the impact of telemedicine on cost, quality, and access is very promising, the evidence I believe is not conclusive. And, as a result, I believe that the gradual expansion of telemedicine coverage under Medicare is a sensible course of action, and one that will produce a slow but steady increase in the number of small practices that effectively and efficiently use telemedicine,” she added.

In related news, a bill has been introduced in the Senate that seeks to expand telehealth coverage for Medicare beneficiaries and other patients in underserved areas. A companion bill to legislation in the House, the Telehealth Enhancement Act of 2014 would waive statutory Medicare restrictions on telehealth services in order to encourage greater use of telehealth technologies.

By adjusting Medicare home health payments, patients would be given access to nearby services through remote monitoring technologies. The legislation would also extend telehealth coverage to all critical access and sole-community hospitals regardless of metropolitan status.