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Telemedicine Trialed for Obstetric Consultations

Cynthia Johnson, for HealthLeaders Media, July 7, 2010

Under current CMS regulations, hospitals receiving telemedicine services must privilege each physician or practitioner providing services to their patients as if the practitioners were on-site. This process has been simplified: Hospitals that were accredited by The Joint Commission (formerly JCAHO) were deemed to also have met Medicare’s Conditions of Participation—including credentialing and privileging requirements—under the Commission’s statutory deeming authority.

But with the passage of the Medicare Improvements for Patients and Providers Act of 2008, the statutory recognition of The Joint Commission’s hospital accreditation program is ending effective July 15. With this change, small hospitals and CAHs using telemedicine services could face the burden of privileging specialty physicians that academic medical centers make available to them.

“We’re glad to hear that there is a change because that will help us and many other telemedicine providers,” says Lance. “There used to be reciprocity for different Joint Commission accredited hospitals. Medicare was saying as of July 15 this year, they weren’t going to allow that. They’re sort of putting it back in place for the purpose of telemedicine.”

In terms of reimbursement, the STORC program receives payment for services from all but one carrier, which may be experiencing a paperwork glitch. Lance states that all of the other patient insurers are paying and experiencing no problems.

D’Lorio describes reimbursement as an “emerging issue.” Twelve states currently mandate that private insurers reimburse for telemedicine services, he says. Medicare and Medicaid programs work on a national level, so they create their own reimbursement rules.

Adding services and onboarding others

“We see a lot of programs emerging that really illustrate bringing the right talent to the right place at the right time and the value proposition behind that,” says D’Lorio.

For example, STORC recently added neonatology to its offerings because of the success it has experienced delivering perinatal services. Now, a neonatologist can look at a baby born at a rural hospital and determine whether the hospital needs to transport the baby for care or whether the baby can continue to receive care at the hospital. “Neonatology is one of the medical specialties that might be prevalent in the academic university, but in the rural hospitals and even in the suburban hospitals, it’s a hard specialty to maintain,” says D’Lorio. “Video has become a wonderful mechanism to provide it.”

STORC is also sharing its best practices with other communities interested in developing similar programs in places such as North Carolina and Georgia.

“It’s something that we’re pioneering along with other areas around the country, and we’re certainly willing to help any areas who have questions,” says Lance. “We’re happy to network and share all of the information that we’re learning. It is the way of the future, and it seems to make a difference.”

Future Goals

At the end of the STORC project’s first year, the specialists at the two hub sites had served nearly 150 patients at five remote sites in Cookeville, Tullahoma, McMinnville, Newport, and Winchester, TN. In the first quarter of this year, patient volume increased by 229%. STORC has already set up connections at two more locations in Jellico, TN, and Dalton, GA, and will start providing patient care in those locations soon. The long-term goals of the project are to:

    —Connect 11 rural sites in Tennessee
    —Reduce cost of care
    —Reduce unnecessary patient transportation
    —Reduce unnecessary hospitalizations
    —Reduce days of neonatal ICU stays
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