The use of advanced telecommunications technologies to exchange health information and provide health care services across geographic, time, social, and cultural barriers:

–         Telephone, radio, other voice modalities

–         Picture phones, teleconferencing

–         Fax, Emails

–         Computers for data/imaging

–         Interactive video

–         Virtual reality, tele-robotics

The underlying concept of telehealth has traditionally described the use of technology to provide clinical medical services when the healthcare provider and patient are separated by geographic distance. In recent years, the term telehealth has risen as a favorable expansion upon telehealth. Telehealth not only includes clinical services but also non-clinical medical services such as education, research, and administrative functions. (Source: The Association of Telehealth Service Providers)

Telehealth is generally described as the use of communication equipment to link health care practitioners and patients in different locations.  This technology is used by health care providers for many reasons, including increased cost efficiency, reduced transportation expenses, improved patient access to specialists and mental health providers, improved quality of care, and better communication among providers.

The use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Telehealth represents a valuable resource for delivering health-related services to remote, underserved areas, providing greater access to health care for consumers and health professionals.

What are the Different Types of Telehealth

•          Tele-Dermatology

•          Tele-Radiology

•          Tele-Nursing or
Ask-a-Nurse

•          Tele-Psychiatry

•          Tele-Dental

•          Tele-Ophthalmology

•          Tele-education / Continuing Education

Where is Telehealth Practiced?

•          Rural, Remote, Frontier

•          Urban

•          Military: Battlefield, Ships

•          Emergency responders

•          Bioterrorism

•          Ship-to-Shore: Cruise ships, Tankers

•          Schools

•          Extreme: Antarctic, Space, Underwater

•          Prisons

•          Hospitals

How is Telehealth delivered?

Telehealth primarily uses videoconferencing equipment. This is an interactive technology and enables patients and health care providers at distant sites to interact “face-to- face”. Technological advances now allow for these interactions to occur using a desktop computer. An alternative to real-time telehealth is called “store-and-forward”, in which clinical information is sent (like email) to a provider at a distant site for their evaluation. This does not allow for a dialogue between the patient and provider.

Are there problems with licensure across state lines?

Yes, providing patient care across state lines using telehealth can be problematic. Some states, like Montana, have adopted restrictive licensure policies and require full licensure to see patients over telehealth. Other states have less restrictive policies.

What about reimbursement for clinical services?

Many insurance companies are reimbursing for telehealth services. Third party payers and Medicare may be billed for clinical services using standard E&M codes with special modifiers.

Have states passed bills legislating physician licensure for telehealth?
Twenty-seven states, and the District of Columbia, have taken no action regarding interstate telehealth licensure. These states rely upon their statutory 'practice of medicine' clauses, which are typically vague enough to require a full license for diagnosis, treatment, or other direct patient care. In many cases, these clauses can be reasonably construed to consider patient care via telehealth as the practice of medicine without explicitly stating so. (Source: "Interstate Licensure of Telehealth Practitioners" by Glenn Wachter, Telehealth Research Center)

What happens with licensure if telehealth crosses state lines?
In most cases, a physician must be licensed in the state where the patient is. However, the individual states’ regulation of professional licensure creates complicated situations.

For example, State A’s statute narrowly defines telehealth and allows ongoing telehealth interaction not limited to opinions or consultations. But in State B, the statute defines telehealth very broadly and limits its application. Thus, a physician in State C can be involved in telehealth interaction using video communication every day with a patient or physician in State A without requiring a license from State A. This same physician could not contact a State B patient, unless she had provided prior treatment to that patient in State C.

Professionals have to know the laws of each state prior to a telehealth interaction to avoid violation of that state's laws, and they can be individually subjected to board certifications, tests, fees, and other accreditation requirements in order to obtain licensure in all 50 states. (Source: The Association of Telehealth Service Providers)

Does private insurance pay for telehealth?
In some cases it does, but in most cases “No”. The cost-saving aspects of telehealth are not adequately understood by insurance companies. Since telehealth results in less time lost from work, employers who finance insurance programs can be a major force for change. If employers insisted that telehealth services be covered by their insurance plans, things could change significantly. (Source: The Association of Telehealth Service Providers)

Where does Medicare reimburse for telehealth services?

Medicare beneficiaries are eligible for telehealth services only if they are presented from an originating site located in either a rural Health Professional Shortage Area (HPSA) as defined by §332(a)(1) (A) of the Public Health Services Act or in a county outside of a Metropolitan Statistical Area (MSA) as defined by §1886(d)(2)(D) of the Act.

However, entities participating in a federal telehealth demonstration project that were approved by or were receiving funding from the Secretary of Health and Human Services before January 1, 2001, qualify as originating sites regardless of geographic location. Therefore, such entities are not required to be in a rural HPSA or non-MSA.

What is an originating site?

An originating site is the location of an eligible Medicare beneficiary at the time the service being furnished via a telecommunications system occurs and must be located in a rural HPSA or non-Metropolitan. Originating sites include the following:

• The office of a physician or practitioner.
• A rural health clinic.
• A critical access hospital.
• A federally qualified health center
• A hospital.

When does Medicare reimburse for telehealth?

Medicare reimburses for telehealth if the services are performed in one of the following originating sites:

1.  The office of a physician or a practitioner;

2.  A critical access hospital (as defined in section 1861 (mm)(1));

3.  A rural health clinic ((as defined in section 1861 (aa)(s));

4.  A federally qualified health center (as defined in section 1861 (aa)(4); and

5.  A hospital (as defined in section 1861 (e)).