By Heidi Emerson

Although telehealth is not a new concept, new technologies, greater comfort with technology, and changing payment models are driving increasing use by patients and providers. As a result, there has been new activity and interest in supporting the use of telehealth to expand access and improve care at health centers:

• In a rural county in Georgia, Mercer University School of Medicine has coordinated a special program which was launched in the summer of 2015 with funding by the Governor’s budget.[1] In a county with no doctors or hospital, Community Health Care Systems, a health center in Sparta, has been using the program to conduct electronic home visits.
• Ravenswood Family Dentistry, a health center in San Mateo, California, has been using teledentistry to provide dental exams to children at a Head Start center in an area where dental care is limited, or dentists do not accept new Denti-Cal patients.[2]
• In Mississippi, a new rule that took effect on Dec. 1, 2015 has added language to allow FQHCs or look-alikes to be reimbursed an additional fee as an originating site.[3]  (Mississippi Regulations, 10/27/15)

These are only some examples of how state programs and policies facilitate the use of technology to deliver care at health centers. According to a legislative scan by the Center for Connected Health Policy (CCHP), over 200 pieces of legislation related to telehealth were introduced in the 2015 state legislative sessions.  In addition to legislation around reimbursement and payment, some of the other policies and programs that are being considered by states include the Interstate Medical Licensure Compact[4] passed by 12 states, and the Nurse Licensure Compact which preceded the physician compact by 15 years, with 25 states participating.[5] The Nurse Licensure Compact would allow nurses to practice in both their home state and other compact states with a multistate license.  The Medical Licensure Compact would streamline or expedite the licensing process for physicians practicing in multiple states.

Expansion of broadband networks to facilitate connections for telehealth are also being considered by states such as West Virginia.  Funding for the expansion of broadband access is also available as part of the Federal Communications Commission’s National Broadband Plan through the FCC’s Rural Health Care Program, and its Healthcare Connect Fund, created in 2012. [6]

According to a 2015 report released by the Robert Graham Center and the American Academy of Family Physicians (AAFP), reimbursement continues to be a major barrier for physicians in utilizing telehealth in their practices.[7]  In their survey of 1,557 physicians, among users of telehealth, the most common use was for referrals to specialists (68%) and mental health providers (28%).  For health centers, other challenges include the complexity of billing and reimbursement rules, shortages of providers, interoperability of data systems, and coding of telehealth claims and encounters, according to a report from CCHP that examined telehealth programs at 3 federally qualified health centers and 2 rural health centers in California.[8]

The National Conference of State Legislatures (NCSL) released a report that reviews telehealth policy trends and focuses on three issues: coverage and reimbursement, licensure, and safety and security.[9] Furthermore, the report provides a policy checklist for legislators on these three key issues, and suggests that other ways that states can support telehealth include state reforms that transform care delivery through state plan amendments, waivers and grants. Similar to other reports, other policy issues to consider are liability coverage, scope of practice, credentialing and privileging, prescribing and informed consent.

As we start 2016, it is likely that telehealth and telemedicine policy will be topics under consideration by both states and Congress. It is worth watching policies that will ease restrictions, promote reimbursement, and will allow the use of technology to expand access to both primary and specialty care. The integration of telehealth into practice can improve quality of care for the chronic and complex conditions of the vulnerable populations that health centers serve.

For other resources on state telehealth policies that impact health centers, please see NACHC’s 2013 report, and 2015 issue brief.

 

[1] http://www.georgiahealthnews.com/2015/11/struggling-rural-county-vanguard-telemedicine-revolution/?ref=ft

[2] http://centerforhealthreporting.org/article/teledentistry-could-boost-access-california%E2%80%99s-poor-kids

[3] https://www.medicaid.ms.gov/providers/administrative-code/final-administrative-code-filings/

[4] For more information: http://www.fsmb.org/policy/publications-media/news-releases; http://www.licenseportability.org/

[5] For more information: https://www.ncsbn.org/nurse-licensure-compact.htm

[6] For more information, see also: https://transition.fcc.gov/national-broadband-plan/health-care-broadband-in-america-paper.pdf

[7] Family Physicians and Telehealth: Findings from a National Survey, Robert Graham Center, October 30, 2015. Accessed at: http://www.graham-center.org/content/dam/rgc/documents/publications-reports/reports/RGC%202015%20Telehealth%20Report.pdf

[8] Community Health Centers and Telehealth: A Cost Analysis Report and Recommendations. Center for Connected Health Policy, July 2015.

[9] Telehealth Policy Trends and Considerations, National Conference of State Legislatures, December 2015. Accessed at: http://www.ncsl.org/research/health/telehealth-policy-trends-and-considerations.aspx