OCR Text |
Show Georgia has permission to bill Medicare for two-way interactive video consultations as face to face consultations. Georgia persuaded their Regional Medical Director to reimburse for two-way interactive video consultations because they demonstrated that it was cheaper than the current system of transporting rural patients to urban centers. Legal i issues The legal issues posed by telemedicine are too lengthy and complex to examine in any detail here (Collins and Charboneau, 1993). Many of the legal issues will be resolved on a state-by-state basis. For a sample of the kind of issues posed consider these questions: Licensing: If a specialist in state A consults via telemedicine on a patient in state B, does the specialist need a license to practice in both states? While it is accepted practice to consult via telephone with specialists in any locale, does this translate to live, real-time consultations via two-way interactive video? Malpractice. If a specialist assists in a real-time procedure via two-way interactive video, is the specialist liable for any negative outcomes? Again, if the specialist is licensed to practice in another state, which state's malpractice laws would apply? Confidentiality: If medical records become computerized, how will states ensure confidentiality? This issue has been partially addressed, but the size of the data base involved in managing an entire state's population medical records creates some unique confidentiality problems. Utah Examples Some health care facilities in rural Utah are moving towards implementing telemedicine systems. For example, Castleview Hospital in Price is currently testing an inexpensive but quality teleradiology technology at several small clinics. Using off-the-shelf equipment and public domain software, Castleview Hospital has created a quality teleradiology connection with the Castleview Clinic in Emery. The staff at Emery has become enthusiastic users of this service. Castleview Hospital is considering creating a teleradiology network using similar equipment to the clinics in Green River, East Carbon, and Bullfrog among other possible sites. In another example, the hospitals in Vernal and Roosevelt have long shared a teleradiology link so that their radiologists can call and consult easily with each other. Other states that have embarked on establishing state-wide telemedicine systems include Texas (Alston, 1993), Oregon, Montana (Reid, 1993), Idaho, Georgia (Sanders and Tedesco, 1993), and Kansas (Kansas Telemedicine Policy Group - Vol I, 1993) among others. Policy Implications Policy will play a major role in how and when telemedicine systems are utilized by rural communities particularly in the unknown arena of health care reform. It is important that government not get in the way of implementing these systems. However, government has an decisive role in (1) setting standards so that systems are compatible and of clinically acceptable quality; (2) supporting the state-wide internet so that the skills/technology training/maintenance necessary to operate and maintain these system are taught and maintained; (3) setting reimbursement policy; (4) setting policy that encourages progress and then gets out of the way; (5) creating safeguards that protect consumers; and (6) establishing policy that maximizes the number of potential users. Telemedicine systems can have a substantial impact on the cost of providing health care to rural residents. If health care is a "right" then government has a role in ensuring it is equally available to everyone, particularly in rural areas where market forces are not likely to develop such systems. The implementation of telemedicine systems may become closely tied to health care reform in several respects. First, telemedicine systems could be structurally determined by the implementation of large area health plans. If, for example, rural health care facilities and providers are mandated to participate in large urban-based health plans, then this will dictate with whom rural hospitals and providers may electronically connect. On the other hand, if rural health care systems are allowed to maintain the current fee-for-service system or some close approximation, then they will continue to be able to chose their consultation and referral patterns. Second, reimbursement rates for telemedicine interactions could be set or altered or abolished during the health reform effort. Policy discussion on reimbursement need to consider the impact on rural telemedicine systems. Because telemedicine systems are being developed concurrently with the process of health care reform, it is possible that the two will become inextricably linked, at least in how rural people perceive these changes. 100 TELEMEDICINE |