Tele-Rheumatology Offers Lots of Benefits

A plunge into telehealth takes full commitment, proper training & staying attuned to patient needs
& input.

She cautioned that although coverage for telehealth is expanding, a lot of variation across states exists. “All of us really need to become familiar with our own state’s policies and coverage schemes.”

Work Closely with Administrators

Daniel Albert, MD, a rheumatologist at Dartmouth-Hitchcock Medical Center, New Hampshire, and professor of medicine at Dartmouth School of Medicine, said that—despite all the obvious advantages when done well—the decision to jump into telemedicine shouldn’t be made lightly.

“If you’re going to do this, you have to be very pragmatic about it. It’s not something that you can start on a whim,” he said. “My basic message to you is that it may be anathema to you to deal with your administrators, but you’re going to have to—and you’re going to have to deal with them right from the start before you ever even think about getting this up and running.”

Concerning U.S. Medicare reimbursements, the relative value units generated by telehealth visits are identical to those generated by in-person visits, “so why shouldn’t you do all these visits, as much as you can, by telemedicine? It’s not so easy,” Dr. Albert cautioned.

If your hospital is in a different state from where the patients are—the physician has to be licensed in that other state. If the telehealth site is a hospital, the physician must be fully credentialed at that hospital. This means physicians venturing into telehealth must work closely with administration, he stressed.

“This is not a trivial procedure,” Dr. Albert said.

Variations in State Rules

Knowledge of individual state laws is essential—in some states, for instance, prescribing by telehealth is acceptable; in others, it’s not. And no state is comfortable with the prescribing of controlled substances via telemedicine because of the potential for abuse. The rules vary.

Dr. Albert also cautioned that records and documentation can be more of a burden with telehealth—records are coming from several sources rather than just one electronic medical record at one center.

And, before telehealth can begin, the contracts between the institutions are not a simple matter, either.

“These take a long time to hammer out,” Dr. Albert said. “I would say that if you start today, you’re probably looking at six months to get this thing rolling—and that would be good.”

Despite all of these cautionary messages, telemedicine can be a huge benefit to patients and medical centers, he said.

“People are very appreciative at the ability to speak with a consultant without a really arduous journey,” Dr. Albert said. “Some people can’t do four hours in a car. They’re in too much pain.” A telehealth option could mean the difference between seeing a doctor and not seeing one, he said.

“Is it as good as an in-person [visit]? I don’t think so,” he said. “But it’s good—and it’s certainly better than a telephone meeting, especially if you have a good consulting nurse.”

Some centers, Dr. Albert said, shy away from seeing new patients via telemedicine, but many new patients don’t need to be seen in person.

“My attitude toward it is, if I’m confused, I ask them to come down,” he said. “I’m not sure that we need to make that very arbitrary decision that all ‘news’ have to be seen in person. I don’t think that is necessary.”