Telehealth: TELEMEDICINE UPDATE
Recent events are pressing me to share some important new developments which may be upsetting for some, and exhilarating for others. I trust most of you are seated.... I want to alert you to changes that already are taking place in healthcare delivery in California. Before I start, please allow me to state that I am not speaking for the APA or any other organization. I am simply a psychologist who has done a lot of reading on the topic of telehealth care delivery. I strongly encourage you to do the same.
Let's begin with definitions. Various pieces of legislature and medical journal articles refer to telemedicine as communication between doctor and patient through electronic equipment in different or remote locations. The equipment can range in sophistication from telephones to fiber optic and satellite video conferencing. When referring to telemedicine and telehealth in the mental health arena, most professionals are referring to some sort of video conferencing equipment that enables both parties to view the other in real time.
There are a number of nationwide trends in telehealth that have been
developing rapidly, and without our participation. The legal race among
states wanting to pass telemedicine acts has already been won by California.
Its *Telemedicine Development Act of 1996* was signed into law last
September, and will be enacted this July (1997). The majority of
psychologists seem to be unaware of the law, despite Barry Gordon's posting
about this law last November in NetPsy, the email list for Internet
Psychology. The California law defines and regulates the practice of
telemedicine on a state-wide level for the first time. Remarkably, it was
unopposed throughout the entire legislative process, including the powerful
Insurance Committee, and was passed unanimously only eight months after its
Why is this Law Important?
Even if you've heard of this law, you should still re-read it very carefully. It not only restricts California telemedicine services to practitioners licensed in California, but also requires insurance carriers to reimburse providers for its delivery, including HMO's and Medi-Cal. It amends 4 major state codes to add telemedicine as normal part of healthcare services.
Did you catch that? Please re-read this last statement slowly. Telemedicine will be a part of *normal healthcare delivery* within five months in California. How could this happen so quickly? Many more things than we imagine are already in place for telemedicine to be enacted.... Aren't we already seeing patients go to insurance companies first when they want mental health services? Don't those companies do some form of assessment and screening before we get the patient as a referral by telephone? Don't we already get case consultations (with managed care case workers) by telephone? Haven't we been doing this for a few years now?
There is more...the law stipulates that third party carriers cannot *require* face-to-face contact as a condition for reimbursement. How will that impact us? How will it impact our clients and patients? Those of us on panels are official employees of the insurance companies. What will happen if we decide a patient requires face-to-face treatment? Do we get to decide? "Impossible!", you say? The law goes fully into effect in July, so we'll soon see what the wording means. How strong can opposing voices be, given the fact that the majority of nationwide telemedicine pilot projects are saving millions of dollars in insurance healthcare costs?
Healthcare is moving in ways we haven't even begun to contemplate. The lack
of attention paid to telecommunications by most psychologists has put us far
behind our medical and psychiatric colleagues in other arenas as well. For
over three decades, physicians have successfully developed programs to
experiment and research numerous telehealth delivery models. For example,
over 40 states have ongoing "telemedicine" projects, including a number of
urban based "Telepsychiatry" centers serving the needs of rural primary care
physicians and their patients. Over twenty medical schools have established
departments, graduate programs and fellowships in "Medical Informatics". The
American Medical Association recently recommended unrestricted licensure for
all physicians who wish to practice telemedicine across state lines.
There is a fierce battle waging between states like California and the
Federal Government. States do not want to lose their individual power, but
the very nature of telecommunication requires some Federal management. A
newly introduced federal bill, the "Comprehensive telehealth Act of 1996"
would create a Federal telehealth Agency, facilitate telehealth services
across state lines, and *require Medicare* reimbursement for telehealth
services by 1998. A number of pilot programs have already begun. The
Department of Health and Human Services recently awarded $42 million to 19
new *physician-run* telemedicine projects, and the Health Care Financing
Administration launched a three-year test of telemedicine services at 57
What Can We Do?
Well, if we approach this situation as we did managed care, our path is clearly delineated:
- Continue to ignore national trends and hope they'll go away.
- Complain amongst ourselves for a few more years.
- Fill this list with our views of why telemedicine or telehealth won't work.
- Let hungry students graduating from our training schools fill the new job openings created by these new laws and programs.
- Let other types of professionals move into decision-making positions. ;-)
But wait -- maybe the coming of telehealth has benefits to be mined by skillful hands....Here's What You Can Do
Get informed. Educate others. Let's learn to make telehealth work for us, not against us. Let's be proactive, not reactive.
I urge all list members to carefully review the above websites. Ethics principles are heavy reading, but now is the time to read those identified by the APA as being relevant to online work. These issues will surely change with telehealth technology, but our understanding of the issues will help all of us understand and participate in formulating the new research, practices, and teaching models immediately required by telehealth. We all need to work together to define psychology's role in telemedicine and telehealth delivery, as well developing ethical and effective therapeutic use of this new and rapidly changing medium. And the Internet gives us the needed tool to spread the word, mobilize energies, and strengthen our stumbling profession.
Do any of you have media connections to help us spread all the information we can find about telehealth? Send this post to those people. Can you post this message to other lists? Will you start your own investigations and keep people up to date in your state? Will you help create a new future for us all?
Marlene Maheu / 858-277-2772 / firstname.lastname@example.org
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