Tuesday, January 22, 2013

NV to Lead Telemedicine Regulation

With a population of 2.8 million people, but 1 million of them spread out across 110,000 square miles of remote and difficult terrain, Nevada may benefit by leading the nation with proposed regulations for telemedicine.

Telemedicine is the practice of medicine using modern telecommunications systems and protocol. It is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.

The American Telemedicine Association (you KNEW there would be an association for this special service!) says:

"Telemedicine is not a separate medical specialty. Products and services related to telemedicine are often part of a larger investment by health care institutions in either information technology or the delivery of clinical care. Even in the reimbursement fee structure, there is usually no distinction made between services provided on site and those provided through telemedicine and often no separate coding required for billing of remote services. ATA has historically considered telemedicine and telehealth to be interchangeable terms, encompassing a wide definition of remote healthcare. Patient consultations via video conferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education, consumer-focused wireless applications and nursing call centers, among other applications, are all considered part of telemedicine and telehealth."

The practice requires special skills and a physician will need to be licensed by the Nevada State Board of Medical Examiners to provide telemedicine services, but the physician could be located anywhere. The board offers a special-purpose telemedicine license for physicians who are licensed in other states.

Telemedicine services are sometimes used in prisons and in remote worksites such as offshore oil rigs. Additionally, 35 Medicaid programs in states including Arizona, California, Illinois, Texas and Washington use telemedicine, according to a 2012 report by the Connecticut Office of Legislative Research.

But the practice is not very common in workers' compensation.

Only Oklahoma has mandated that the service be made available to injured workers. The Oklahoma Telemedicine Act says workers’ compensation programs can’t require face-to-face interaction between a provider and a patient “for services that a health care practitioner determines to be appropriately provided by means of telemedicine.”

Nevada's Division of Industrial Relations is proposing rules that would standardize the requirements and reimbursement for providing telemedicine services in the state's workers' compensation system. The rules provide for authorization protocol, appointment protocol and of course reimbursement protocol.

States in the Western region, which have broad swaths of open land where people work and live in remote areas, stand to benefit from the technology and regulation of the practice.

Proponents of telemedicine say the technology offers advantages to employers at remote work sites, such as the 48 mines, 12 geothermal power plants and six oil fields scattered throughout Nevada. After an accident, a doctor or specialist could examine a worker remotely and diagnose the severity of the injury, then make a determination as to the next step - emergency room, hospital, local minor treatment, etc.

The key in implementation in workers' compensation settings is the development of regulatory protocol, and of course particularly a reimbursement schedule.

Telemedicine stands to be the most useful in medical-legal examinations where getting the patient to the examining physician requires extraordinary travel arrangements or transportation is difficult, if available at all.

While there may be a physician that is close to the injured worker, travel to an independent medical examination for medical-legal purposes may not be practical. In those instances telemedicine could be implemented so that the local physician is guided in the examination process by the remote, independent medical examiner.

Nevada is leading the way with the Division's proposed rules. In my view this is an exciting development and one that will be embraced by other states, particularly in the west. It will help provide workers' compensation services to folks outside urban areas.

The Division of Industrial Relations will hold a public hearing on proposed telemedicine rules on Feb. 19 at 9 a.m. The hearing will be held by video conference at the Sawyer Building, 555 E. Washington Ave. Suite 5100 in Las Vegas, and in the Guinn room of the Capitol. 101 N. Carson St., in Carson City.

Written comments can be submitted until 5 p.m. on Feb. 19. Comments can be mailed to Terry Simi, Division of Industrial Relations, 1301 North Green Valley Parkway, Suite 200, Henderson, NV 89074.

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