Question

You are the Vice President for Network Operations of Regnat Populus Health System, comprised of three hospitals and two clinics. The system is located in “the Delta,” the most rural parts of Arkansas. You want to inform the In-House Counsel (Attorney) and the Chief Medical Officer (CMO) about the value of telehealth.   Prepare a short slide presentation, not to exceed 10 slides including the title slide and references slide.

Focus on the Medicare and Medicaid populations served by the hospitals and clinics. (Find some data that reflect populations in rural Arkansas). Explain how they will benefit from telehealth. Now, find the laws in the state of Arkansas that pertain to telehealth. How will the laws help you to leverage your vision of instituting telehealth across the hospital system and clinics? What are the common legal barriers to instituting telehealth? How can they be overcome?

Answer 1

Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies.^[1] It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. It is not limited to telemedicine which is focussed to monitoring and diagnosis.

Why rural area needs telehealth?

• lack of transport,
• a lack of mobility,
• decreased funding, or
• a lack of staff restrict access to care, telehealth may bridge the gap.

As well as provider distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration

FOR EXAMPLE, LET'S TAKE A PATIENT WITH DIABETES WHO IS USING TELEHEALTH:

• Use a mobile phone or other device to upload food logs, medications, dosing and blood sugar levels for review by a nurse who responds electronically.
• Watch a video on carbohydrate counting and download an app for it to your phone.
• Use an app to estimate, based on your diet and exercise level, how much insulin you need.
• Use an online patient portal to see your test results, schedule appointments, request prescription refills or email your doctor.
• Order testing supplies and medications online.
• Get a mobile retinal photo screening at your doctor's office rather than scheduling an appointment with a specialist.
• Get email, text or phone reminders when you need a flu shot, foot exam, or other preventive care.

TELEHEALTH INCLUDES:

• two clinicians discussing a case over video conference;
• a robotic surgery occurring through remote access
• physical therapy done via digital monitoring instruments
• live feed and application combinations;
• tests being forwarded between facilities for interpretation by a higher specialist;
• home monitoring through continuous sending of patient health data;
• client to practitioner online conference; or even videophone interpretation during a consult.

GOALS OF TELEHEALTH:

• Make health care accessible to people who live in rural or isolated communities.
• Make services more readily available or convenient for people with limited mobility, time or transportation options.
• Provide access to medical specialists.
• Improve communication and coordination of care among members of a health care team and a patient.
• Provide support for self-management of health care.

BENEFITS OF TELEHEALTH

• Telemedicine can be beneficial to patients in isolated communities and remote regions, who can receive care from doctors or specialists far away without the patient having to travel to visit them.
• Recent developments in mobile collaboration technology can allow healthcare professionals in multiple locations to share information and discuss patient issues as if they were in the same place.
• Remote patient monitoring through mobile technology can reduce the need for outpatient visits and enable remote prescription verification and drug administration oversight, potentially significantly reducing the overall cost of medical care.
• It may also be preferable for patients with limited mobility, for example, patients with Parkinson's disease.
• Telemedicine can also facilitate medical education by allowing workers to observe experts in their fields and share best practices more easily.
• Telemedicine also can eliminate the possible transmission of infectious diseases or parasites between patients and medical staff. This is particularly an issue where MRSA is a concern.
• Additionally, some patients who feel uncomfortable in a doctors office may do better remotely. For example, white coat syndrome may be avoided.

The limitations of telehealth

• it also runs the risk of fragmenting health care.
• Fragmented care may lead to gaps in care, overuse of medical care, inappropriate use of medications, or unnecessary or overlapping care.

Arkansas Telehealth Policy

The state did pass a telemedicine parity law in March 2015, Arkansas places arbitrary limits on patient location and requires an in-person visit to establish a provider-patient relationship.

In April of 2015, Arkansas enacted a telemedicine parity law requiring coverage for telemedicine by Medicaid, private insurance, and state employee health plans.

• They amended their telehealth regulations in 2016 to eliminate the mandate that a doctor and new patient first meet in person before using telehealth while keeping in place guidelines that mandate the use of audio-visual technology.
• One year later, they amended the law again to include the patient’s home as an originating site for telehealth services.
• The healthcare professional should follow existing state and federal laws regarding informed consent
• A health plan shall cover telehealth-delivered services on the same basis as it would in-person services.
• A health plan must provide a reasonable facility fee to an originating site if they are licensed to bill the health plan.

BENEFITS FROM LAWS BY STATE:

• maintains standard of care
• preserves patient right
• avoid making any error, mistake and negligience in proving care to the client
• active participation of patient if self care
• build a good interaction and IPR between physician and patient.
• easy to access good health
• avoid giving high prices anf fees for health. It limits the physician fee

LEGAL BARRIERS ARE :

• Reimbursement State Medicaid programs, however, have been a bit more lax since states are free to establish their own policies. States also create their own reimbursement rules for private payers, which often involve parity in coverage of services though not necessarily in cost.
• Malpractice. providers should still ensure their malpractice insurance covers telehealth services and that the coverage extends to any other states they intend to practice in.
• Licensing. Since states control and regulate licensing, some challenges and complications ensue.
• Privacy and security Providers must also abide by any other state privacy laws. Therefore, providers may need to take additional steps, like establish rules and safeguards for its tech support team, which may be inadvertently exposed to patients' protected health information when addressing tech issues.
• Prescribing.Using telehealth to prescribe controlled substances can only be done under certain circumstances, as laid out in the Ryan Haight Act.
• Credentialing and privileging. Smaller hospitals don't always have access to the specialists they need or the resources to credential physicians, so CMS allows hospitals and critical access hospitals to credential by proxy.

SOLUTION TO THESE BARRIER:

• One reasonable move that could help solve the problem would be to create a national telemedicine license.
•   physician specialists at every hospital in the system must have telemedicine credentials at all the other hospitals
• The time and money invested in approving physician credentials for telemedicine could be used to train hospital staff and onboard patients instead.

• Physicians can take things into their own hands by advocating for reform in the health technology industry.

• Many of the problems surrounding telemedicine reimbursement can only be resolved through legislative action, so in the meantime, physicians are stuck finding workarounds.