Telemedicine Trialed for Obstetric Consultations

Cynthia Johnson, for HealthLeaders Media , July 7, 2010

“We see that telemedicine is having an impact in changing the way that healthcare is delivered in just a very positive way.”


A virtual handshake

When patients learn that their specialist plan to use telemedicine services for an appointment, the typical reaction is: “What is it going to cost me?” For example, one patient’s spouse commented that the services made it possible for him to be present for his wife’s ultrasound without taking time off work; however, in the middle of the visit, he asked whether the services were going to cost him more.

“We were able to say no,” says Lance. Then the clinicians pointed out that the appointment would be less expensive for the couple because it eliminated travel expenses.

Satisfaction surveys reveal that patients are pleased with the improved access to care. One may think that the experience would be anything but intimate, but patients supported the use of videoconferencing tools, she says. In fact, one nurse practitioner reported that at the end of an appointment, a patient stood to shake the hand of a specialist with whom she was “meeting.”

“You’re that connected and it’s that real to them,” says Lance.

Hometown hospitals and referring physicians have been equally pleased and appreciative of the services, she says. The referring physicians have built relationships with ROC specialists, and they feel comfortable reaching out to them should they need to discuss a patient’s case further.

From credentialing to reimbursement

Lance is responsible for building the relationship between the specialists and local obstetricians. She discusses their needs, describes how the program will work, and credentials ROC clinicians who provide care and make decisions for patients at the remote hospitals. (Credentialing is not necessary if the appointment occurs in a physician’s office or a clinic.)

“The business of healthcare mandates that medical professionals be licensed in the state in which they’re delivering medical care and that they are credentialed and verified with medical centers,” says D’Lorio, adding that telehealth must conform to those rules as well.

On May 26, the Centers for Medicare & Medicaid Services published a proposed rule in the Federal Register—and opened it to public comment—that could simplify this credentialing process for hospitals. The rule states that hospitals, including critical access hospitals (CAH), will soon be able to use credentialing and privileging information about telemedicine providers from the remote location. Previously, CMS allowed hospitals and CAHs to accept credentialing information about telemedicine providers from the distant site, but not privileging information.

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