- The Washington Times - Thursday, February 26, 2004

Less than 1 percent of all money spent on medical technology is used to fund telemedicine, even though online medical care can improve access to doctors for people in rural areas and could lower the cost of care.

A report released yesterday by the Commerce Department concludes that about $380 million will be spent this year to support telemedicine services. That is a fraction of the estimated $80 billion that will be spent on all health care technology.

“There is a lag in the application of technology in the real world,” Undersecretary of Commerce Phillip J. Bond said. “So the question is, what’s the holdup?”

The report concludes that health care providers slowly are embracing telemedicine, the practice of online communication between patients and physicians or nurses. Most online medical practices allow doctors to offer a consultation or provide a diagnosis.

Tens of thousands of Americans have electronic access to health care, but one barrier to wider adoption of telemedicine is persuading third-party payers — from private insurance companies to Medicare and Medicaid, the federal health insurers for the elderly and poor — to reimburse doctors who use technology to provide remote consultations.

“Medicaid coverage for telehealth is idiosyncratic,” the report concludes.

Although California, Louisi-ana and Texas have passed laws that prohibit insurers from discriminating between traditional medical services and telemedicine, Medicaid in Michigan is not reimbursing doctors who generate charges using tele-medicine.

Health care providers have been “generally unsuccessful in persuading Medicare to reimburse many of its applications,” the report stated.

State licensing procedures also have raised a barrier to the broad adoption of telemedicine, according to the Commerce Department study. Regulation of health care professionals is left to each state. But telemedicine allows doctors to make virtual house calls and to practice in any state, including those where they might not be licensed.

The Internet has helped the health care industry outpace state regulatory procedures, and states must figure out how to issue licenses for doctors and nurses practicing online, said Robert Waters, a lawyer for the Center for Telemedicine Law.

“The technology is moving way ahead of the regulatory scheme,” he said.

Some state licensing boards are restricting telemedicine to prevent health care professionals from providing care in states where they aren’t licensed, but 24 states allow out-of-state doctors to practice medicine in their jurisdiction online provided that the doctors obtain their state’s license, according to information in the report compiled by the Center for Telemedicine Law.

A separate program allows nurses to earn credentials to provide health care online in any of 20 states.

“If you can get rid of the barriers, so much can be done,” said Jon Linkous, executive director of the American Tele-medicine Association.

That includes providing better care to people in rural areas.

“If you live on a Navajo reservation, you don’t get the same quality of care as you do if you’re here in D.C.,” Mr. Waters said.

Telemedicine should increase patients’ access to medical specialists, the Commerce Department said.

It also should make health care more convenient for all people, and consumers are likely to become more vocal about online access to doctors and nurses, especially as high-speed Internet connections become more widespread, Mr. Waters said.

“Why should I have to get in my car in a driving snowstorm to see my doctor when I can see him online?” he asked.

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