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IT IS NO SECRET that the healthcare industry lags behind other sectors in implementing new technology. Other information-intensive industries spend up to five times more of gross revenue on technology than the healthcare industry. The use of telemedicine is an example of how certain chal- lenges in the healthcare industry have affected the implementation of technology. The use of telecommunications for patient care has long been touted as the future of practicing medicine. Decades after this technology has been available, why isn't telemedicine widely used? In 2014, surveys found that only 33 percent of providers and 52 percent of hospitals are using telemedicine. Following the Money The main barrier to widespread implementation of telemedicine is reimbursement. A survey by the Academy of Integrative Health & Medicine, the source of the statistics cited above, found that only 19 percent of providers received reimbursement for providing telemedicine services. Medicare covers interactive audio and video telecommunications that provide real-time communications between a provider and a Medicare beneficiary, and the provider rendering the service is paid an amount equal to the amount that would have been paid if the service had been furnished without the use of a telecommunications system. However, providers are reimbursed for limited services under specific conditions. Medicare beneficiaries are eligible for telemedicine services only if they are presented from an originating site in a rural area. Authorized originating sites include a physician's office, skilled nursing facilities and hospitals. A patient's home is not an authorized originating site; thus, telemedicine is as or more restricted as the traditional practice of medicine. Few procedure codes are reimbursable, but new services were added for 2015, and the list may continue to grow. For Medicaid, each state's laws, regulations and program policies vary. Forty-eight state Medicaid programs reimburse for some form of telemedicine, according to the American Telemedicine Association. Private payers are also subject to state regulation regarding reimbursement. As of May, 27 states and the District of Columbia have enacted telemedicine parity laws. In Ohio, only certain services delivered via telemedicine are covered and the legislature has not passed a parity law for private payers. Common Problems The cost of implementing technology and overcoming resistance to change are additional barriers to the widespread use of telemedicine. Little information is available regarding the actual cost of telemedicine platforms. One telemedicine cart with a video camera, screen, tablet and microphone costs $30,000. In addition to the cost of the technology, a physician must be licensed in each state in which he or she wants to practice unless an exception applies. A recent study by the University of Texas Medical School examined the impact of telemedicine on patients in the intensive care unit. In a unique twist, the majority of physicians in the study wanted as little remote involvement as possible. The physicians expressed concern about possible adverse effects on patient care, and some physicians were hesitant or skeptical about using technology. Acceptance of telemedicine by physicians, nurses and others involved in patient care is just as important as overcoming the other barriers. The Key to Widespread Use Policies that encourage telemedicine are the key to the future of widespread use. Medicare reimbursement is limited, and Medicaid programs vary significantly. However, telemedicine may follow the trend in the use of electronic health records. In 2013, 59 percent of hospitals and 48 percent of physicians had at least a basic EHR system, a respective increase of 47 percentage points and 26 percentage points since 2009, when CMS was authorized to provide financial incentives for the adoption and meaningful use of EHRs. Other barriers to telemedicine will likely diminish once reimbursement is expanded. Until then, widespread adoption and use of telemedicine will remain the way of the future. Laura Fryan is an attorney with the full-service corporate law firm of Brouse McDowell in Akron, Ohio. Her practice focuses on health care. ■ ++++++++++++++++++++ +++ + +++ + ++++++++++++++++++++ ❮ TELEMEDICINE in Everyday Practice By Laura F. Fryan Telemedicine and Barriers to Implementation 2 0 1 5 J U LY/AU G U S T ■ M D N E W S . CO M ■ MD NEWS Cleveland/Akron/Canton | 3 3