Navigating Telemedicine Challenges: Exams, Rules, Reimbursement, Tech

Although, telemedicine has proven a great tool for the health promotion in recent healthcare system, there are some limitations to it such as the absence of the physical examination; varying state practice and licensing regulations; reimbursement policies and limited technological knowledge-base.

Limitation in physical examination

Although, telemedicine can be very effective for many minor conditions, physicians may not feel comfortable conducting an examination over video chat. The review study conducted by Pathipati, Azad, and Jethwani (2016) indicates that for some telemedicine doctors, a virtual appointment may not seem enough to diagnose or treat a patient.

Often, it is difficult to remotely carry out a physical exam in detecting a complex health care problem. For example, a patient's self-reported blood pressure from home may differ from what has been measured in a clinic. Some patients may also see this as a reason to choose in-person visit over virtual appointments. Also, if a patient receives telemedicine from one provider, but chooses another provider for his/her next visit, then the second provider may not have all the information needed to diagnose the patient's problem.

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Thus, failure to coordinate the care may result in deficiency in quality of care and/or medical malpractice issues.

State practice/ licensing regulations

Another concerning issue regarding telemedicine is that the regulations vary from state-to-state and can be hard to interpret. Some physicians may not want to endure the trouble of figuring out what is needed to meet the telemedicine guidelines in their state. Additionally, physicians may worry that patient privacy may not be adequately protected via this medium.

Dowell (2019) states in his article, "Although the Health Insurance Portability and Accountability Act (HIPAA) security rule requires covered entities to implement technical safeguards to protect against unauthorized access to protected health information (PHI), some telemedicine tools fall in a grey area of security "(Dowell, 2019, p. 9). Moreover, issues in the E-Health industry, like a lack of interoperability in electronic medical records (EMR) systems can sometimes further complicate the use of telemedicine. Some practitioners are reluctant to use telemedicine when it seems that industry is constantly changing.

Reimbursement policies

In addition to state regulations, many legal issues are also raised by the practice of telemedicine, particularly the impact of fraud and abuse laws. Dowell (2019) stressed that licensure is important because reimbursements can result in false claims if the telemedicine provider is not licensed appropriately. Traditionally, at least one initial in-person encounter between a patient and provider is required to be eligible for reimbursement. Many payor reimbursement schemes do not permit a provider to establish a new physician-patient relationship via telemedicine. Likewise, according to Center for Medicare and Medicaid Services ([CMMS], 2015), Medicare limits telemedicine reimbursement to select live video encounters with the patient at a clinic or facility in a rural area. Furthermore, most state Medicaid programs require the telemedicine provider to be available for follow-up care to ensure the continuity of care, and identification of telemedicine patients in an unlikely event (Mehrotra et al., 2016).

Telemedicine equipment and technology

Telemedicine coordinates many remote health services, including chronic patient monitoring, appointments, and post-operative care management. All these services run on software and hardware which can be costly and requires additional purchase of equipment, recruitments of technological staff and their training. Also, with the use of any technology, technical glitches do come up. In support of this finding, Pathipati, Azad, and Jethwani (2016) argues that technological limitations may cause some disparity in data quality between clinic and remote visits. If problems arise during a virtual visit, the communication halts and can result in poor coordination. In addition, some physicians may not have a computer-literate patient base as well as some medical providers themselves lack the proper training. Therefore, nowadays medical schools are learning to include telemedicine competencies into the undergraduate medical education of future physicians so that they can more effectively leverage telemedicine technologies for improving the quality of care (Waseh & Dicker, 2019).