Reimbursement Challenges And Alternatives For Renewable Funding For Telemedicine Programs

Third-party payers seldom recognize services that are rendered by means other than face-to-face patient care. The Rural Telehealth Act does not recognize service needs based on lack of specialty care providers for each region. Most telemedicine programs started as funded research or with unrestricted sponsored grants; few have attracted ongoing payment for these services (Table 2).

The practice of contractually based services is a solution that is gaining acceptance. Our medical center group, in conjunction with a member of our telemedicine network, agreed to develop a contract for services (21). Legal, financial, administrative, clinical, technical support, and medical practice compliance representatives from each institution comprised our contract development team. Critical components of the contract were defined, by committee consensus of the issues related to this care model, as follows: relationship of the parties, professional and hospital services, patient consent and confidentiality, insurance and definitions of liabilities, and billing and compensation. Professional fees were based on current medicare consultation reimbursement.

The contract defined terms and duties specific to the referring hospital and consultant's hospital. Duties of the referring hospital included accessing the specialty stroke service, obtaining consent from the patient to transmit audio-video recording for their care, providing staff responsibilities during the remote stroke consultation, making available medication and clinical services, and planning for emergency department after care. Duties specific to the consultants included details about appropriate times for response to a referring provider, hours of coverage, protocol development, and educational services provided.

A separate contract was developed for the technology portion of the service, and terms for equipment costs, linkage line fees, technology expertise, maintenance, and hours of technology support were defined.

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