Indiana Medicaid pays for teleconsultations

Indiana's Medicaid program as of May 1 began reimbursing physicians for telemedical consultations in which primary care physicians and their patients remotely access the services of specialists located hundreds of miles away via videoconferencing.

While almost every state reimburses for telemedicine services such as teleradiology in which doctors don't "see" patients directly, only half, including Indiana, pay for telemedicine services in which doctors use a real-time video connection, said Jonathan D. Linkous, executive director of the Washington-based American Telemedicine Assn.

The AMA's policy is that physicians should uniformly be compensated a fair fee for their professional services whether the consultation is rendered by telephone, fax, electronic mail or other form of communication.

Under the Indiana program, referring physicians will be paid a flat administrative fee of up to $21.86 while specialists will be paid the same fee as if they had seen a patient in person, said Marc Sirkin, deputy communications director at the Indiana Family and Social Services Administration, which oversees the state's Medicaid program. That means the level of physician reimbursement will vary according to the services they perform, Sirkin said.

A key reason the agency is reimbursing for telemedicine is to encourage more insurers to cover the service. It also wanted to encourage wider use of telemedicine to improve access to care for residents in rural areas, which often have a shortage of specialists, Sirkin said.

"It's to enable people who would not otherwise have access to specialists greater access without them having to drive 100 miles to the nearest city," he said.

Kevin Burke, MD, an internist and president of the Indiana State Medical Assn., praised the state's decision because telemedicine is "a reasonable way to provide care" to rural as well as homebound patients.

"This mode of health care delivery in select cases, I think, is advantageous and useful. Therefore it should be a service that should be reimbursed," Dr. Burke said. Still, he said, doctors should be careful not to overuse telemedical consultations in lieu of examining patients in person because doctors could potentially miss something they likely would have spotted during an in-person examination.

"When I meet a patient, all my senses are attuned to the condition of the patient, and if you're doing this through telemedicine ... [your] ability to fully appreciate the condition of the individual [might diminish]," Dr. Burke said.

"I'd say that over the last five years, there's a general trend toward state approval of reimbursement for telemedicine under Medicaid," Linkous said. Nearly every state pays for telemedicine, though the types of services covered vary from state to state, he said.

The Centers for Medicare & Medicaid Services' policy is to pay for real-time telemedicine if a patient is located in a nonmetropolitan area. And at least one private insurer in every state covers real-time telemedicine, Linkous said.

Reimbursement along with better and more affordable technologies have helped raise the level of telemedicine activity, he said. Approximately 3,500 sites are linked to 200 telemedicine networks around the country, he added. Despite that progress, however, reimbursement -- and interstate physician licensure -- still remain the biggest barriers to widespread adoption of telemedicine, Linkous said.