Telemedicine coverage now mandated in Virginia
■ The state is one of a dozen that require health plans to cover the virtual visits, but insurers say more guidelines are needed.
By Chris Silva — Posted April 19, 2010
Virginia Gov. Bob McDonnell has signed into law a bill that requires insurers to cover services provided through telemedicine.
With enactment of the legislation on April 5, Virginia becomes the 12th state to mandate that health plans cover telemedicine. Under the new statute, telemedicine services include the use of interactive audio, video or other electronic media used for the purpose of diagnosis, consultation or treatment.
It does not include services provided using an audio-only telephone, e-mail message or fax transmission. Continuing medical education and call center services are not required to be covered, either.
The enactment of the bill was supported by several physician organizations, including the Medical Society of Virginia, the American Heart Assn., the American College of Emergency Physicians and the Virginia Telehealth Network.
"With telemedicine, physicians in all areas of the state who have the technology will be able to consult with specialists, regardless of location or other circumstances, such as foul weather," said MSV President Daniel Carey, MD. "It is extremely beneficial in areas of the state which are underserved by certain specialties, such as ob-gyn, and also when transporting the patient is not an option."
The American Medical Association supports payment to physicians for any telemedicine services they provide.
Doctors get new options
Although physicians have criticized the federal government for moving too slowly in expanding telemedicine coverage, more states recently have started embracing the technology on their own.
Three states enacted legislation requiring insurers to cover telemedicine in 2009 alone, the most in one year since Louisiana became the first state to do so in 1995. And at least two more, Kansas and Ohio, have pending legislative proposals.
The American Telemedicine Assn. estimates that about 25 states are paying physicians for telemedicine services through Medicaid, and it expects all 50 states to be doing so within the next few years.
"It's always good when physicians are paid for their services," said ATA CEO Jon Linkous. "It allows them to open their practices in a different way and to different revenue streams. Telemedicine has the potential to open them to a whole new market."
Linkous, who testified last summer before a Virginia special advisory commission on health insurance, said telemedicine is well regarded for its three main impacts: increased access to care, improved quality and reduced costs.
Linkous said increased coverage in Virginia especially makes sense, because 10 telemedicine networks are already in place and are connected to more than 175 remote sites throughout the state. These networks survive on government grants as well as payments for the specialized services they provide for certain patients, he said. Veterans hospitals in Virginia use telemedicine, as does the state Dept. of Corrections.
In addition, hospitals often use teleradiology for diagnostic imaging, and it has proven particularly useful for patients in rural areas, Linkous said. "Radiologists aren't always available at three in the morning. These are benefits that will accrue for consumers right away."
While supportive of the concept of telemedicine, insurance companies in Virginia want more guidance on when physicians and patients should use the services, and when plans should be required to pay for it.
"Telemedicine is not appropriate for everything," said Doug Gray, executive director of the Virginia Assn. of Health Plans, based in Richmond. "There is no disagreement that an in-person visit is better than a telemedicine appointment, but that isn't always possible."
Sometimes a state mandate has been what's needed for health plans to embrace the potential of the technology, Linkous said. "Telemedicine for some is a new technology, and insurers tend to be a late adopter."
Some insurers expand coverage
Still, some insurance companies have been moving on their own to expand coverage for virtual visits and other remote care.
For example, while Arizona's telemedicine coverage has been largely due to the work of state lawmakers, North Dakota is one state that likely won't need to adopt legislation, because Blue Cross Blue Shield has been a leader in covering services in that state, Linkous said.
Supporters of the new law in Virginia said telemedicine will improve access for patients who don't have enough now.
"In many areas of Virginia, there is not the same access to medical care and expertise that we may find in our more populated regions," said state Sen. William Wampler. "Telemedicine brings that expertise to every community through the simple means of a laptop or telephone."
The issue of access despite geographic limitations will become even more crucial as the new health system reform law takes effect, physicians said.
"Telemedicine does gain additional importance in health reform as more patients are covered by insurance with increasing demands for access to specialty care," said Karen Rheuban, MD, medical director of the University of Virginia Office of Telemedicine.
"There remain serious specialty shortages in rural and urban communities," she said. "Telemedicine is one such tool to improve access and quality."
Dr. Rheuban, who is also president of the telemedicine association, said the legislation will also help boost care quality. "A proper diagnosis provided in a timely manner can all too often be the difference in a positive or negative outcome," she said. "Unfortunately, doctors cannot be everywhere, and for a long time geography proved to be one of the greatest impediments to proper care.
"Telemedicine utilizes our new technologies to ensure that patients in every community have access to the best possible care," she added.