THE OFFICIAL NEWS SOURCE OF ACR CONVERGENCE 2022 • NOVEMBER 10-14



Telehealth provides easier access, but not without jumping through a few hoops

Christine Peoples, MD
Christine Peoples, MD

There is increasing demand from patients and health care systems for access to specialists through telemedicine. With workforce estimates predicting a shortage of 2,500 rheumatologists by 2025, according to data published in Arthritis & Rheumatology, and a recent ACR workforce analysis highlighting a lack of rheumatology care in rural areas, the need for telehealth access may be greater than ever. 


Rheumatology has started to embrace opportunities for delivering telemedicine to patients in need. A Clinical Practice session on Wednesday will review reimbursement and financial models, implementation, client engagement, insurance, and regulations surrounding telehealth. The session, Reimbursement in Telehealth, will be held from 11:00 am – 12:00 pm in Room B308, Building B of the Georgia World Congress Center. 


In order to give a sense of how telehealth in rheumatology works, Christine Peoples, MD, of University of Pittsburgh Medical Center, PA, will open the session with an overview of the functioning telerheumatology program at the University of Pittsburgh Medical Center. In existence for more than six years, UPMC’s telerheumatology program can provide ample examples of how best to set up a telerheumatology program, the type of patients that can benefit most from this type of program, and how to address benefits and challenges of delivering care in this manner. 


Dr. Peoples’ presentation will also discuss the investment of setting up a telerheumatology program by both the specialist’s institution and the teleconsult center location. 


“It takes an elevated level of enthusiasm and commitment to make a telerheumatology program succeed,” Dr. Peoples emphasized. “It is important to establish what I call a ‘computer-side manner’ during telerheumatology visits when we are treating a patient but are not there physically with the patient.” 


Daniel Albert, MD
Daniel Albert, MD

Daniel Albert, MD, of the Dartmouth-Hitchcock Medical Center, NH, will discuss the technical, regulatory, and legal standards required for telehealth. 


“In theory, telemedicine could be done using something simple, like Facetime, or another video conferencing system,” Dr. Albert said. “In fact though, it can be fairly complicated for regulatory reasons.” 


The current regulatory climate for telehealth requires a HIPAA-compliant video conferencing system, with limited portability. 


Another hindrance to telemedicine is state-by-state variations for medical licensure, and limitations on physicians’ ability to prescribe controlled substances. 


“Some states cooperate with each other with regard to licensure, but many states don’t,” Dr. Albert said. It took Dr. Albert more than six months to gain licensure in neighboring Vermont to treat a patient remotely. 


Clinicians delivering telemedicine to another facility must obtain clinical privileges to practice at that facility and will be required to establish a legal contract with the facility. 


Different constraints on the practice of telehealth also exist in the form of insurance coverage. 


“Some insurance companies are all on board with this system because they feel like it is saving money and improves access,” Dr. Albert explained. “Other carriers, though, will not cover telemedicine, and Medicaid’s coverage is variable from state to state.”


Reimbursement rules for telehealth are based on the location of the patient, not the provider. That means if the provider is in a different state, Medicare must be billed through the MAC in the provider location. Additionally, there is frequently not payment parity from state to state, meaning that a payor may reimburse physicians at a lower rate than they are accustomed. 


During his presentation, Dr. Albert will outline additional regulatory aspects of telehealth with regard to documentation and billing, as well as prescribing.