The state of Maryland held several roundtables to discuss improving access to primary and specialty care in rural areas and how to implement the Maryland Rural Health Plan released by the State Office of Rural Health in 2007.
In 2009, it was decided to do a statewide inventory of current telehealth/telemedicine projects so that the state could move forward. The Maryland Rural Health Association (MRHA) was put in charge to administer the survey in cooperation with the Rural Maryland Council (RMC).
In 2010, the Upper Shore Regional Council and a member of the RMC’s Health Care Working Committee and the Telehealth Subcommittee received grant funding to do the telehealth/telemedicine survey. A roundtable discussion will be held December 6, 2010 to review the results.
However, in the meantime, a review draft or interim report based on the results gathered from the survey as of September 2010 was compiled and released. According to the draft Report, 95 facilities were surveyed. So far, four major conclusions can be drawn from the information and the comments received so far.
First of all, there is a need for reimbursements by state Medicaid and other third-party payers for telehealth/telemedicine services along with other funding streams to support the cost of buying, setting up and maintaining equipment plus funds are needed for related administrative costs.
Maryland is one of only 18 states that Medicaid does not reimburse for telemedicine services. Twenty six states have private payers reimbursing for telemedicine but Maryland is not one of them. Recently the Department of Health and Mental Hygiene (DHMH) approved regulations to allow Medicaid reimbursement for telemental services delivered in areas DHMH designate as underserved.
In addition, although federal funding for telemedicine has expanded in the last few years, Maryland has lagged behind other states in securing funds. For example, the USDA Distance Learning and Telemedicine program has not funded Maryland since 2003 when Sheppard Pratt received funding to start a telemental service.
The FCC Rural Healthcare Pilot Programs awarded 69 statewide or regional broadband telehealth networks in 43 states, but none in Maryland. Some projects have been funded to develop telemedicine/ telehealth projects, but have not been included in a coordinated statewide plan.
The survey reports that there is a lack of state leadership surrounding telehealth coordination. Services are not coordinated through any one agency or organization and so at the present time, multiple state and federal agencies are funding telehealth and telemedicine projects. As a result, the state continues to miss out on federal funding opportunities because of this lack of coordination. This also means that individual facilities have started projects on their own and indicate that they do not have an accurate inventory of the projects within their own systems.
Also, poor access to high speed broadband services in rural areas deprives some rural residents access to state-of-the-art medical care. In addition, with so many projects being started in isolation, there is a real risk that the technological infrastructure being developed and implemented in one facility will be incompatible with other facilities.
The University of Maryland, School of Law held a roundtable on the legal impediments to telemedicine in April 2010. The attendees looked at the legal questions that are still unresolved involving licensing and credentialing across state lines. The Law School has prepared a White Paper, “Legal Impediments to the Diffusion of Telemedicine” clearly laying out the conflicts and the questions that still remain.
For more information email Michelle Clark Executive Director of the MRHA at mrha@allconet.org. Go to www.rural.state.md.us/Publications/Interim_Telehealth_Report.pdf to download the Interim Report. For details on the “Maryland Telehealth Telemedicine Survey Roundtable” to be held December 6, 2010 in Annapolis Maryland go to www.rural.state.md.us/Roundtables/RRT10_Telehealth.htm. The School of Law’s White Paper is available on that site.
