Sunday, January 23, 2011

TH/TM Issues in the State

In 2010, the state of Maryland conducted a statewide inventory of current projects to better understand the present state of telehealth/telemedicine (THTM) projects. This information was needed before the state could move forward with a consortium to deliver services, develop a compatible infrastructure, address key issues, use technology more widely, and potentially be able to apply for increased funding.

In 2010, the Upper Shore Regional Council obtained a grant to fund the survey through the Maryland Agriculture Education and Rural Development Assistance Fund and sub-contracted with the Maryland Rural Health Association to administer the survey.

The THTM Survey targeted 95 facilities including hospitals, FQHC’s, departments within the University of Maryland Medical System, JHU Health System, and MedStar Health, as well as local health departments, state correctional institutions, and projects within the Maryland Department of Health and Mental Hygiene. The survey respondents included 30 facilities representing 53 different THTM clinical sites. However, 12 of the 95 facilities reported having no involvement in THTM.

The response rate was lower than anticipated but the survey found that THTM projects were more plentiful but it was also found that the THTM programs were far more fragmented than expected. The survey also found that the four barriers to telehealth implementation included reimbursement and other funding issues, lack of coordination and leadership, lack of broadband in areas, and legal barriers still exist that relate to licensing and credentialing providers especially across state lines.

On December 8, 2010, the Rural Maryland Council hosted a roundtable in partnership with the Maryland Rural Health Association and Upper Shore Regional Council to review the results of the THTM survey and discuss recommended potential next steps to try to eliminate the barriers.

Potential steps and ideas included:

• Monitoring the impact of any proposed legislation related to THTM reimbursement during the 2011 legislative session
• Monitoring CMS response to the proposed THTM reimbursement regulations for telemental services and if approved monitor the cost to implement
• Advocating for broader implementation of THTM reimbursement outside of the public health setting
• Not pitting rural and urban providers against each other in the reimbursement arena
• Educating doctors about THTM to reduce a sense of competition for reimbursement dollars

The state also realizes that THTM does not having the appropriate state leadership and coordination to deal with the issues. To remedy this situation, the state plans to create a statewide telehealth network, establish a statewide coordinating boy, coordinate activities with the Health Care Reform Coordinating Council’s Telemedicine Task Force, and advocate for better telehealth training and education.

The state also needs to address the poor access to high speed broadband services available in rural areas. The goal is to support the expansion of the state’s high speed internet highway, consider incentivizing last mile providers to provide service to private practices and to the homes of physicians living in areas with no high speed broadband, encourage local ISPs in rural and underserved areas to improve service, and monitor the environmental assessment process.

The state realizes that it is necessary to deal licensing and credentialing that is especially important to providers across state lines. The recommended thought is to continue to communicate with the University of Maryland Law School as the School continues to study the issue, work with stakeholders and practitioners on recommendations, educate and inform legislators on the issues, provide medical services to underserved areas in surrounding states via THTM, and develop mutual credentialing and licensing procedures as part of that strategy.

A draft of the Final Report of the “December 2010 Maryland THTM Roundtable” was prepared January 2011. To view the report, go to