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Big summer ahead in Idaho for rules on remote medical practice

William Hazle, a Boise psychiatrist, provides consultations to patients in rural areas through arrangements with Saint Alphonsus Regional Medical Center in Boise and Portneuf Medical Center in Pocatello.

William Hazle, a Boise psychiatrist, provides consultations to patients in rural areas through arrangements with Saint Alphonsus Regional Medical Center in Boise and Portneuf Medical Center in Pocatello.

Efforts to set up guidelines for remote medical services in Idaho are gathering momentum this summer, with the formation of a new state Telehealth Council in June and an important conference on telehealth planned in August.

Doctors, administrators, and regulators are trying to ensure patient safety, quality of care, and the privacy of health information as new technology enables physicians to consult with patients who are miles away.

As policymakers work to formalize telehealth, Idaho doctors are providing remote medical services around the state already. Some of them have been doing so for years.

“All my work is done through telemedicine,” said William Hazle, a Boise psychiatrist who provides consultations to patients in rural areas through arrangements with Saint Alphonsus Regional Medical Center in Boise and Portneuf Medical Center in Pocatello. Hazle said he carried out decades of face-to-face counseling before moving to Boise, where he started to consult remotely about seven years ago. Now, he often speaks over his laptop to rural Idaho patients who have never met with a specialist.

“I see patients who have had chronic mental illness all their lives, and they’ve been treated by primary care docs, physician assistants, and they’ve never seen a specialist, a psychiatrist,” said Hazle. “That happens fairly frequently.”

Telemedicine is a hot topic. Large for-profit companies such as the Dallas-based Teladoc – which entered Idaho in 2008 and then departed in February after an Idaho-licensed physician was sanctioned by the state Board of Medicine for prescribing over the phone – and sole practitioners like Hazle have come up with their own systems for practicing remote medicine. St. Luke’s Health System runs a widely acclaimed program that provides critical care support to rural hospitals. Now policymakers are trying to formalize the rules around the licensing and the technology.

On June 11, the American Medical Association came out with recommendations on telemedicine, a word often used synonymously with telehealth. The AMA said Medicare pays about $6 million each year for telemedicine services, and that 46 states, including Idaho, offer some form of Medicaid payment for telemedicine services.

Some private insurers offer payment as well. But the standards of care and the practice guidelines for telemedicine vary. The AMA’s rules prohibit patients “from providing any clinical services via telecommunications.” That rule, issued in 1994, will need to be updated in an environment where physicians consult or prescribe medicine from hundreds or thousands of miles away.

Physician William Hazle uses two computers when he's consulting with a patient remotely from his home office. One computer is to pull up patient medical records while the other is primarily for video conferencing. Photo by Glenn Landberg

Physician William Hazle uses two computers when he’s consulting with a patient remotely from his home office. One computer is to pull up patient medical records while the other is primarily for video conferencing. Photo by Glenn Landberg

Lynda Bennett, the coordinator of the Idaho task force, said Idaho has made rapid progress since Reps. Fred Wood, R-Burley, and John Rusche, D-Lewiston, both physicians, submitted a proposal to the Legislature for the formation of a state council on telemedicine. That passed in March.

The council’s mission is to set up standards and policies for the use of telehealth in Idaho. Rusche said the meetings this summer will probably result in some proposed legislation and some industry agreements.

The newly formed council will have its first meeting in late June or early July, said Nancy Kerr, a council member who is the executive director of the state Board of Medicine.

The Board of Medicine has a lot at stake in the discussions, but its goal, Kerr said, is relatively simple.

“Our board has held that the standard of care must be met regardless of the method of delivery,” she said. “The board’s whole function is patient protection.”

Jason Gorevic, the CEO of Teladoc, noted that in a very rural state like Idaho, telemedicine can help give some people access to care that they wouldn’t have otherwise. The Dallas-based Teladoc now operates in every state except Idaho, Gorevic said.

“As we’ve looked at the situation and the regulatory environment there, honestly the position the Board of Medicine has taken seems at odds with the access challenges in the state,” Gorevic said June 17. “We’ve very hopeful that the legislative process will run its course and come out with new legislation that is very favorable for telemedicine.”

A big job for the council and the task force will be coordinating the needs and preferences of long-time remote providers..

“As a task force, we’ve met with people all over the state, and there’s a lack of consensus about what types of tools and circumstances are appropriate use,” Bennett said. “People disagree about what kind of technology is appropriate, what kind of licensure should be required.”

The Aug. 20 Boise conference will gather experts and stakeholders from Idaho, Montana and Utah. Bennett is also trying to get a feel for how much telemedicine is going on already. She surveyed all 27 of the state’s critical access hospitals on the topic, but only received 13 surveys back from those generally rural hospitals – “and that’s where a lot of the telehealth happens,” she said.

One point of consensus is that telemedicine can save lives and money in Idaho, one of the most rural states in the nation. As for the personal touch that goes missing when consulting with a physician on a computer screen, Bennett said it’s ideal to have a provider and a patient in the same room.

“But our experience has been that those who had to drive four hours to get that personal touch are more than happy to do telehealth,” she said. “It hasn’t been a negative thing to the patients.”

An emerging force in healthcare

Like so many areas of medicine, telemedicine is big business with large sums of money at stake. Teladoc, which claims to be the largest and oldest telemedicine company in the United States, was founded in 2002 and now serves 7.5 million members in 49 states. CEO Jason Gorevic said Teladoc will carry out about 300,000 telemedicine visits this year.

Gorevic declined to release the company’s revenues but said business grew about 25 percent in 2010 and again in 2011, 75 percent in 2012 and 100 percent in 2013.

“This year we’ll be over 100 percent,” Gorevic said. “So while it is an emerging part of the health care system, it is growing at an extremely rapid rate now.”

Despite the legal limbo of telemedicine in Idaho, Idaho physicians are regularly invited to contract with telemedicine companies.

“We anticipate a significant increase in the volume of available telehealth consultations for our active network physicians,” a Florida company called TelMed emailed in June to one Idaho physician, inviting him to sign on. “As an active member of our network, you will be among a select group of physicians with the foresight to capitalize on this emerging trend.”

 

About Anne Wallace Allen

Anne Wallace Allen is the editor of the Idaho Business Review.