Over a year ago, in a short profile that BusinessNH Magazine published of me, the editor asked what I thought were some exciting trends in healthcare. My response was that telemedicine offered new opportunities. I still believe that, and I think that more than ever now, if only because we collectively have become used to instant communication, instant feedback, and instant replies to questions we have. I don’t see this trend lessening anytime soon. Moreover, given the ubiquity of our devices, our growing dependence/reliance on the internet, and, crucially, society’s emerging “lack of allegiance and loyalty to brands and organizations” (for lack of better words), it stands to reason that many will consider consultations, and even diagnoses, provided via smartphones and lap-tops a consumer and patient “expectation” ( if not a “right”) that needs to be met. This will be true whether the telemedicine provided is monitoring (as in heart rate monitors), synchronous (real-time, as in face-time consults), or asynchronous (store-and-forward – as in digital images).
As with all things in healthcare, of course, reimbursement is a major issue, and it will determine the pace of adoption of telemedicine as a whole. The compensation arrangements and structures between physicians and hospitals require adherence to certain fundamental standards, such as the Stark law’s and the Anti-kickback statute’s requirements of fair market value. In determining FMV payments, providers should examine the level of involvement of the physician and the detail of the tasks that the physician must undertake to provide the services. Some have equated such an analysis to determinations concerning on-call coverage (see, e.g. Ben Ulrich, in The Health Lawyer, ABA, June 2016), which is a reasonable step. Indeed, Ulrich rightly points out that the OIG has issued Advisory Opinions concerning the determination of FMV for on-call coverage and that these “burden of coverage factors” can be used to examine compensation arrangements for telemedicine services between providers.