Easing the process

Hospitals and their advocacy groups were relieved last week by the announcement of a proposed change to CMS’ telemedicine credentialing rule.

If implemented, the rule would address concerns that, in order to remain eligible for reimbursement, hospitals would soon be required to independently credential and privilege each physician providing telemedicine services to their facilities. The CMS has proposed instead allowing hospitals to accept the credentialing and privileging decisions of the distant-site facilities providing the telemedicine services.

This is “a step in the right direction, and it signifies a jump in understanding and recognition of the importance of telemedicine,” said Jonathan Linkous, CEO of the American Telemedicine Association.

The proposed rule was released for comment just weeks before the July 15 implementation date of a provision in the 2008 Medicare Improvements for Patients and Providers Act that will terminate Congress and CMS’ long-standing automatic recognition of the Joint Commission’s hospital accreditation program for deeming purposes.

Under current law, hospitals with Joint Commission accreditation are automatically deemed eligible for Medicare reimbursement. The new law will require the Joint Commission to periodically secure CMS approval of its standards in order to confer Medicare-deemed status onto hospitals. Those standards must match or exceed Medicare’s conditions of participation.

But a review of the two organizations’ credentialing policies unearthed a significant discrepancy that threatens to pile mountains of duplicative physician-credentialing activity onto hospitals and stall the growing use of a much needed care-delivery tool.

“In going through the standards, it became apparent that the CMS’ conditions of participation would require each hospital to credential every doctor who supplied telemedicine services,” said Nancy Foster, vice president of quality and patient safety policy for the American Hospital Association. The Joint Commission’s standards already allow hospitals to accept the physician credentialing and privileging decisions of distant-site hospitals they contract with to provide services. The proposed CMS rule would adopt a similar policy.

Don Kelso, executive director of the Indiana Rural Health Association, said the move would be particularly helpful to small and rural hospitals, which rely on telemedicine for specialty and imaging-consultation services. “It makes the use of telemedicine a lot easier and less expensive because a small hospital just doesn’t have the resources to go through all the credentialing, which is a laborious process.”

Kelso and other experts couldn’t point to data tracking the growing use of telemedicine services. But all said usage has grown significantly over the past two years, with the CMS and other payers now offering reimbursement for the services; meanwhile, the cost of equipment has been declining.

While the proposed CMS rule would relieve providers of an unnecessary administrative burden, hospitals still would be required to take several steps to ensure that physicians providing telemedicine services are properly credentialed. The rule would stipulate that the agreement between two hospitals specifies that the distant-site facility is responsible for meeting the credentialing requirements.

The proposed rule would also require that a distant-site hospital be a Medicare-participating provider; that the doctors being offered to provide telemedicine services have privileges at the distant-site facility; and that the doctors are licensed in the state where the distant-site hospital is located.