Telehealth: An Overview for Trustees


Telehealth connects patients to vital health care services though videoconferencing, remote monitoring, electronic consults and wireless communications. By increasing access to physicians and specialists, telehealth can help ensure patients receive the right care, at the right place, at the right time.

Currently, more than half of U.S. hospitals connect with patients and consulting practitioners at a distance through the use of video and other technology. Almost every state Medicaid program has some form of coverage for telehealth services and private payers are embracing coverage for telehealth services. However, there are barriers to wide adoption of telehealth. For example, Medicare limits coverage and payment for telehealth services, lagging behind other payers. In addition, limited access to adequate broadband services hampers the ability of some rural facilities to deploy telehealth. The challenge of cross-state licensure looms as a major issue. Other policy and operational issues include credentialing and privileging; online prescribing; privacy and security; and fraud and abuse. These issues are discussed in more detail below.

Limited Medicare coverage impedes the expansion of telehealth services. Current statute restricts telehealth services to patients located in rural areas and in specific settings (such as a hospital or physician office), covers only a limited number of services, and allows only real-time, two-way video conference capabilities. Changes needed include: eliminating geographic and setting locations requirements so patients outside of rural areas can benefit from telehealth; expanding the types of technology that can be used, including remote monitoring; and covering all services that are safe to provide, rather than a small list of approved services.

Significant federal and state legal and regulatory issues will determine whether and how providers can offer specific telehealth services. In general, the provision of telehealth services requires compliance with an array of federal and state rules. Legal and regulatory challenges abound in the following areas:

  • Coverage and payment;
  • Health professional licensure;
  • Credentialing and privileging; 
  • Online prescribing;
  • Medical malpractice and professional liability insurance;
  • Privacy and security; and
  • Fraud and abuse.

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