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devices, or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulations.”2
What is Telemedicine?
Telemedicine is a form of telehealth and refers to the more traditional clinical diagnosis and monitoring that is delivered by technology.1
telemedicine as “a form of telehealth which is the delivery of clinical health care services by means of real time two-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support healthcare delivery,
which facilitates the assessment, diagnosis, consultation, treatment, education, care management and self- management of a patient’s health care by a health care provider practicing within his or her scope of practice as would be practiced in-person with a patient, and legally allowed to practice in the state, while such patient is at an originating site and the health care provider is at a distant site.”2
There are four categories of telehealth modalities:1
Live video (synchronous real-time; eg. primary care to patient primary care professional to specialist, and professional education programs such as Project ECHO — Extension for Community Healthcare Outcomes,: http://echo.unm.edu/about-echo/; https:// www.weitzmaninstitute.org/about-chc-project-echo)
Store-and-forward (asynchronous; eg. pre-recorded videos, digital images such as x-rays or photos)
Remote patient monitoring (RPM) (eg. tracking of health care data via home care programs such as for congestive heart failure; hospital eICU programs)
Mobile health (mHelath) (eg. medical/behavioral health care and public health education through use of apps for cell phones and tablets)
Does insurance reimburse for telehealth/telemedicine in Delaware?
Important considerations regarding potential insurance reimbursement include:
Delaware’s telehealth legislation2 is parity legislation, ie. it regulates fully insured commercial health plans to allow for parity payment for telemedicine versus comparable in person visits. An
important caveat is that many employers in Delaware have self- insured group plans and, while they may opt in on a voluntary basis, they are not governed by state insurance laws.
and is therefore not eligible for Medicare telehealth reimbursement via the current CPT code rules (however other new care models may include Telehealth).
DE Medicaid does allow for telemedicine coverage RPM is not as yet reimbursed by most health plans
Are you aware of state licensing regulations?
In Delaware, licensure is required in the state where the patient is located.
You’re ready to begin the process of selecting a vendor
your practice.
You’ve developed a business case for your program.
You’re familiar with state regulations and licensure requirements.
In most all use cases,3 an organization/practice partners with a technology vendor.
The technology vendor either delivers the service such as in
an urgent care model with vendors ( eg. Teledoc, American Well, and others) contracting with a self-insured employer to administer illnesses, OR
The technology vendor creates a platform for the organization/ practice to deliver the service (e.g., for organizational integration of telehealth services including specialty consultation, primary care, behavioral health, mHealth, RPM). Some technology vendors are hybrids and do both. The following is focused on the organizational integration model of telehealth.
Considerations in beginning the vendor selection
process include:
Research vendors and other programs and talk to others who have experience with the technology and vendor that you are considering.
Utilize Delaware’s federal regional telehealth center’s free consultative services (“Request Technical Assistance” via website). Delaware is served by the Mid-Atlantic Telehealth Resource Center (MATRC).4
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Del Med J | July 2017 | Vol. 89 | No. 7
