BackgroundDespite increasing practice of teledermatology in the U.S., teledermatology practice models and real-world challenges are rarely studied.MethodsThe primary objective was to examine teledermatology practice models and shared challenges among teledermatologists in California, focusing on practice operations, reimbursement considerations, barriers to sustainability, and incentives. We conducted in-depth interviews with teledermatologists that practiced store-and-forward or live-interactive teledermatology from January 1, 2007 through March 30, 2011 in California.ResultsSeventeen teledermatologists from academia, private practice, health maintenance organizations, and county settings participated in the study. Among them, 76% practiced store-and-forward only, 6% practiced live-interactive only, and 18% practiced both modalities. Only 29% received structured training in teledermatology. The average number of years practicing teledermatology was 4.29 years (SD±2.81). Approximately 47% of teledermatologists served at least one Federally Qualified Health Center. Over 75% of patients seen via teledermatology were at or below 200% federal poverty level and usually lived in rural regions without dermatologist access. Practice challenges were identified in the following areas. Teledermatologists faced delays in reimbursements and non-reimbursement of teledermatology services. The primary reason for operational inefficiency was poor image quality and/or inadequate history. Costly and inefficient software platforms and lack of communication with referring providers also presented barriers.ConclusionTeledermatology enables underserved populations to access specialty care. Improvements in reimbursement mechanisms, efficient technology platforms, communication with referring providers, and teledermatology training are necessary to support sustainable practices.
Understanding the referring provider's perspective and subsequently adopting policy and practice solutions to address their challenges are vital to prompting further teledermatology participation for underserved communities.
The Center for Connected Health Policy conducted a scan of current state policy affecting occupational therapy (OT) and physical therapy (PT) practice, supervision, and additional requirements for using telehealth. While most states have established telehealth policies for other health care professions, this 50-state scan shows that many states made some reference to telehealth practice for OT (37 states) and PT (40 states). The states that adopted these policies also tended to adopt them in either law or regulation, but not both, and showed no discernable patterns favoring either. Additionally, eight states included OT and PT within telehealth laws that concurrently apply to multiple health professions. More commonly, states enacted policy within laws or regulations specific to OT and PT. Most policies including limitations on telehealth practice for OT and PT did not appear to create requirements that are more restrictive than what is generally seen in telehealth across all states.
This study conducted a scan of telehealth occupational therapy and physical therapy state laws and regulations. The laws and regulations were analyzed to determine the potential effect they could have on occupational therapists’ and physical therapists’ utilization of telehealth. The results indicate that the majority of occupational therapy and physical therapy boards are silent on telehealth. A handful of physical therapy laws and regulations address “consultation by means of telecommunication,” but do not provide any guidance for practitioners seeking to provide direct telehealth-delivered services to patients. Of the few states that do provide guidance, policy had the potential to provide clarity or inhibit adoption. The findings suggest that as state boards consider crafting telehealth regulations, they should do so in a manner that facilitates, rather than hampers adoption, while upholding their providers to a high standard of care.
Background and Purpose: Using video-based directly observed therapy (VDOT) to remotely monitor tuberculosis (TB) patients’ treatment is now a viable option due to the advancement and expansion of technology. This study determined the utilization levels, benefits, barriers, and outcomes of California public health departments using VDOT to treat TB. Methods: Interviews (n=7) with pilot site staff in California and a survey (n=56) were used for data collection. In 2015 the survey was disseminated to attendees of the California Tuberculosis Control Association annual conference. Results: Almost 27 percent (n=15) of survey respondents were using VDOT. Reported benefits were high and centered on patient and provider satisfaction, cost savings, and staff safety. The highest concern was reimbursement, specifically that California’s Medicaid program, Medi-Cal, reimburses for in-person DOT but not VDOT. Conclusion: VDOT is a practical and effective option for providing DOT as it has many benefits with minimal concerns. Reimbursement equal to that of in-person DOT and the continued technological improvements should alleviate the existing hindrances that are currently preventing many health departments from implementing VDOT or expanding their existing program. Satisfaction is high, outcomes are positive, and VDOT is cost effective so efforts should be made to break down the barriers to expansion.
Telehealth is progressively being considered as a possible approach for delivering more efficient healthcare and addressing access issues. Since the establishment of the Affordable Care Act (ACA), new reform-based programs and initiatives often focus around the three goals of the “Triple Aim”: (a) improving population health, (b) enhancing the patient care experience, and (c) reducing per capita costs. As telehealth adoption and utilization within health systems is expected to increase, the Health Resources and Services Administration (HRSA) has shown initiative by investing in programs that help facilitate the growth of telehealth by providing non-partisan, unbiased information and technical assistance. One such program is the telehealth resource centers (TRCs). TRCs are funded to increase the use, efficiency, and raise awareness about telehealth through education and training. This article provides an overview of the services offered by twelve regional TRCs, as well as the National Telehealth Technology Assessment Center (TTAC) and the National Telehealth Policy Resource Center (NTRC-P). It also provides suggestions about what more can be done by the federal government to maximize telehealth's potential to address the needs of a strapped health system.
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