Telemedicine Delivery and Successful Reimbursement in Toxicology

Hospital-Level Implementation Barriers, Facilitators, and Willingness to Use a New Regional Disaster Teleconsultation System: Cross-Sectional Survey Study

BACKGROUND

The Region 1 Disaster Health Response System project is developing new telehealth capabilities to provide rapid, temporary access to clinical experts across US jurisdictions to support regional disaster health response.

OBJECTIVE

To guide future implementation, we identified hospital-level barriers, facilitators, and willingness to use a novel regional peer-to-peer disaster teleconsultation system for disaster health response.

METHODS

We used the National Emergency Department Inventory-USA database to identify all 189 hospital-based and freestanding emergency departments (EDs) in New England states. We digitally or telephonically surveyed emergency managers regarding notification systems used for large-scale no-notice emergency events, access to consultants in 6 disaster-relevant specialties, disaster credentialing requirements before system use, reliability and redundancy of internet or cellular service, and willingness to use a disaster teleconsultation system. We examined state-wise hospital and ED disaster response capability.

RESULTS

Overall, 164 (87%) hospitals and EDs responded-126 (77%) completed telephone surveys. Most (n=148, 90%) receive emergency notifications from state-based systems. Forty (24%) hospitals and EDs lacked access to burn specialists; toxicologists, 30 (18%); radiation specialists, 25 (15%); and trauma specialists, 20 (12%). Among critical access hospitals (CAHs) or EDs with <10,000 annual visits (n=36), 92% received routine nondisaster telehealth services but lacked toxicologist (25%), burn (22%), and radiation (17%) specialist access. Most hospitals and EDs (n=115, 70%) require disaster credentialing of teleconsultants before system use. Among 113 hospitals and EDs with written disaster credentialing procedures, 28% expected completing disaster credentialing within 24 hours, and 55% within 25-72 hours, which varied by state. Most (n=154, 94%) reported adequate internet or cellular service for video-streaming; 81% maintained cellular service despite internet disruption. Fewer rural hospitals and EDs reported reliable internet or cellular service (19/22, 86% vs 135/142, 95%) and ability to maintain cellular service with internet disruption (11/19, 58% vs 113/135, 84%) than urban hospitals and EDs. Overall, 133 (81%) were somewhat or very likely to use a regional disaster teleconsultation system. Large-volume EDs (annual visits ≥40,000) were less likely to use the service than smaller ones; all CAHs and nearly all rural hospitals or freestanding EDs were likely to use disaster consultation services. Among hospitals and EDs somewhat or very unlikely to use the system (n=26), sufficient consultant access (69%) and reluctance to use new technology or systems (27%) were common barriers. Potential delays (19%), liability (19%), privacy (15%), and hospital information system security restrictions (15%) were infrequent concerns.

CONCLUSIONS

Most New England hospitals and EDs have access to state emergency notification systems, telecommunication infrastructure, and willingness to use a new regional disaster teleconsultation system. System developers should focus on ways to improve telecommunication redundancy in rural areas and use low-bandwidth technology to maintain service availability to CAHs and rural hospitals and EDs. Policies and procedures to accelerate and standardize disaster credentialing are needed for implementation across jurisdictions.

Methods of Reimbursement for Telemedicine Services: A Scoping Review

Background: With the advent of coronavirus-2019 (COVID-19), telemedicine services have played an essential role in reducing the transmission of this virus between patients and health care providers. Nevertheless, financial and reimbursement barriers are the biggest challenge in adopting these technologies. It seems necessary to determine the successful reimbursement methods in different countries. The purpose of this study was to identify methods of reimbursing telemedicine services.

Methods: A search without time limitation was conducted on the PubMed, Web of Science, and Scopus databases in December 2020 and updated in January 2022. Articles were identified using predefined inclusion and exclusion criteria. Two researchers independently evaluated the titles, abstracts, and full text of the articles.

Results: Out of 4946 identified articles, 28 articles were included. In these studies, the most used insurances were Medicare (n = 17), and Medicaid (n = 15). The majority of services included telepsychiatry (n = 7), telehealth (n = 7), and telemedicine (n = 7). There was no difference between the reimbursements in telemedicine services and face-to-face visits in 18 studies.

Conclusion: Various government, state, and private insurance reimbursed telemedicine services. In most studies, there was no difference between reimbursing telemedicine services and in-person visits. Differences in the type and number of reimbursements may be due to the year of publication of the articles, changes in covered service policies, and state laws. Because of the COVID-19 pandemic, it is crucial to develop and update the guidelines and regulations for telemedicine reimbursement. Future studies can examine the telemedicine reimbursement methods in developed and developing countries before and after the COVID-19 pandemic.