Telemedicine

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Physician: Medicine and the Unsuspected Battle for Human Freedom Richard Leviton See book keywords and concepts

It's called telemedicine or whimsically, the "300-mile stethoscope." The idea is that doctors can examine patients using closed-circuit two-way televisions, interactive video hookups, electronic stethoscopes, long-distance x-ray transmissions. The new house call is made by the doctor's electronic double, a cybernetic Dop-pelgdnger. According to one supporter of the approach, telemedicine is "the perfect use of the technology" because patients "get the same kind of care they'd get if they were sitting next to me"—minimal, disinterested, technologized.

Oxymorons: The Myth of a U.S. Health Care System J.D. Kleinke See book keywords and concepts

Small wonder HCFA and the health insurers have not rushed to figure out a way to regulate and pay for the bulk of telemedicine services. By contrast, HCFA and the managed care industry might be happy to figure out a way to reimburse e-visits; unlike telemedicine, e-visits may prove to reduce total costs. This, of course, is exactly why physicians, then, will not embrace them as alternatives. Until reimbursement to physicians for providing an e-visit is worked out, they will continue to regard such alternatives warily, as yet another threat to their income.

Physician: Medicine and the Unsuspected Battle for Human Freedom Richard Leviton See book keywords and concepts

According to one supporter of the approach, telemedicine is "the perfect use of the technology" because patients "get the same kind of care they'd get if they were sitting next to me"—minimal, disinterested, technologized. If the doctor has any intangible healing presence (once called, pejoratively, the placebo effect), it is now conveyed by pixels and bytes and mediated by a mechanical (Ahrimanic) contrivance. • Molecular engines. To its supporters, nanotechnology is the ultimate in the technological conquest of nature.

Oxymorons: The Myth of a U.S. Health Care System J.D. Kleinke See book keywords and concepts

Notwithstanding the ambitions and representations of dozens of health care Internet entrepreneurs, Web-based processing of medical claims will never occur in several states that still have "quill-and-pen" laws requiring that various medical claims forms be submitted on paper (Havighurst, 2000). telemedicine services cannot be delivered in several other states, thanks to archaic state reimbursement rules that require physical contact between physician and patient, even though "many consultations could be done effectively over the Internet" (Bentivoglio, 2000, p. 76).

Our pursuit of these goals as an industry has generated a long and wearying list of IT's boldest promises and most spectacular failures: the smart card, Community Health Information Networks (CHINs), telemedicine, the Electronic Medical Record (EMR), client-server "enterprisewide" systems, and in the mid-1990s, the clinical data warehouse (Starr, 1997; Kleinke, 1998c). Then came the Internet, billed as nothing less than the next panacea for what ails the U.S. health care system.

If we believe that either of these new services will displace, rather than add new costs to the health care system, we should look at the realities of medical practice and the sad fate of telemedicine over the past decade. Many have argued that e-visits between physicians and patients have the potential to preclude some office visits entirely. The key issue associated with the supplanting of office visits by e-mail is not privacy, as many have argued.

By contrast, HCFA and the managed care industry might be happy to figure out a way to reimburse e-visits; unlike telemedicine, e-visits may prove to reduce total costs. This, of course, is exactly why physicians, then, will not embrace them as alternatives. Until reimbursement to physicians for providing an e-visit is worked out, they will continue to regard such alternatives warily, as yet another threat to their income.

But that doctrine is downright useless when applied to a health care system that sprawls across borders, uses telemedicine technologies to treat patients, wants to use the Internet to conduct much of its business, and long ago adopted national clinical standards for liability.

Making Them Pay: How to Get the Most from Health Insurance and Managed Care Rhonda D. Orin See book keywords and concepts

No contract may exclude a service from coverage solely because the service was provided through telemedicine rather than face-to-face contact (Sec. 21.53F). Offer of coverage for loss of speech and hearing (Sec. 3.70-2 (G). Special dietary products for those suffering from hereditary metabolic disease (Sec. 31A-22-623). Offer of coverage for treatment of alcohol or drug dependency (Sec. 31A-22-715). Mental health coverage (Sees. 31A-22-625; 31A-22-720). Dietary products used for treatment of inborn error of amino acid or urea cycle metabolism (Sec. 31A-22-623). Diabetes (Sec. 31A-22-626).

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