Cath Lab Digest

T elehealth refers to the contact between a patient and a healthcare provider through electronic communications (ie, use of audio, video, and other telecommunications) to administer healthcare services at distant sites. This broad definition includes several means of transmission, including telephone and fax, interactive video, store-and-forward technology, electronic patient records, and emails. Nurses began to formally use the telephone to interact with patients as early as the 1970s.¹ Telehealth can be used to provide a number of services such as patient care and staff and patient education. While much attention has been paid to the technology itself, evaluation of the efficiency and effectiveness of telehealth applications has been limited.

Telehealth applications have the potential to improve access to healthcare and reduce costs.¹ The former has been consistently demonstrated in telehealth studies; however, few cost studies regarding nursing application of telehealth have been published. Most studies are cost minimization analyses, which compare the cost of at least two alternative interventions assumed to be equally effective — for example, the costs of an interactive video consultation compared to traditional face-to-face consultation.²

Telehealth systems vary greatly. The number and size of these projects is growing throughout the country but total integration of telehealth into the healthcare system is not without obstacles, including inconsistent reimbursement policies.³ The Balanced Budget Act of 1997 authorized partial Medicare (the federal health insurance for senior citizens) reimbursement for telehealth services. However, Medicare required the referring physician and the consulting physician to share teleconsultant fees, which was thought to be too restrictive.³ The Benefits Improvement and Protection Act of 2000 expanded the payment for telehealth services, eliminating the provider fee-sharing requirement and broadening telemedicine services, including payment for nurse practitioners at distant and originator sites.³

Unlike Medicare (which is nationally run and managed), most state Medicaid programs provide reimbursement for healthcare-related costs. A number of states collaborated with their individual state Medicaid programs to develop telehealth reimbursement policies in anticipation of transportation savings from telehealth. Currently, 27 state Medicaid programs offer at least some reimbursement for telehealth services.³

Private insurers tend to follow Medicare’s lead. Improved Medicare reimbursement is anticipated to pave the way for broader private payor reimbursement. Five states have enacted laws requiring reimbursement for services via telehealth if the same service is reimbursed in a clinic or office setting.³

Telehealth provides a viable alternative to “seeing” patients with chronic wounds in the long-term care setting because it can transfer audio and visual patient information from remote locations to health professionals with specialized wound knowledge and skill. In the case of chronic wound consultations, nurse experts can provide diagnostic and evaluative support to nurses caring for patients with chronic wounds in long-term care settings. In addition to improving chronic wound outcomes of individual patients, these consultations also provide an opportunity to enhance the wound care skills and knowledge of the remotely located nurse.