Telemedicine: follow the money modalities.

Until the late 1990s,e private and public third-party payers generally did not have explicit policies to pay for telehealth services. The Balanced Budget Act of 1997 signaled a significant change in Medicare payment policies opening the door for telemedicine reimbursement. This article traces the development of current Medicare telemedicine payment policies, beginning with the BBA of 1997 and including current medicare payment legislation. Issues related to telemedicine payment by both Medicare and other third party payers are presented; implication for the future, and the role of the nursing community are discussed.

Program activity in the second year of the Rural Telemedicine Grant Program Part 2.

Part 1, in our last issue, detailed the activity levels, number and types of consults, and transmission costs of the 13 telemedicine networks funded in 1994 by the Office of Rural Health Policy's Rural Telemedicine Grant Program. This concluding section presents the authors' conclusions drawn from the objective data in Part 1.

Rural telemedicine: a national snapshot.

OBJECTIVES: To estimate the use of telemedicine in rural hospitals in the U.S. and to identify and describe those rural hospitals that are active in telemedicine. MATERIALS AND METHODS: Nationwide mailed survey, with telephone follow-up, to all hospitals not located in a Metropolitan Statistical Area. RESULTS: The overall response rate was 95% of all rural hospitals. Of these, 416 (17.55%) reported having telemedicine, and more than 530 more have plans to begin telemedicine programs during the next few years. Rural hospitals of all sizes and in all regions of the country are initiating telemedicine programs, but there is significant variation by region. Specifically, hospitals located in more populous rural counties near metropolitan areas are less likely to have telemedicine than are hospitals located in less populous rural counties in more remote areas. Conservatively, more than 4000 teleconsults per month are estimated among rural hospitals nationwide in 1995, including all forms of telemedicine. CONCLUSIONS: Telemedicine is becoming an important means of providing specialty medical services in rural areas. This screening survey generated information about the extent of telemedicine use in rural communities, but it also raised many new questions. These questions are being pursued through a detailed follow-up survey.

Telemedicine infrastructure development.

While there are significant technical and regulatory barriers to developing an adequate infrastructure for telemedicine, even more fundamental organizational and financial infrastructure issues must be addressed if this technology is to realize its potential. The lack of good evaluative data on telemedicine consultations has been a further major stumbling block to its acceptance by both practitioners and policy-makers. This paper discusses these issues and suggests approaches for overcoming many of the impediments to telemedicine.

Opportunities and challenges to telemedicine in rural America.

Rural communities have chronically suffered from a lack of adequate health care resources. Too few primary care practitioners and the need to travel long distances for specialty care have made it difficult for many rural residents to receive the care they need when they need it. Telemedicine provides one tool for improving this situation. As is often the case, however, telemedicine's potential has not been realized in rural America. Significant technical, regulatory, organizational, and financial barriers have prevented rural communities from benefiting from the technology. This paper discusses these issues and suggests a prescription for establishing successful rural telemedicine programs.