Part 2 of a 2-part series on telemedicine and telenursing
Telemedicine, especially as applied to home health care, is largely a nursing occupation. Studies have shown that appropriate uses of telenursing can increase both nurses’ productivity and satisfaction, while improving the patient’s access to care. Telemedicine has also been shown to lower health care costs while maintaining or improving quality.
The arguments for advancing the state of telemedicine are compelling. Yet many nursing leaders have limited knowledge of the current state of telemedicine or existing telemedicine applications like remote patient monitoring. As telemedicine becomes an increasingly valuable tool, it’s important for nurse leaders to not only be aware of its emerging roles, but to consider it as a viable option for delivering care.
Nurses play a key role in telemedicine systems. They have coordinated telenursing programs and been at the forefront of preventive services ever since the earliest days of “ask a nurse” telephone lines. Now, nursing should also have a strong voice in shaping telemedicine policy, and they should be part of the discussion when legislation is being considered. These are the issues:
State regulations and licensing
As a new method of delivering care, telemedicine has presented challenges to both nurses and regulators. The purpose of telemedicine is to provide care from a distance, eliminating geographic boundaries. Yet nurses are justifiably concerned when the reach of their care extends across state lines, creating a situation in which they are practicing in a state where they’re not licensed. State regulating boards are similarly uncertain as to how they can control the quality of care rendered by out-of-state providers.
Some states have adopted a nurse licensure agreement based on what’s known as the mutual recognition model. The National Council of State Boards of Nursing (NCSBN) explains it this way:
The mutual recognition model of nurse licensure allows a nurse to have one license (in his or her state of residency) and to practice in other states (both physical and electronic), subject to each state’s practice law and regulation. Under mutual recognition, a nurse may practice across state lines unless otherwise restricted. This is referred to as a multi-state nurse licensure model, specifically referred to as the Nurse Licensure Compact (NLC). All states who currently belong to the NLC, also operate the single state licensure model for those nurses who do not reside legally in a NLC state or do not qualify for multi-state licensure. In order to achieve mutual recognition, each state must enact legislation or regulation authorizing the NLC. States entering the compact also adopt administrative rules and regulations for implementation of the compact.
To see where your state stands on this issue, view this map of NLC states.
Since the 1990s, the kinds of telemedicine covered by Medicare and other third party payors have grown considerably. At one time, only services provided to patients in federally designated rural Health Professional Shortage Areas (HPSAs) were eligible for reimbursement under Medicare. In 2001, Medicare expanded coverage of telemedicine services, and private insurers have followed suit. Still, there are gaps in what’s covered and what’s not – for example, telemedicine services provided to patients in nursing homes are not reimbursable, even though they would be under traditional Medicare payment guidelines. And in home health care, nursing services are covered, while virtual “home visits” by physicians are not.
Clearly, there is advocacy work to be done, until access to telemedicine is ensured. One of the ways nurses can advocate for telemedicine is by taking an active role in shaping policy. Crucial telemedicine policies will be forged in the decades ahead. When state advisory panels are formed, nurse leaders should have a voice in the discussion. And when reimbursement policies are being considered, nurses should be there to advocate for coverage of preventive services.
For those interested in pursuing a career in telemedicine, American Sentinel University’s online nursing programs include an MSN with specialization in informatics, in which students develop a detailed project management plan for evaluating, contracting, and implementing a new technology in a healthcare organization.