CMS Removes Credentialing Barrier to Telemedicine

May 03, 2011

May 3, 2011 — New regulations issued yesterday by the Centers for Medicare and Medicaid Services (CMS) remove a barrier to telemedicine that had nothing to do with computer technology.

The problem, CMS said, was its own old regulations on how hospitals should vet physicians who are hundreds or thousands of miles away, yet practice medicine within their walls by virtue of digital technology.

If an oncologist on the medical staff of a big city hospital, for example, sits down with a Medicare or Medicaid patient at a rural hospital via teleconference, the rural hospital also needs to grant him or her staff privileges to stay in the good graces of CMS. In the past, CMS required the hospital on the receiving end of telemedicine to follow the same credentialing procedures with remote physicians as it did with local ones. That meant relying on the recommendation of its medical staff, which has the duty of appraising candidates for practice privileges and verifying their credentials.

However, CMS recently concluded that this requirement was not only duplicative but also burdensome on small hospitals that might lack the resources to vet physicians practicing telemedicine. The agency noted in its new regulations on the subject that small hospitals often lack in-house medical staff who have the clinical expertise to "adequately evaluate and privilege the wide range of specialty physicians that larger hospitals can provide through telemedicine services."

Acknowledging that its requirements might make it harder for small hospitals to take advantage of telemedicine, CMS has opted for a simpler approach. Under the new regulations, a hospital still must grant practice privileges to a telemedicine physician based on the recommendation of its medical staff. However, the medical staff can dispense with its own fact-finding and instead rely on the credentialing and privileging decisions of the distant hospital where the physician in question practices.

In a press release issued yesterday, CMS Administrator Donald Berwick, MD, stated that his agency wants to "devise policies that reflect the most innovative practices in delivering care to all patients, especially patients in rural or remote parts of the country through telemedicine."

More information on the new CMS regulations is available on the agency's Web site.

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