Prior to March 21, 2016, Indiana was one of just a handful of states that had not legislatively addressed the subject of telemedicine. Meanwhile Illinois and Ohio currently have proposed telemedicine parity bills but nothing set in stone – and Wisconsin has no parity legislative activity at this time. Michigan’s laws went into effect in 2012 and Kentucky was well ahead of the game with legislation in 2000, but the first state to address telemedicine by law was actually Louisiana in 1995. 21 years ago?! Why was Indiana so late to answer the call?
First let’s cover the basics…
- The American Telemedicine Association defines telemedicine as: “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.”
- Telemedicine is often associated with Health Information Technology (HIT) and remote health care, but it is its own service that may be used in conjunction with those two aspects of health care, not in place of.
- Indiana’s law is derived from House Bill 1263 – the bill was passed on March 21, 2016 and goes into effect July 1, 2016. It replaces a pilot program that the legislature enacted in 2015.
- The bill was passed with strong support from both Republicans and Democrats and includes the interests of hospitals, specialty physicians, primary care physicians, optometrists, insurance companies, and of course, telemedicine companies.
- The Indiana Professional Licensing Agency and the Medical Licensing Board of Indiana will issue final guidance regarding the licensing of out-of-state providers and establishing guidelines for the practice of telemedicine.
- Telemedicine is intended to improve access to primary care, reduce costs, improve patient experience, and hopefully improve the overwhelming demand on the medical system.
Why Does This Matter?
Telemedicine services have been part of the health care industry since Louisiana enacted telemedicine in 1995. Although these services were commercially available, Indiana law was silent on how such services may be sought and delivered in Indiana. Prior to March 2016, it was unclear if a physician could legally treat a patient who he or she had not previously seen in person in order to establish a provider-patient relationship. As a result, human resources professionals and benefit managers waited on the sidelines to see what would happen before they connected their employees with these services. Without certainty regarding its legality, it was a gamble for employers to give employees a benefit they might enjoy only to later have to take it away if the state would not permit the delivery of such services.
What Should Indiana Employers Know?
According to Mike Ripley, the Vice President of Health Care and Employment Law Policy at the Indiana Chamber of Commerce, it was surprising the law was not passed sooner, as it had many supporters. Ripley explained that insurance carriers, employers, and health care providers were ready to embrace telemedicine technology, yet the stakeholders could not agree on exactly how it should work in the Hoosier state.
The competing interests that delayed the law were ultimately united when the stakeholders agreed that the standard of care for a virtual visit would have to be the same as the standard of care for an in-person visit. Once all parties were able to rally around this central concept, the bill passed swiftly through the legislature. The standards of care at the heart of the bill are yet to be clearly defined in terms of telemedicine, but you may read the specific language of Indiana’s House Bill 1263 to gain a better understanding of the law.
Although the issues around the standards of care continue to develop, the law clearly states a phone call is insufficient to satisfy the standard of care. We anticipate technology such as video chatting and Skype will be used to effectuate the provision of care by telemedicine. The law also addresses the types of maladies that may (and may not) be treated through telemedicine. In Mr. Ripley’s words, one easy way to remember what is fair game under the bill is “anything ending with ‘-itis’ – is permissible to treat via telemedicine.” The law prohibits narcotic prescribing and psychiatric services through telemedicine.
What Should You Do Now?
Ask your consultant as many questions as you can about telemedicine. Find out what type of cost impact virtual medicine might have on your company’s claim experience, how many of your employees would use it, and what telemedicine vendors have the right model for your group. Ultimately, not everyone will want to “visit” the doctor over a tech tool like Skype. But for those that do, the convenience and reduced cost of telemedicine will be a big home run!