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Expanding Telemedicine – Joint Commission “Privilege by Proxy” Expires in July – The Effect on Small Rur

Posted May 06 2010 7:49am

This is something that we hope gets a second look here before the time runs out as the small and rural hospitals more than likely will not be able to afford the cost of having to credential twice.  The approval processes of the Joint Commission have become a popular discussion area on the web.  You can read the link about labimage decisions here to get a little more insight.

Back in 2008 the Joint Commission came under the review of Congress and were granted re-certification. 

The next upcoming area according to this article has to do with telemedicine provisions being at risk with Medicare and their laws and provisions as relates to Medicare.  Now it appears the “bug” in the process is going to require double the work and more than likely double the amount paid to do the credential process twice.  Initially the Joint Commission was established to ensure quality and standards in the US and now if you read about some of the medical tourism articles, you can see where those outside the US use the credentials to attract patients to facilities outside the US with the stamp of approval and I am thinking this “privilege by proxy” is going weigh in there in the future if Medicare funds eventually are provided for payment for procedures outside the US. 

At any rate, this is a battle here between the Joint Commission, Congress and CMS that might need some attention soon if telemedicine is going to continue to grow and be provided for Medicare participants.  BD 

Health I.T. is marching forward on many fronts. But July 15 might be the day, barring Congressional intervention, that telemedicine moves in the opposite direction. On that day the Joint Commission’s “privilege by proxy” program bites the dust, which could have serious ramifications for the industry.

Privilege by proxy permitted hospitals to credential telemedicine practitioners from a distant site based on the credentialing/privileging decisions at that distant site. In a nutshell, it allowed physicians from large hospitals to provide telemedicine services to small or rural facilities without having to go through the credentialing process twice (as long as both hospitals were Joint Commission-accredited).

In July 2008 the Joint Commission lost its statutory deeming authority for accrediting hospitals. In order to get that authority back the commission had to reapply to CMS and brings its accreditation standards in line with Medicare’s conditions of participation for hospitals.

I brought these issues up with a couple of Medicare officials during a background call. They contended that the privilege by proxy program was eliminated not by any change in Medicare policy or subjective interpretation by agency officials, but as the result of the Joint Commission having to comply with straightforward, long-standing Medicare conditions of participation for hospitals.

Fingers can be pointed at a lot of the actors in this drama, but the bottom line is telemedicine in the United States will suffer a setback this summer. So much attention is being directed at health care reform and HITECH that many that spend their lives in telemedicine are worried that these and other blockades to expanding telemedicine services aren’t receiving the attention they deserve.

This move by CMS threatens the years of work and millions of dollars the providers have invested in telemedicine programs.”

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