SUMMARY OF RECOMMENDATIONS

GENERAL

Associations
Hospitals and Clinics
Insurance Companies
Practitioners

State Departments
Health and Welfare Agency
Department of Health Services
Department of General Services
Department of Information Technology
Medical Board of California

LEGISLATIVE / REGULATORY

U.S. Congress
California Legislature
State Departments

California Public Employees Retirement System
California Public Utilities Commission
Department of Health Services
Medical Board of California
Other Departments






SUMMARY OF RECOMMENDATIONS

GENERAL

Associations

Recommendation 1

The California Medical Association (CMA) should stress to the American Medical Association the importance of modifying existing procedure codes and/or developing new procedure codes in the Official Medical Fee Schedule (OMFS) to facilitate reimbursement for telemedical services.

Recommendation 2

Healthcare associations should sponsor educational seminars for their members to provide information relevant to the planning, development, implementation and operation of telemedicine systems.

Recommendation 3

An appropriate health-related foundation should establish a home page for this final report on the Internet to serve as a resource to Californias legislators, government agencies, civic leaders, health care providers, associations, foundations, educators, equipment manufacturers and vendors.

Recommendation 4

Specialty medical societies should develop standards for the appropriate use of telemedicine within each clinical discipline, following the lead of the American College of Radiology.

Recommendation 5

Medical schools and professional societies involved in providing continuing medical education should develop and implement curricula/programs/courses to ensure that health care professionals are sufficiently informed to make determinations about the appropriate use of telemedicine.

Hospitals and Clinics

Recommendation 6

Hospitals should modify their medical staff bylaws to ensure that their peer review procedures include rules regarding the practice of telemedicine.

Recommendation 7

Health care entities should ensure, when assistance is sought in the telemedicine planning stages, that the assistance is vendor-neutral, however, when program implementation begins, a vendor should be chosen who will be a full partner in the process.

Insurance Companies

Recommendation 8

Insurance companies should ensure that policies issued to provide professional malpractice and liability insurance for physicians and other health professionals include coverage for the practice of telemedicine.

Practitioners

Recommendation 9

Telemedicine practitioners should be certain that the physicians for whom they are providing telemedical services are licensed and in good standing with their respective medical boards and that they have professional liability insurance.

Recommendation 10

Consulting physicians should request a face-to-face consultation if they do not feel that they are being presented with adequate visual and sound quality, or if the patient's condition does not lend itself to a telemedicine consultation.

Recommendation 11

The practitioner should obtain appropriate informed consent. As with any procedure, the patient must be made aware of the potential risks and consequences as well as the likely benefits of the telemedicine consultation, and must be given the option of not participating in the telemedicine consultation.

State Departments

Health and Welfare Agency

Recommendation 12

The Secretary of the Health and Welfare Agency should support development of and participate in regional forums on rural telecommunities to bring together potential telehealth and telemedicine partners/collaborators.

Department of Health Services

Recommendation 13

The Department of Health Services is encouraged to participate in a federal project, partly funded by the Office of Rural Health Policy, to develop an evaluation instrument to measure the impact of telemedicine in rural areas. State or private funding should be used to support participation in this national evaluation because it will save the state of California the significant cost of developing a comparable evaluation tool.

Recommendation 14

The Department of Health Services should expand the scope of the California Healthy Cities Project to include resource information about community telehealth projects and technical assistance to unincorporated communities throughout the state.

Recommendation 15

The Department of Health Services should provide financial incentives to establish telehealth/telemedicine in rural and urban medically underserved areas, particularly through rural health grants to develop partnering among communities and the sharing of telemedicine information and resources.

Recommendation 16

The Department of Health Services should provide grants, waivers, and demonstration projects, for research to assess the clinical effectiveness of telemedicine and the programmatic administrative effectiveness of telehealth applications.

Department of General Services

Recommendation 17

Under the State of California Master Purchasing Contracts, the California Department of General Services should:
a) develop a plan to inform and educate eligible health care providers about their purchasing options for videoconferencing equipment;
b) encourage health care providers, who have the option of using the State of California Master Purchasing contract(s), to take full advantage of the State negotiated volume discounts to acquire videoconferencing equipment; and
c) include peripherals for telemedicine in contracts or modify contracts to allow them to be purchased.

Recommendation 18

The Department of General Services should inventory satellite downlinks throughout the State of California to avoid the unnecessary expenditure of public funds for communications equipment, and to ensure that current resources for distance learning are being used effectively and efficiently.

Department of Information Technology

Recommendation 19

The Department of Information Technology should seek opportunities to collaborate with and share resources among state agencies to optimize the investment in videoconferencing systems and state conferencing facilities.

Medical Board of California

Recommendation 20

The Medical Board of California should coordinate telemedicine licensure, credentialing and reimbursement policies with neighboring states.

LEGISLATIVE / REGULATORY

US Congress

Recommendation 1

Congress should enact and the President should sign, national legislation to set a uniform cap on damage awards, to prevent "forum shopping" for the biggest awards, using California's Medical Injury Compensation Reform Act (MICRA) as a model. MICRA, enacted in 1975 in response to a health care crisis related to malpractice insurance rates, places a cap on non-economic damages of $250,000; 100% of all economic damages, such as wages, medical care and related expenses, are covered. It also places a limit on attorney contingency fees, allows for periodic payments of awards over $50,000 to insure that injured patients have resources for life or the extent of the injury, and allows for disclosure of any payment for economic losses that the plaintiff already received from other sources. By limiting potential awards, MICRA has stabilized malpractice insurance premiums.

California Legislature

Recommendation 2

The California Legislature should enact laws to provide telemedicine consent forms for the patient to sign that include a waiver so that the venue issue is settled by the parties before treatment is begun.

State Departments

California Public Employees Retirement System

Recommendation 3

The California Public Employees Retirement System should, through incentives, encourage health plans who provide coverage for state employees to establish a policy on telemedicine and provide coverage for telemedical services.

California Public Utilities Commission

Recommendation 4

The California Public Utilities Commission should implement Section 254(h) of the federal Telecommunications Reform Act of 1996. The Act directs telecommunications carriers ...to provide telecommunications services which are necessary for the provision of health care services in a State...to any public or nonprofit health care provider that services persons in rural areas in that State at rates that are reasonably comparable to rates charged for similar services in urban areas in that State.

Department of Health Services

Recommendation 5

As mandated in SB 1665 (Chapter 864), the Department of Health Services (DHS) should develop a work program and timeline for implementing the telemedicine policies required by law and communicate them to the public by March 1, 1997.

Recommendation 6

The Department of Health Services should, after proper review of telemedicine programs and technologies, issue a bulletin outlining its policies with respect to the credentialing of off-site telemedicine practitioners by California hospitals. In particular, the DHS should indicate in what circumstances, if any, a hospital must credential a remote physician.

Medical Board of California

Recommendation 7

As mandated in SB 2098 (Chapter 902) the Medical Board of California should design a proposed physician registration program and submit it to the Legislature no later than the legislative deadline for bill introduction in 1997.

Other Departments

Recommendation 8

The Department of Corporations, the Department of Workers Compensation, and the Department of Health Services should each issue, after a proper review of telemedicine programs and technologies, regulations outlining the acceptable use of telemedicine by health care service plans.

Recommendation 9

The Department of Corporations, the Department of Workers Compensation, and the Department of Health Services should encourage participating prepaid health care plans and health care organizations, through targeted financial incentives, to use telemedicine. Proper incentives will improve accessibility to specialist physician services in medically underserved areas of the state.

Recommendation 10

The Department of Health Services, Joint Commission on the Accreditation of Healthcare Organizations, National Committee on Quality Assurance, and health care organizations should take action to alleviate the burden of obtaining credentials at each health care organization where a remote physician practices via telemedicine. These authorities must provide a final, formal and precise determination of the credentialing requirements to be applied to those physicians who are present within a health care organization only through telemedicine.