Conflicting language about Medicare reimbursement stalls teledermatology

National report - Many dermatologists would be eager to get involved with teledermatology, experts say - if only they could get paid for it.

The snag is in federal rules pertaining to reimbursement. Currently, the Centers for Medicare & Medicaid Services (CMS) operates under conflicting language in the rules regarding teledermatology, says Hon S. Pak, M.D., chairman of the teledermatology task force of the American Academy of Dermatology (AAD).

Under Medicare's clinical services rules, he says, "You could interpret telehealth as part of (covered) dermatology services." But CMS' telehealth rules say that, generally, CMS will not reimburse for telemedicine, including teledermatology.

The latter limitations came about by design, says Karen E. Edison, M.D., chairwoman of the AAD's workforce task force. Dr. Edison worked in the 106th Congress as a Robert Wood Johnson Foundation health policy fellow when the Medicare reimbursement rules for live interactive telemedicine - originally approved in 1997 - were "relaxed and made workable in the real world," she says. The changes took effect in 2001.

Choosing 'rural'

Dr. Edison says the group of U.S. Senators working on this issue limited reimbursement to rural areas "not because we thought it was only appropriate there," she says. "We were trying to keep the costs down, because we really wanted it to happen."

However, says Anne E. Burdick, M.D., M.P.H., CMS' definition of a rural area can be problematic.

"If you were to look at an area you might think is rural, it may not be federally designated as such," she says.

Because of that limitation, care often is not available in specialties such as dermatology in areas of the country not designated "rural," she says. Dr. Burdick is professor of dermatology and associate dean for telehealth and clinical outreach, University of Miami Miller School of Medicine, Miami.

Dr. Pak says he and other teledermatologists constantly receive inquiries from dermatologists interested in participating in such programs - until they learn that they generally can't get paid for these services.

"Clearly, the capacity and demand are there," he says. "But the financial model to encourage adoption isn't."