Teledermatology gains ground, but reimbursement remains a challenge

Key Points

National report - While the U.S. Centers for Medicare & Medicaid Services (CMS) continue to consider whether to expand reimbursement for teledermatology services, dermatologists say the diagnose-at-a-distance tool is here to stay.

Anne E. Burdick, M.D., M.P.H., says that one day, it will no longer be necessary to say "teledermatology" - this function will be considered a routine part of a dermatologist's job.

"Nobody says 'teleradiology' anymore; it's just 'radiology,' but it's all done remotely, with advanced information and communications technology," she says. Dr. Burdick is professor of dermatology and associate dean for TeleHealth and clinical outreach, University of Miami Miller School of Medicine, Miami.

Reimbursement limited

"It's about time that teledermatology is covered by Medicare and Medicaid," says Dr. Burdick, who founded the ATA's Teledermatology Special Interest Group (SIG) in 1999.

While not every case is appropriate for teledermatology, "If we want to save money, (CMS) should pay for it," says J. Scott Henning, D.O., director of teledermatology for the U.S. Army and deputy chief of dermatology at San Antonio Military Medical Center, San Antonio.

For example, the Army does not attempt to diagnose pigmented lesions remotely, he says, but teledermatology works well for managing acne and other straightforward conditions, and it's particularly useful for follow-up visits.

Accuracy, efficiency

"Evidence-based medicine is all the rage," says Karen E. Edison, M.D., Philip C. Anderson Professor; chairwoman, department of dermatology; and director, Center for Health Policy, University of Missouri Medical Center, Columbia, Mo.; and chairman of the AAD workforce task force. However, she says, "Very little of what we do in modern medicine has randomized, controlled trials behind it."

Indeed, the main Missouri Telehealth Network (MTN) program boasts a 96.8 percent patient satisfaction level, she says. Additionally, patients for whom the University of Missouri provides SF teledermatology through a voluntary AAD program that includes 15 federally operated free clinics typically get their medical questions answered in one to two days, versus waiting one month or more to see a dermatologist in Springfield, Mo., she says.

Dr. Henning says a key benefit of the Army's teledermatology network is that it usually provides "a consensus of four or five opinions." The Army staffs the system with eight dermatologists - who usually discuss all but the simplest cases - on duty at any given time, he explains. A portion of the network serving U.S.-based soldiers, which debuted in 2001, has facilitated 34,500 teledermatology consults total, he says, while a network for deployed soldiers worldwide has saved approximately $30.4 million in travel costs since 2004.