Telemedicine Wisconsin: Hasty Improvements

Posted by Michael Hsu on 6/22/20 11:03 AM
Michael Hsu

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Without the complete parity law, Wisconsin is still not using telehealth to its full potential. Telemedicine practice seems to be booming in the state because it became a member of the Interstate Medical Licensure Compact (IMLC). The program allows the providers from the Badger State to care for patients from other states that also joined the IMLC.

With the current public health crisis, it is evident that Wisconsin officials have been short-sighted when it comes to the benefits of remote care. Telemedicine advocates are working hard to find ways to improve the situation. The U.S. healthcare system was struggling to provide for all requesting patients even before the COVID-19 pandemic. With the national emergency, the inadequacy of the system is threatening to deepen the crisis.

The recent development is promising, and we can only hope that the authorities realized that new models are needed to boost patient care in Wisconsin. Medicaid is now covering a broader range of services, and we hope that the private payers should soon follow.

How Can Telemedicine Help? 

Wisconsin's Medical Examining Board (MEB) defines telemedicine as the practice in which patient care, treatment, or services are delivered through the use of medical data exchange via electronic communication technologies, while the provider and the recipient are in different locations. The Board requires that the virtual visit mimics an in-person appointment, meaning that it has to happen in real-time and face-to-face. 

This implies that an interactive video conference is deemed to be the mandatory form of communication. Emails, audio-only calls, text messages, and facsimile transmissions do not suffice as per MEB. 

Even with these restrictions, telehealth has helped reshape the inefficient system that could not provide adequate care to everybody in need. The most important aspect of remote care is that it democratizes healthcare and allows:

  1. Better access to the services for people in remote areas
  2. Release of the pressure in the emergency rooms and hospitals
  3. Improvement of the patient experience by the reduction of travel time and waiting
  4. Easier access to specialist care and consultations

Telemedicine can do a lot for Wisconsin residents, especially the elderly. They are already struggling to get the care they need. In some cases, it is the location, while in others, it is the patient’s restricted mobility that is causing the problem.

The number of unnecessary visits to emergency rooms and hospitals is causing confusion. It prevents medical professionals from treating the most critical cases, and it is financially unsustainable in the long run. The only way to keep the system afloat in Wisconsin, and beyond, is to establish a triage that would direct patients effectively.

Telehealth may be an answer, as it allows the physicians to assess and examine the patients online. They can decide about further actions and advise accordingly. Now, more than ever, it is essential to engage all capacities and use them to provide adequate care for everyone. 

Telemedicine vs. Telehealth in Wisconsin

MEB views the terms telemedicine and telehealth as synonyms and does not make any clear distinction between them. There are no definitions on the federal level that would suggest how to differentiate between the two.

In some states, telemedicine is reserved for clinical practices, while telehealth is a broader term that incorporates health education and disease prevention. With the development of remote care, federal officials should define these terms to avoid confusion. Providers should check how their jurisdiction views telemedicine and telehealth and use the terms accordingly.

Wisconsin Telemedicine Rules and Regulations

The Wisconsin Medical Examining Board offers clear guidelines on how to practice telemedicine in Wisconsin. It focuses on the professional recommendations to the providers to ensure that all standards of care are respected and that the patients are receiving the best possible treatment.

With high-quality service offered in the traditional practice, MEB considers telehealth providers to be equally accountable for their practice. The same rules and regulations apply to both models.

The guidelines cover all essential aspects of the practice:

  1. Doctor-patient relationship
  2. Licensing
  3. Medical records
  4. Evaluation
  5. Standards of care
  6. Prescriptions

Doctor-Patient Relationship

MEB does not require the in-person appointment for the doctor-patient relationship to be valid. It does insist on a face-to-face visit, which means that a real-time video call is a minimum standard. There are strict rules to follow to comply with the regulation:

  • The physician must verify the identity and the location of the patient
  • The physician must disclose their identity, contact information, and credentials
  • The patient should provide informed consent, stating that they are fully aware of the evaluation and treatment, in terms of both benefits and limitations

Once these are provided and documented, the doctor-patient relationship is valid, and the diagnosis and treatment may begin. The responsibilities that the physician has when caring for the patient in traditional practice apply to telehealth as well.

Licensing

Telemedicine virtual visits happen at the location of the patient, meaning that the physician has to be licensed in Wisconsin to treat the patients residing in the state. The provider does not require separate permits for telehealth services, though some other states may impose such rules.

This is especially important for Wisconsin practitioners. With incomplete parity law, many telemedicine providers developed their businesses by treating patients from other states. It is crucial to understand the legislation of the patient's place of residence.

When Wisconsin joined IMLC, the cross-state licensing became much more manageable. The program allowed WI practitioners to offer their services to residents of all the participating states. IMLC has helped simplify the procedures for obtaining the necessary licenses and permits.

Medical Records

MEB requires all telehealth providers to keep clear and precise medical records on all patients they admit. Even one-time visits have to be correctly documented. Medical record of the patient should include:

  • All patient-related communication, which means both doctor-patient communication and peer-to-peer consultations
  • All laboratory and diagnostic test results conducted during the treatment
  • Instructions from the physician, as well as all the information relevant to the current or future treatments
  • Complete medical history if it is available
  • Prescriptions issued by the physician including the medication intolerance and allergies
  • Informed patient consent

The medical records are confidential documents, according to the Board and the Wisconsin legislation. They should meet the same standards as their equivalents in the traditional practice. Most healthcare providers in the U.S. have already switched to electronic health records, so the technology is usually the same in both models.

The records and all communication channels must be HIPAA compliant. Data security and privacy are essential, and it is imperative to use the tools with encryption and password protection to prevent any third-party breaches and the loss of data. Curogram offers integration with medical documentation software, as well as absolute compliance with the Health Insurance Portability and Accountability Act (HIPAA). Medical records should be available to the patient on request. 

Evaluation 

The provider must be able to fully assess and evaluate the patient. That is why it is essential to have a face-to-face visit, according to MEB. The complete and proper evaluation consists of:

  • Physical and mental examination
  • Necessary laboratory and diagnostic tests
  • The insight into the patient's prior medical history if it is available

Telemedicine practitioners shall not evaluate patients and design treatment based on emails, text messages, audio-only calls, or online questionnaires. MEB considers these communication tools to be insufficient for proper diagnosis.

Upon the initial visit, the provider should determine whether the patient or their condition is appropriate for the telemedicine treatment. If not, they should recommend another course of action and restrain from providing services.

Standards of Care

When it comes to standards of care, it is vital to provide adequate and responsible care to all patients regardless of the model being used for the treatment. This means that the services must correspond with the requirements of the specific diagnosis.

If the diagnosis exceeds the possibilities of telemedicine, the provider must inform the patient that they have to seek different treatment. If the patient experiences deterioration, the doctor must have emergency backup plans ready. These plans include referral to other medical professionals or institutions.

The equipment and technology used for telemedicine must ensure patient privacy and confidentiality of the relationship. That is why the providers should opt for reliable telehealth vendors. Curogram offers complete IT support to telemedicine practices.

All limitations and potential dangers of telemedicine services should be explained to the patient before the treatment begins.

Prescription

There is no need for in-person contact before prescribing medication, according to MEB. Wisconsin providers are allowed to issue prescriptions via telehealth. They should meet the necessary standards that apply to the traditional model of practice. This means that a physician must:

  1. Complete full examination and assessment of the patient
  2. Prepare a comprehensive patient record
  3. Obtain informed consent from the recipient

With these in check, the providers can issue online prescriptions at their discretion. MEB recommends integrating with e-Prescriptions to avoid errors and ensure patient's safety.

Some controlled substances may be subject to different rules on the federal level. It is the provider's responsibility to act in accordance with such regulation.

 

Reimbursement for Telehealth in Wisconsin

More than 20 legislators advocated for SB 380 in November 2019. The bill passed and was instrumental in introducing significant expansions to telemedicine services in the American Dairyland. It did not include the complete parity law, unfortunately.

Although it is a step forward, SB 380 will need amending to allow telehealth practice to develop fully. The number of costly emergency room and hospital visits has already decreased, but payment parity is necessary to help the system stay afloat, especially during these critical times.

Reimbursement policies

Live telemedicine

Store-and-forward

Medicaid

Yes

Yes (as of March 2020)

Private payers

Not mandatory

Not mandatory

Medicaid

WI Medicaid defines telehealth/telemedicine as a medical service provided from a remote location using a combination of interactive video, audio, and externally acquired images through a networking environment. The recipient's location is called the originating site, while the provider's is known as the distant site. The communication should be of visual and audio fidelity to equal that of a face-to-face encounter. Using written or audio-only electronic communication does not meet the standards required for the telemedicine visit.

According to the new law, Wisconsin Medicaid is mandated to reimburse for live video, store-and-forward, remote patient monitoring, and technology-based services conducted through brief communication. It is a significant improvement to the previous legislation as it allows a wider range of services to the beneficiaries of the program.

Some limitations still apply because not all services and providers qualify for Medicaid's reimbursement policies.

Eligible providers

Audiologists

 

Physicians

 

Nurse practitioners

Physician assistants

 

Nurse midwives

Ph.D. psychologists

 

Psychiatrists

Professionals providing services in mental health or substance abuse programs certified by the DQA

 

 

Eligible types of service

Outpatient substance abuse services

 

Office or other outpatient services

Crisis intervention services

 

Initial inpatient consults

Comprehensive community services

 

Outpatient mental health services

Audiology services

 

Health and behavior assessment/intervention

 

Community support program services

End-stage renal disease-related services

Private Payers

Private payers are still not obliged to cover telehealth, although many insurers do include it in their plans. Most major insurers recognized the benefits of telemedicine, so Wisconsin residents use remote care often.

Since there are no more location restrictions, even patients living in remote areas have access to primary and specialist treatments. The private payer parity law would enhance the possibilities of remote care and improve the situation even further. We can only hope that the legislators will speed up these legal processes.

Choosing the Right Technology 

When it comes to telehealth, the right technology is crucial for the impeccable service. There are many benefits for practitioners who decide to establish telemedicine practice or incorporate it into their existing services. Cutting on administration and reallocating resources to patient care is among the most important ones.

For it to work, the technology has to be reliable, HIPAA compliant, and secure in terms of privacy and protection of information. We at Curogram offer comprehensive solutions that can help providers focus on medical aspects of their practice. Some of the upsides of choosing our platform are:

  • Two-way texting feature that enables quick and secure communication between the provider and the recipient
  • An internal messaging system that helps the employees exchange information through a secure communication tool
  • The simulation of a workflow which supports virtual clinics and waiting rooms, allowing better time management and overview of the tasks

Curogram understands the importance of proper integration with EHRs, and we built a system that integrates with over 700 most popular electronic health records. This allows the medical personnel to cut down on administrative work by preventing double entries.

Curogram EHR integrations

eClinicalWorks

Athena

Epic

Cerner

DrChrono

NextGen

Practice Fusion

CareCloud

Kareo

OfficeAlly

See More Integrations Here

With the COVID-19 pandemic hitting hard, telehealth practitioners are stepping up to release the pressure off the acute care providers. Curogram assists with establishing testing sites by providing software and IT support to medical professionals who decide to engage in such an endeavor.

The Future of Telehealth in Wisconsin

The national health crisis showed that remodeling of the patient care is not only necessary but also long overdue. The states with regulated telemedicine services are responding to the pandemic much better. It is crucial to utilize all available resources to manage the situation, and remote care is an excellent solution.

In the times when people should stay home, telehealth is sometimes the only solution, not just for those affected by the coronavirus, but for chronic and elderly patients as well. The Wisconsin Department of Health Services (DHS) advised the patients and the insurers to opt for telemedicine whenever they can. It should reduce the exposure of both medical workers and patients to the virus.

The most important decision introduced in March 2020 was that Medicaid beneficiaries can receive treatment from their homes. Until recently, a patient's home was not among the eligible sites for WI Medicaid. Audio-only calls can now be used as a valid communication tool for telehealth in the State of Wisconsin.

Although some of the measures are temporary and apply only during the pandemic, DHS advised that they will continue to work with the providers to enhance the services and create a model that would help with the current and future crises. For practitioners seeking ways to contribute to fighting the crisis by introducing telehealth services, Curogram offers a free trial that can be accessed here.

Telemedicine by State

Don’t see your state? We just haven’t written about it yet! Stay tuned on our blog or check out our article on telemedicine reimbursement by state.

Telemedicine by State in the US

Alabama

Indiana

Nebraska

South Carolina

Alaska

Iowa

Nevada

South Dakota

Arizona

Kansas

New Hampshire

Tennessee

Arkansas

Kentucky

New Jersey

Texas

California

Louisiana

New Mexico

Utah

Colorado

Maine

New York

Vermont

Connecticut

Maryland

North Carolina

Virginia

Delaware

Massachusetts 

North Dakota

Washington

Florida

Michigan

Ohio

West Virginia

Georgia

Minnesota

Oklahoma

Wisconsin

Hawaii

Mississippi

Oregon

Wyoming

Idaho

Missouri

Pennsylvania

 

Illinois

Montana

Rhode Island

 

Topics: telemedicine

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