 "Photo: Coleman Morefield")
Proposed changes in April 2009 to telemedicine Medicare and Medicaid reimbursement polices will allow the Texas Tech Telemedicine Center to offer increased medical services to 105 West Texas counties.
Telemedicine allows physicians to consult examinations and medical procedures occurring over a great distance through live interactive video, according to the Tech Center for Telemedicine Web site.
Debbie Voyles, director of the Tech Center for Telemedicine, said the Medicare and Medicaid reimbursement policy changes will expand the number of health care service providers that can present patients to physicians using telemedicine and will allow physicians to offer services in diverse locations like community centers.
"The new policy changes will allow Medicare and Medicaid to cover basic consultations, medical checks for mental issues, and follow-up consultations," she said. "However, it is not at the point where it includes surgeries yet."
Voyles said patients who receive care through telemedicine services are not charged extra for the service.
Claudia Cortez, clinic coordinator for the Tech Telemedicine Center, said the center saw 1,002 burn, school-based, rural and pharmacy telemedicine patients in 2008, with 120 patients in the rural and burn telemedicine divisions being non-funded or Medicaid patients.
"A specific number is hard to say," she said, "but rural clinics typically don't take Medicare or Medicaid patients because they are concerned about proper reimbursement. Say if there's a $120 bill, they may only get $80 for example, but of course they still have to treat the patient."
Cortez said 152 Medicaid and Medicare patients were treated by Tech physicians in 2008 through telemedicine, but she did not know whether the billing department for the Tech Telemedicine Center billed each individual.
Adriana Villagrana, El Paso Centro San Vicente Health Center business officer, said San Vicente accepts Medicare and Medicaid patients due to the nature of their clinic.
"We treat Medicare and Medicaid patients because we are a family qualified clinic," Villagrana said. "We are JCAHO accredited, which is required by hospitals, and also offer health care to homeless patients who qualify under the Coalition of the Homeless."
Voyles said the Tech Health Sciences Center has 20 to 25 physicians involved in the telemedicine program along with third-year medical students who work with correctional facility patients as part of their upper level residency program.
In the Tech telemedicine program, 85 percent of telemedicine patients are from correctional facilities in West Texas, while the remainder need rural health care, she said.
"Patients who live in rural areas typically have to drive 30 to 60 miles to reach a health care provider," Voyles said. "Telemedicine allows the patients to stay in their communities and be treated, which can prevent them from driving four hours for specialty services too."
According to the Tech Center for Telemedicine Web site, the Tech telemedicine program began as a grant-funded research project aimed at connecting the Health Sciences Centers in Lubbock, Amarillo, Odessa and El Paso in 1989.
Proposed Medicare and Medicaid reimbursement policy changes will include patient site location expansion to include state hospitals, schools and locations in rural or underserved areas, according to the Texas Health and Human Services Commission Web site.
The current telemedicine Medicare and Medicaid policy covers site locations within the office of a physician or practitioner, critical access hospitals, rural health clinics, federally qualified health clinics, hospitals, skilled nursing facilities, community mental health centers, and in-hospital dialysis centers, according to the Web site.
Medicare and Medicaid currently cover consultations, outpatient visits, psychiatric diagnostic interviews, pharmacologic management, and psychotherapy through telemedicine. The proposed reimbursement policies to take effect in April will not affect the eligibility of these medical services according to the Texas Health and Human Services Commission Web site.
The first telemedicine test consult occurred June 29, 1990, between the Tech Health Sciences Center in Lubbock and a hospital in Alpine where a newborn went into respiratory distress. The newborn was saved by an Alpine physician under the direction of a Tech neonatologist specialist using Tech telemedicine equipment, according to the Web site. More than 18,000 consults have occurred using the Tech telemedicine program since the initial 1990 test consult, exceeding 3,000 examinations annually. Consultations include patients from the Texas Department of Criminal Justice, rural areas and assisted living centers.
In addition to its telemedicine program, Tech also launched the first telepharmacy project in Texas in 2002, allowing Tech pharmacists to counsel patients and supervise prescription dispensing in distant communities, according to the Tech Center for Telemedicine Web site.
Following the telepharmacy program, Tech constructed the first telemedicine school-based clinic in Hart, a new burn treatment telemedicine system in El Paso, and a border telemedicine program located between small clinics along the Texas-New Mexico border and the Tech Health Sciences Center El Paso campus.
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