There are many ways that these issues can be worked out, and most contracts will reflect the needs of the two parties. Some hosting hospitals may want to pay for services on a per-patient or hourly basis and recover a fixed telemedicine facility fee. Others may want to rent the space and let the physician bill the patient directly. Of course, the practice also has to decide what works best for its needs.
“The situation is individualized according to the needs of the doctors, host and especially the patients,” says Dr. Albert. “Anything goes in the way of structure, [because] it is driven more by demand and other commitments.”
For the most part, telemedicine will not require much additional staff. Current administrative employees should be able to handle the extra work.
The major concern will be in finding the presenter to act as liaison between the doctor and the patient. The person can be an RN, LPN or MA, although those interviewed say a nurse was preferable. If someone is available with a background in rheumatology, so much the better, but training is also important.
Success Depends on the Presenter
“In many ways, the success of the remote location depends on the person at the other end,” says Dr. Aggarwal. “Did they learn what you taught them? Do they understand the medical terminology and what the physician wants them to do? What you don’t want during a telemedicine visit is a communications problem between the doctor and the presenter.”
The relationship with the presenter is another aspect that can change based on the needs of the involved parties. If a practice has a telemedicine presence in a number of places, a person employed by doctors may travel. Other times, it may be a person employed by the local host who works with patients once a week or month, when the rheumatology clinic is held.
Equipment
The actual teleconferencing equipment is another area in which there can be a variety of options available. At the patient’s end is a telemedicine clinical cart, available for around $30,000. It includes the necessary software, camera and assessment equipment. At the provider’s is a desktop unit, which can be purchased for around $3,000. A computer with appropriate Web-enabled telepresence software and a Web camera can be purchased for less than $100. Skype, FaceTime and other commercial packages cannot be used because they are not secure and HIPAA compliant.
