Argument: It is not necessary to include mid-level providers in telemedicine policy

Advocates for telemedicine policy that includes mid-level providers will likely face opposition.  Three likely arguments will be: (1) patients aren’t interested in telemedicine, (2) telemedicine should not replace in-person visits and (3) if telemedicine policy does change, there is no need to include mid-level providers.  Below is a sample evidence-based response to the third argument.

Argument:  It is not necessary to include mid-level providers in telemedicine policy.

Response: Unless mid-level providers are reimbursed for services provided via telemedicine, they will remain underutilized.  In the proposed policy we include nurse practitioners (NP), physician assistants (PA), nurse midwifes, and clinical nurse specialists (CNS). There are three main reasons they should be included as reimbursable for telemedicine services.

1.  According to the Association of American College work force projections “nationwide physician shortages are expected to balloon to 62,900 doctors [by 2015] and 91,500 by 2020 (Krupa, 2010).”  Mid-level providers can help fill this gap.

2.  It has been suggested that “in telemediated heath care nurses or physicians’ assistants are the key actors who have to perform many tasks in the absence of physicians (Oudshoorn, 2009).”  Mid-level providers are an ideal workforce to train as technology experts for delivering telemedicine services.

3.  Under the Interstate Nurse Liscensure Compact, a nurse that is liscenced to practice in one state of the compact, may practice in any state of the compact (Bailey, 2011).  This means that nurses are not subject to the same laws governing licensing of physicians which prohibit them from practicing medicine (or telemedicine) outside of their state.  There are currently 24 states that have adopted the compact (Bailey, 2011).  Nurses, therefore, are able to offer telemedicine to a wider range of patients nationwide than primary care physicians.

The utilization of mid-level providers is integral to maximizing the potential benefits of telemedicine.

Bailey, R.A. (2011). The Legal, Financial, and Ethical Implications of Online Consultations, HEINONLINE, 16, J. Tech. L. & Policy, 53

Krupa, C. (2010) Physician Shortage Projected to Soar to More than 91000 in a Decade, American Medical Association. Retrieved from http://www.ama-assn.org/amednews/2010/10/11/prsb1011.htm

Oudshoorn, N.(2011) Telecare Technologies and the Transformation of Healthcare. United Kingdom, Palgrave MacMillan.

Argument: Patients don’t want to use telemedicine services

Advocates for telemedicine policy that includes mid-level providers will likely face opposition.  Three likely arguments will be: (1) patients aren’t interested in telemedicine, (2) telemedicine should not be allowed replace in-person visits and (3) if telemedicine policy does change, there is no need to include mid-level providers.  Below is a sample evidence-based response to the first argument.

Argument:  Patients don’t want to use telemedicine services

Response: Telemedicine patients have reported good acceptance rates and satisfaction with the technologies and treatment via telemedicine has been proven to be efficacious (Whitten, 2007).  Additionally, a recent Price Waterhouse Cooper Study found that 50% of people surveyed stated that they “would seek healthcare through online consultations” and that “email consultations were the most preferred method”, followed by “Webcam/video consultations (Thompson et al, 2011).”

Thompson, M., Isgur, B., & Foong, S. (2011) Focusing on Healthcare Value, Price WaterHouse Cooper, Retrieved from http://www.pwc.com/us/en/view/issue-12/focusing-on-healthcare-value.jhtml

Whitten, P. & Buis, L. (2007) Private Payer Reimbursement for Telemedicine Services in the United States, Telemedicine and e-Health, Vol. 13, DOI: 10.1089/tmj.2006.0028