CMS Proposes Change to Hospital Telemedicine Credentialing Requirements 

Email Alert

June 8, 2010

By Gerard Nussbaum**

Summary

The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule that would revise the conditions of participation (CoPs) for hospitals and critical access hospitals (CAH(s)) to allow new credentialing/privileging processes for physicians and practitioners providing telemedicine services.¹

The essence of the proposed rule would be to permit a hospital, including a CAH, which is the recipient of telemedicine services for its patients, to rely on the credentialing and privileging decisions of the distant-site hospital, rather than conduct its own individual appraisal and examination of the credentials of each distant-site physician or practitioner.²

Background

Current CMS regulations require hospitals and CAHs receiving telemedicine services to privilege each physician or practitioner providing services to its patients as if such a practitioner worked on site.³ While the current regulations permit the use of third-party credentialing verification organizations, the hospital's/CAH's governing body retains responsibility for all privileging decisions.⁴

Section 125 of the Medicare Improvements for Patients and Providers Act of 2008 terminated the statutory recognition of The Joint Commission (TJC's) hospital accreditation program, effective July 15, 2010.⁵ This removes the ability of TJC-accredited hospitals to privilege by proxy distant-site physicians and practitioners by accepting the privileging decisions of another TJC-accredited hospital. This has profound implications for existing telemedicine programs, particularly those of small or rural hospitals or CAHs, which would face the significant burden of credentialing distant-site physicians and practitioners. Smaller providers often receive telemedicine services from larger institutions with numerous specialists, such as academic medical centers, and would likely lack the resources required to undertake extensive credentialing functions with respect to each individual who may provide telemedicine services.

Changes to Hospital CoPs

The proposed rule adds paragraph § 482.12(a)(8) that would permit the hospital's medical staff to rely upon the credentialing and privileging decisions of the distant-site hospital in lieu of the current requirements at 42 C.F.R. § 482.22(a)(1) and (a)(2). The new paragraph at § 482.12(a)(8) would require a hospital's agreement with a distant-site hospital for telemedicine services to specify that it is the responsibility of the governing body of the distant-site hospital providing the telemedicine services to meet the existing requirements in § 482.12(a)(1) through
(a)(7) with regard to its physicians and practitioners who are providing telemedicine services.⁶

In addition, the hospital at which telemedicine services are being provided must ensure that:

 

1. The distant-site hospital providing the telemedicine services is a Medicare-participating hospital;

    

2. The individual distant-site physician or practitioner is privileged at the distant-site hospital providing telemedicine services, and that this distant-site hospital provides a current list of the physician's or practitioner's privileges;

    

3. The individual distant-site physician or practitioner holds a license issued or recognized by the state in which the hospital, whose patients are receiving the telemedicine services, is located; and

     

4. With respect to a distant-site physician or practitioner granted privileges by the hospital, the hospital has evidence of an internal review of the distant-site physician's or practitioner's performance of these privileges and sends the distant-site hospital this information for use in its periodic appraisal of the individual distant-site physician or practitioner, which shall include all adverse events that may result from telemedicine services provided by the distant-site physician or practitioner to the hospital's patients and all complaints the hospital has received about the distant-site physician or practitioner.⁷

    

Changes to CAH CoPs

The proposed changes to the CoPs, relating to credentialing of distant-site physicians and practitioners for CAHs, are the same as those for hospitals.⁸

In addition, CMS is proposing to change the CAH CoPs to permit the distant-site hospital to evaluate the quality and appropriateness of the diagnosis and treatment furnished by its own staff when providing telemedicine services to the CAH. This provision would add the distant-site hospital to the other three entities currently permitted to perform this evaluation function (i.e., a hospital that is a member of the network, a Quality Improvement Organization, or an entity identified in the state rural health plan).⁹

**We would like to thank Gerard M. Nussbaum, Esquire (Kurt Salmon Associates, New York, NY), for providing this email alert.