Industry Report on Privileging Telehealth Providers

Definitions and Background

Telehealth

(Other terms used include telemedicine, eHealth, etc.)

The use of electronic information and telecommunications technologies to support long-distance clinical health care.

Healthcare environments offering telehealth requiring privileging include:

• Live (synchronous) videoconferencing: a two-way audiovisual link between a patient and a care provider where the care provider will be billing for the services provided to the patient. For example: eICU services where providers monitor patients in critical care units for purposes of managing their care.
• Store-and-forward (asynchronous) videoconferencing: transmission of a recorded health history to a health provider, usually a specialist who will be providing an official opinion/consultation, etc. and will be billing for services provided.
• Remote patient monitoring (RPM): the use of connected electronic tools to record personal health and medical data in one location for review and interpretation by a provider in another location, usually at a different time.

Credentialing by Proxy

The Medicare Conditions of Participation require hospitals and certain other accredited health care facilities and providers to have a credentialing and privileging process for physicians and other practitioners providing services to the hospital’s/facilities patients. This includes practitioners who provide services via telehealth. Recognizing the inherent differences between in-person care and virtual care, the Medicare Conditions of Participation (CoP) allow a process for streamlined credentialing of telehealth-based practitioners, allowing organizations to more efficiently harness the benefits of telehealth and comply with the CoP without incurring the full administrative burden associated with the traditional credentialing process.

This streamlined process is commonly referred to in the industry as “credentialing by proxy.” It permits the hospital/facility receiving the telehealth services (known as the “Originating Site” hospital) to rely on the privileging and credentialing decisions made by the hospital or entity providing the telehealth services (known as the “Distant Site” hospital or “Distant Site Telemedicine Entity” respectively), provided certain requirements are met.

Report Results

Question: Does your organization fully credential telehealth providers, use credentialing by proxy or some combination?

The respondents indicated that only 12% use credentialing by proxy only. 46% use a combination (they do some credentialing by proxy as well as full credentialing) and 42% fully credential all telehealth providers.

Question: Does your organization enter the telehealth providers into the credentialing database?

100% of respondents indicated that they do maintain data on telehealth providers in their credentialing databases.

Question: Does your organization provide telehealth services?

18% of the respondents indicate that their organization provides telehealth services. Only one organization who provides telehealth services requires that organization that receive the telehealth services accept their credentialing (i.e., credentialing by proxy).

Question: Do your telehealth providers have privileges only or medical staff membership and privileges?

This was a 50/50 split. Half of responding organizations grant membership and privileges while the other half grant privileges, but not medical staff membership.

Question: Does your organization use separate privilege delineations for telehealth services, include telehealth on existing forms or some combination?

42% of organizations responding use separate telehealth forms. The remainder of organizations use a combination – some telehealth services are included on existing forms and they also have stand-alone telehealth forms.

Conclusion

This area of credentialing is still evolving and the more the use of telehealth services increases (which is what is currently occurring and is expected to continue), organizations will seek to streamline their processes. There is obviously room for streamlining – particularly in the areas of using credentialing by proxy and eliminating granting membership and clinical privileges and granting privileges only.

You’ll be hearing more about this in the Consulting Connection in the future! Thanks to those organizations that took the time to respond to the recent survey.