CMS Proposes Rule to Cross-Privilege Physicians Practicing Telemedicine

June 22, 2010

Telemedicine consultations are often provided by physicians at large hospitals, often called “distant-site” hospitals (See § 1834(1)(m)(4)(A) of the Social Security Act), to patients at smaller ones, such as those in rural areas. Physicians providing these consultations are privileged and credentialed at their home institutions, but often not, at the outset, at the hospitals to which they provide their advice electronically, which for purposes of this discussion, we refer to as local hospitals.

Under existing Medicare Conditions of Participation (CoP), the governing body of a hospital must make all privileging decisions based upon the recommendations of its staff, after the staff has examined and verified the credentials of practitioners applying for privileges. This means the hospital’s medical staff must conduct individual appraisals of its prospective members and examine the credentials of each candidate to make a privileging recommendation to the governing body.

Hospitals may use third-party credentialing verification organizations, but the governing body remains responsible for the privileging decisions. In a move that may facilitate the growth of telemedicine services, CMS has issued a proposed rule to revise hospital Medicare CoP to facilitate credentialing of distant-site doctors at local hospitals seeking their services.

Under the proposal, the governing body of the local hospital would be permitted to grant privileges based on the recommendations of its medical staff, relying in turn on information provided by the distant-site hospital.

The local hospital must see that:

  1. The distant-site hospital is a Medicare-participating hospital.
  2. The individual distant-site professional is privileged at his own hospital and that the distant-site hospital provides the local hospital a current list of the physician’s privileges.
  3. The individual distant-site professional holds a license issued or recognized by the state in which the local hospital is located.
  4. The local hospital has evidence that the distant-site hospital conducts an internal review of the distant-site professional’s performance of his privileges.

The local hospital must provide relevant information to the distant-site hospital for its use in periodically appraising the practitioner. Information sent for use in the periodic appraisal must include all adverse events that might have resulted from telemedicine services provided by the distant-site physician to the local hospital’s patients, as well as all complaints the local hospital has received about the distant-site physician.

Of course, these provisions are merely proposals, and may never become law. Nevertheless, the proposal may suggest a greater degree of receptivity to the provision of telemedicine services than we’ve seen in the past. Providers should monitor developments so they can take advantage of this evolution should it become a final rule.