A new rule proposed by The Centers for Medicare and Medicaid Services to streamline the credentialing/privileging process for telemedicine could have a very different and disruptive effect if deemed applicable to teleradiology.
“They may think they are fixing something, but requiring that the primary privileging and credentialing had to have been done by a Medicare-participating hospital eviscerates the utility of this rule, at least from the standpoint of teleradiology,” notes W. Kenneth Davis Jr, JD, partner, Katten Muchin Rosenman LLP
Intended to reduce the administrative burden on small hospitals of credentialing physicians who provide services via telemedicine, the rule as proposed specifies that a hospital seeking telemedicine services can rely on a distant-site hospital providing those services to credential and privilege the telemedicine physician, provided that the distant-site hospital is a Medicare-participating hospital, as well as other conditions of participation (CoP).
In reality, most hospitals currently rely on their teleradiology provider for credentialing and privileging.
CMS devised this proposal as the July 15 deadline approached for the expiration of The Joint Commission’s (TJC) statutory authority to privilege by proxy, which allowed providers—including hospitals, teleradiology companies, and physician groups—that were accredited by TJC to have met Medicare’s CoPs, including credentialing and privileging requirements. TJC lost its authority to privilege by proxy with the passage of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). In proposing the simplified process, CMS recognized the administrative burden the CoPs present, particularly for smaller hospitals with fewer administrative resources.
Current and Proposed CoPs
Current Medicare CoPs require hospitals to make all privileging decisions based on recommendations of the medical staff after a completing a review of the applicant practitioner’s credentials that meets Medicare criteria. When the TJC’s statutory deeming authority expires on July 15, hospitals presumably can no longer leave the privileging and credentialing to their TJC-accredited teleradiology provider.
The new proposal gives hospitals the option of making the distant site that is providing telemedicine services responsible for assuring that the telemedicine practitioners meet Medicare’s CoP for credentialing and privileging, under the following conditions: the distant site hospital is a Medicare participating hospital; the physician is credentialed at that hospital and the hospital provides a list of the physicians credentials; the physician holds a license recognized in the state where the hospital receiving services is located; the hospital has evidence of an internal review of the distant site’s physician’s performance and sends the information—including all adverse events that may result— to the distant-site hospital for use in periodic review of the physician’s performance.
“This proposed rule designed to facilitate convenience really does not,” observes Thomas W. Greeson, JD, partner, Reed Smith LLP, Falls Church, Virginia. “If a teleradiologist had privileges at hospital number 1 and then he applies for privileges in hospitals 2 through 99, is hospital number 1 going to agree to be burdened to provide credentials to hospitals 2 through 99? The scope of this, the magnitude of this, is really lost I think on the CMS folks who put this rule together.”
Is It Even Applicable?
One question that CMS needs to answer is whether the regulation even applies to teleradiology. Greeson isn’t so sure: “Nowhere in the Medicare rules do they mention teleradiology. There is no regulation that deals with teleradiology coverage. There are distinct regulations that deal with telemedicine, but CMS always has treated interpretive services in terms of coverage like any other physician services, it is just provided through electronic means.”
Davis, on the other hand, believes CMS did have teleradiology in mind: “I do believe that they meant this to apply,” he says. “The reality is they have expended a lot of effort if they did not intend it to apply to teleradiology, because teleradiology is about the most prevalent use of telemedicine there is. I have to believe they intended it to apply, but that is in fact a question.”
Greeson expects to see organized radiology weigh-in in support of making credentialing and privileging more difficult for teleradiology