When Medi-Cal began in 2007 to cover Store & forward (S&F) tele-dermatology services, telehealth proponents argued that this would spur provider adoption of the telehealth technology.
But a new CCHP issue brief found that there appears to be a gap between the anticipated benefits of tele-dermatology in Medi-Cal and its slow adoption among dermatologists statewide.
The issue brief, “Tele-Dermatology in Medi-Cal: Findings from the Field and Challenges for the Future,” surveyed dermatologists and referring primary care providers (PCPs) statewide.
The survey includes interviews with tele-dermatologists who provide S&F consults to Medi-Cal, primary care providers (PCPs) who refer to tele-dermatologists, and dermatologists who do not employ telehealth.
The issue brief identified both benefits to the technology and barriers to its use:
- Medi-Cal medical claims data indicated that there were fewer than 300 total tele-dermatology claims in 2007-09, and only 100 S&F claims;
- For tele-dermatologists, this technology’s benefits included a combination of improvements in practice efficiency; patient access, satisfaction, and quality of care; cost savings to the state’s health care delivery system;
- PCPs who refer to tele-dermatologists said the practice increased their knowledge of dermatology and improved their patients’ access to specialty care;
- All dermatologists surveyed—those who practice tele-dermatology in Medi-Cal and those who don't—indicate challenges to adoption. These include:
- Low reimbursement rates and a cumbersome reimbursement system in Medi-Cal;
- Lower revenues in tele-dermatology because of fewer follow-up procedures;
- Increased paperwork and telehealth training issues;
- Liability fears.
The issue brief contains four policy recommendations to improve uptake of tele-dermatology in California:
- The California Department of Health Care Services (DHCS) should educate dermatologists, ophthalmologists, and optometrists on Medi-Cal telehealth reimbursement policies;
- DHCS should ease administrative burdens for telehealth providers by eliminating separate reimbursement coding requirements for tele-dermatology;
- Increase dermatologist training in telehealth by a) incorporating telehealth training into federal and state student loan programs, and b) facilitating standardized tele-dermatology training for dermatologists and referral sites;
- Work with insurers to clarify tele-dermatology in policies.
How Store & Forward Works
Store & forward connects PCPs and medical specialists, via high-speed, high-definition communications systems that work like emails with attachments.
PCPs transmit patient information and digital images, such as photos, X-rays and video clips. Specialists review the cases as they come in, and send back diagnoses and treatment plans.
Studies have shown that the quality of care in telehealth is equal to in-person consults, and that telehealth can help eliminate long patient waits for specialty care.
Access to specialty care is a major concern in medically underserved communities. Demand for care is projected to grow with national health reform. Telehealth technologies can serve as tools to improve access to timely, effective and cost-saving care.
The issue brief was authored by April Armstrong, M.D. M.P.H., an Assistant Clinical Professor of Dermatology at the UC-Davis School of Medicine. She is Director of the UC-Davis Teledermatology Program, and Co-Director of the UC-Davis Dermatology Department’s Clinical Research Unit.
This project was funded by a grant from the California HealthCare Foundation.