Tele-Dermatology in Medi-Cal: Findings from the Field and Challenges for the Future

When California’s Medicaid program, Medi-Cal, expanded coverage for store-and-forward dermatology services in 2007, telehealth champions argued more providers would adopt telehealth into their practices as a result. Dermatology is one of the most desperately needed specialties in safety net care, and is one of the most high-performing specialties when store-and-forward telehealth is used.

However, a utilization study conducted by UC Davis and CCHP of primary care physicians and dermatologists employing store-and-forward telehealth revealed an unanticipated gap between tele-dermatology’s expected benefits and its slow adoption across the state.

The resulting issue brief, “Tele-Dermatology in Medi-Cal,” was authored by April Armstrong, MD, MPH, who at the time was an assistant clinical professor of dermatology at the UC Davis School of Medicine. Her brief identified both positive impacts where tele-dermatology is used and remaining barriers that inhibit its further adoption.

KEY FINDINGS

• Medi-Cal data indicated that fewer than 300 tele-dermatology claims were filed in 2007, and only 100 of these claims were for store-and-forward tele-dermatology.
• Dermatologists using telehealth reported increased efficiency in their practice, improved patient access and satisfaction, timelier and better quality care, and a variety of other important benefits.
• Primary care physicians who referred to telehealth-using dermatologists said that the practice increased their knowledge of dermatology and improved their patients’ access to specialty care.
• Every dermatologist surveyed, regardless of their use of telehealth, indicated that low reimbursement rates, Medi-Cal’s cumbersome reimbursement system for tele-dermatology, telehealth training issues, and other concerns created challenges to adopting telehealth.

POLICY RECOMMENDATIONS

The issue brief outlines four policy recommendations to improve tele-dermatology’s use:

• The California Department of Health Care Services (DHCS) should educate dermatologists and other specialists about Medi-Cal reimbursement policies for telehealth-delivered services;
• DHCS should eliminate separate billing codes for telehealth-delivered services;
• Facilitate standardized tele-dermatology training; and
• Work with insurers to clarify tele-dermatology in policies.

Support for the project came from the California Health Care Foundation.