Telemedicine in Georgia

Hospitals and providers across Georgia are increasingly exploring the possibility of providing patient care remotely via telemedicine technology.  Telemedicine, when properly delivered, has the potential to benefit both providers and patients by providing more timely, convenient, efficient, and cost-effective patient care, especially for patients in rural areas far from medical centers.

Georgia has embraced telemedicine since 2005.  Under the Georgia Telemedicine Act, O.C.G.A. section 33-24-56.4 (the “Act”), every health benefit policy as of July 1, 2005 shall include payment for services that are covered under such health benefit policy and appropriately provided through telemedicine.  As indicated by the language of the Act, it was the intent of the Georgia Assembly to mitigate geographic discrimination in the delivery of health care by recognizing the application and payment for covered medical services provided by means of telemedicine.

However, the Georgia Assembly has placed limitations on furnishing telemedicine services to patients located in Georgia.  O.G.C.A. section 43-34-31 requires that any person located outside Georgia who “performs an act that is part of patient care located in this state… and that would affect the diagnosis or treatment of the patient” by any means, including telemedicine, is engaged in the practice of medicine and must be licensed in Georgia and subject to regulation by the Georgia Composite Medical Board.  Additionally, such out-of-state practitioner shall not have ultimate authority over the care or primary diagnosis of a patient located in Georgia.  Id.[1]

In addition to statutory limitations, the Georgia Composite Medical Board restricts the use of telemedicine by deeming the following conduct unprofessional and potentially subjecting the provider to discipline:

“Providing treatment via electronic or other means unless a history and physician examination of the patient has been performed by a Georgia licensee.  This shall not prohibit a licensee who is on call or covering for another licensee from treating and/or consulting a patient of such other licensee.  Also, this paragraph shall not prohibit a patient’s attending physician from obtaining consultations or recommendations from other licensed health care providers.” (emphasis added)

Ga. Comp. R. &. R. 360-3-.02(6).  Thus, a Georgia physician may not furnish telemedicine services prior to conducting a history and physical examination of the patient.

Moreover, from a federal reimbursement standpoint, the Center for Medicare and Medicaid Services (“CMS”) has authorized Medicare reimbursement for telemedicine services provided certain conditions are met.  Under 42 C.F.R. section 410.48, Medicare Part B pays for certain services furnished by an “interactive telecommunications system” that contains, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and the distant site physician or practitioner (not including telephones, facsimile machines, and e-mail systems).  These reimbursable services include but are not limited to:

• Office or other outpatient visits;
• Subsequent hospital care services (with the limitation of one telehealth visit every 3 days);
• Professional consultations;
• Individual psychotherapy; and
• Pharmacological management

Additionally, the following conditions must be met for reimbursement:

• The physician or practitioner must be licensed under State law to furnish a covered telehealth service and delivery the service via a telecommunications system;
• The practitioner at the distant site must be on the list of approved providers, such as a physician, nurse, psychologist, or social worker.
• The services are furnished to a beneficiary located at an approved originating site, such as the physician office, critical access hospital, hospital, or skilled nursing facility.
• The medical examination of the patient is under the control of the physician or practitioner at the distant site.

42 C.F.R. sections 482.12, 482.22, and 486.616 permit hospitals and critical access hospitals to provide telemedicine services to its patients through an agreement with a distant site hospital, provided the agreement is written and specifies the governing body and medical staff of the distant site hospital comply with the applicable provisions in the regulations.  The governing bodies may grant privileges based on its medical staff recommendations that rely on information provided by the distant site hospital.

As discussed above, hospital and providers in Georgia have the opportunity to avail themselves of telemedicine as a tool to both improve the quality of patient care while reducing the cost of delivery of such care.  It is important, however, that a telemedicine program be carefully implemented to ensure the furnishing of telemedicine services is both lawful and reimbursable. 

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 [1] This prohibition under section 43-34-31 does not apply to: