Medicaid Medical Directors: Telemedicine Critical, But Must Be Clinically Appropriate
By Joey Berlin


Telehealth services “should continue to be embraced as a critical way to deliver needed health care services” during the COVID-19 pandemic, but it’s important for policymakers to determine where those services are clinically appropriate, according to a new white paper from the national Medicaid Medical Directors Network (MMDN).

The network wrote the white paper, “Perspectives on Telehealth Modernization,” with the help of its Telehealth Advisory Committee, which includes San Antonio pediatrician Ryan Van Ramshorst, MD, chief Medicaid director for the Texas Health and Human Services Commission.

The paper examines the “digital divide” between telehealth and certain groups that have trouble accessing it, such as Medicaid patients and rural populations. (While the white paper notes that “telehealth” and “telemedicine” are defined in different ways, it uses the two terms interchangeably.)

The report also touches on projects under way to address those inequities, such as the U.S. Department of Veterans Affairs (VA) program that established remote access clinics in communities that need them, where patients can schedule an appointment and walk in for a virtual video visit.

On clinical appropriateness, “Perspectives on Telehealth Modernization” lays out the guiding principle that practitioners using telehealth be held to the same standard of care as those seeing patients through in-person care.

“There appears to be consensus among [Medicaid medical directors] that some services are less appropriate than others for delivery via telehealth, especially where a comprehensive physical examination and point of care testing or other service is indicated,” the medical directors wrote. “Providers, advocates, and policy-setting organizations recommend that clinicians use professional judgment to determine whether the service delivery via telehealth is suitable for a specific patient.”

For example, the white paper says, some medical directors believe telephone-only care “may not be commensurate with audio-visual or in-person care.”

The paper makes eight policy recommendations across the areas of equity, quality, and payment. Among them:

  • Medicaid programs should work to reduce patient and practitioner barriers to using telehealth, including underlying health disparities and digital literacy among patients. Barriers for practitioners include access to integrated, secure, and user-friendly telehealth platforms.
  • Medicaid programs should hold telehealth services to the same standards of care as traditional, in-person services, and quality should be measured through process and outcome-based metrics.
  • Medicaid payment rates should be adequate to facilitate telehealth care, and those rates should consider additional costs that aren’t associated with in-person services.
  • Programs should support continuity of care and require a contingency plan to enable timely transition from telehealth to in-person when necessary.

The Texas Medical Association is working during this legislative session to build on past  gains advancing telemedicine in Texas, advocating for both improved access to telemedicine services and permanent payment parity for those services.

Last Updated On

March 31, 2021

Originally Published On

March 31, 2021

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Joey Berlin

Associate Editor

(512) 370-1393

Joey Berlin is associate editor of Texas Medicine. His previous work includes stints as a reporter and editor for various newspapers and publishing companies, and he’s covered everything from hard news to sports to workers’ compensation. Joey grew up in the Kansas City area and attended the University of Kansas. He lives in Austin.

More stories by Joey Berlin